ANALYSIS OF FAILURES AFTER NEGATIVE 2ND-LOOK IN PATIENTS WITH ADVANCED OVARIAN-CANCER - AN ITALIAN MULTICENTER STUDY

This multicenter retrospective study is based on 192 patients with adv anced ovarian cancer in pathological complete response at second-look surgery. Ninety-four (48.9%) patients developed recurrent disease afte r a median time of 18 months (range, 4-89 months) from surgical reasse ssment. The recurrence involved the pelvis in 45 (47.9%) cases, the ab domen in 42 (44.7%), the retroperitoneal lymph nodes in 13 (13.8%), an d distant sites in 20 (21.2%). On the whole series, 5- and 7-year dise ase-free survival rates after negative second-look were 47.4 and 44.5% , respectively. By log-rank test the disease-free survival rate was re lated to FIGO stage (P = 0.008), tumor grade (P = 0.0021), size of res idual disease after initial surgery (P = 0.0038), and type of second-l ook (laparoscopy vs laparotomy, P = 0.0061), but not to histological t ype and first-line chemotherapy. Cox proportional hazard model showed that tumor grade, size of residual disease, and type of second-look we re independent prognostic variables for disease-free survival. The ris k ratio of relapse was 2.386 (95% CI, 1.140-4.990) for grade 2 and 3.1 18 (95% CI, 1.515-6.416) for grade 3 compared to grade 1 disease. For patients with residual disease 1-2 cm and > 2 cm the risk ratio was, r espectively, 1.877 (95% CI, 1.117-3.156) and 2.156 (95% CI, 1.324-3.51 1) compared to patients with residual disease < 1 cm. The risk ratio w as 1.826 (95% CI, 1.121-2.973) for patients who were submitted to a la paroscopic second-look compared to those who underwent a laparotomic r eassessment. Poorly differentiated grade and large residual disease af ter initial surgery are the strongest prognostic variables for recurre nce after a negative second-look. (C) 1998 Academic Press.