PRIMARY OVARIAN SARCOMA - ANALYSIS OF PROGNOSTIC VARIABLES AND THE ROLE OF SURGICAL CYTOREDUCTION

BACKGROUND. Data regarding the value of cytoreduction and cell histolo gy in ovarian sarcomas are limited. The goal of this study was to asse ss the value of surgical cytoreduction, preoperative CA 125 levels, st age, histology, and platinum-based chemotherapy in the primary treatme nt of ovarian sarcomas. METHODS. A retrospective analysis of 47 women with primary ovarian sarcomas was performed. RESULTS. Forty-one patien ts (87%) presented with advanced stage disease (International Federati on of Gynecology and Obstetrics Stage III or IV. Optimal surgical cyto reduction (<1 cm residual tumor burden) was achieved in 25 patients (5 3%). Forty patients (85%) had a malignant mixed mullerian tumor wherea s 7 patients had a pure sarcoma. Eighteen women with mixed mullerian t umors had homologous tumors and 22 had heterologous elements. Patients treated with platinum-based chemotherapy were significantly more like ly to have a response (P = 0.008) compared with those treated with oth er regimens. Treatment with platinum-based chemotherapy also showed a survival advantage (P = 0.03). Preoperative CA 125 levels were elevate d (>35 U/mL) in 93% of patients with ovarian sarcomas. A preoperative CA 125 level < 75 U/mL was significantly associated with better surviv al (P = 0.01). In univariate analysis, other significant predictors of improved survival were early stage (P = 0.04), homologous tumors (P < 0.05), and optimal surgical cytoreduction (P < 0.001). In multivariat e analysis of various prognostic variables, optimal surgical cytoreduc tion (P < 0.001) was the most significant factor, followed by histolog ic subtype (P < 0.02). CONCLUSIONS, Ovarian sarcomas are rare malignan cies with a poor prognosis, All women with suspected ovarian carcinoma or sarcoma should have a preoperative CA 125 level taken. Surgical cy toreduction to a residual tumor burden of cl cm improves outcome and s hould be the goal of surgery. Although the optimal consolidation chemo therapy regimen remains unknown, platinum should be included as part o f the regimen. (C) 1998 Americnn Cancer Society.