Cytoreductive surgery for stage IV epithelial ovarian cancer

We tried to determine the role of cytoreductive surgery for stage IV epithe lial ovarian cancer and in what conditions this surgical procedure could ca rry the best benefits. From January 1986 to December 1997, seventy-one of 73 patients with stage I V epithelial ovarian cancer who were treated in Cancer Hospital of Shanghai Medical University were retrospectively reviewed. Clinical information inc luding age, grade, histology, presence of ascites, size of residual disease , site of extra-abdominal metastasis, whether initially presenting as metas tatic disease or not, neo-adjuvant chemotherapy, platinum-based chemotherap y and second-line chemotherapy was obtained. Survival was calculated by lif e-table and survival curves were computed using the Kaplan-Meier method wit h differences in survival estimated by log-rank test. Independent prognosti c factors were identified by Cox's proportional hazards regression model. The median age of the patients' population was 54 years (range 22-82), medi an follow-up time was 12 months (range 3 to 130) and estimated 5-year survi val rate 6.1%. Thirty out of 71 (42.3%) patients were successfully de bulke d (less than or equal to 1 cm) at the time of initial surgery. There was a significant difference in five-year survival rate between patients optimall y (14.1%) vs suboptimally (0%) cytoreduced, with an estimated median surviv al in the optimal group of 23 months vs 9 months in the suboptimal group (P =0.0001, long-rank test). When the variables were factorized, only in patie nts with malignant pleural effusion or positive supraclavicular lymph nodes , optimal cytoreduction could beet the greatest benefits. Multivariate anal ysis revealed that the size of residual disease and ascites were independen t factors of survival. However, only ascites was the prognostic factor of p rogression-free survival. Optimal cytoreductive surgery is an important determinant of survival in wo men with stage IV epithelial ovarian cancer, mainly in those with malignant pleural effusion or positive supraclavicular lymph node pathology.