Survival impact of surgical cytoreduction in stage IV epithelial ovarian cancer

Objective. The aim of this study was to evaluate the influence of surgical cytoreduction on survival in patients with Stage IV epithelial ovarian canc er and to determine the survival impact of debulking extrahepatic disease i n the subgroup of patients with liver metastasis. Methods. Medical records were retrospectively reviewed for all women with I nternational Federation of Gynecology and Obstetrics Stage IV ovarian cance r treated between 1/1/82 and 12/31/94. Clinical information abstracted incl uded age at diagnosis, performance status, histologic subtype, tumor grade, Stage IV criteria, ascites volume, predominant peritoneal tumor pattern, s urgical procedures performed, hepatic tumor residuum, extrahepatic tumor re siduum, and postoperative complications. Optimal surgical status was define d as residual disease sl cm. Chemotherapy treatment and follow-up were reco rded. Survival analysis and comparisons were performed using the Kaplan-Mei er method and the log-rank test. The Cox proportional hazards regression mo del was used to identify independent variables associated with an improved survival rate. Results. There were 84 women with Stage IV ovarian cancer and complete oper ative and postoperative information available. Median age at diagnosis was 61 years (range 26-85 years). Performance status was less than or equal to 2 in 83% of patients (70/84). Papillary serous histology was found in 44/84 patients (52%) and 55 patients (65%) had grade 3 tumors. Thirty-seven of 8 4 patients (44%) had parenchymal liver metastasis and 32/84 (38%) had malig nant pleural effusion. Overall median survival was 18.1 months and was high ly correlated with performance status (P = 0.002), predominant peritoneal t umor pattern (P = 0.0002), and the number of chemotherapy regimens received (P = 0.0039). Primary surgical cytoreduction was attempted in all patients and 25/84 (30%) achieved optimal status. Median survival of optimally cyto reduced patients was 38.4 months, compared to 10.3 months for patients with suboptimal residual disease (P = 0.0004). In patients with liver metastasi s, optimal extrahepatic cytoreduction was achieved in 46% (17/37). Six of 3 7 patients (16%) underwent optimal resection of both extrahepatic and hepat ic disease and had a median survival of 50.1 months, compared to a median s urvival of 27.0 months for the 11 patients (30%) with optimal extrahepatic dis-ease but suboptimal residual hepatic tumor. Twenty patients (54%) were left with both suboptimal residual extrahepatic and hepatic disease and had a median survival of 7.6 months (P = 0.0001). Optimal debulking surgery an d performance status retained significance as independent predictors of sur vival on multivariate analysis. Conclusions. Optimal surgical debulking and performance status appear to be important determinants of survival in patients with Stage IV epithelial ov arian cancer. Even in patients with unresectable liver metastasis, optimal debulking of extrahepatic disease is associated with a significant survival advantage, (C) 1999 Academic Press.