Abstract:

Objective To investigate the prognosis and influencing factors of secondary cytoreduction surgery （SCS） in patients with platinum-sensitive recurrent ovarian cancer whose tumor reduction with unsatisfactory primary cytoreduction surgery. Methods The clinical and follow-up data of 116 patients with platinum-sensitive recurrent ovarian cancer whose tumor reduction with unsatisfactory primary cytoreduction surgery and received the first diagnosis and operation in Shanxi Provincial Cancer Hospital from January 2005 to December 2018 were retrospectively analyzed. Among them，33 patients received SCS+chemotherapy and 83 patients received chemotherapy alone. In order to eliminate the component differences in general clinical data between the two groups，28 pairs total 56 patients were selected from each group to form a matching cohort by propensity score matching，and their data were analyzed. The main outcome measures were progression-free survival （PFS） and overall survival （OS）. Kaplan-Meier method was used to draw the survival curve accompanied with log-rank test. Cox regression model was used to analyze the prognostic factors of patients with platinum-sensitive recurrent ovarian cancer whose tumor reduction with unsatisfactory primary cytoreduction surgery. Results The median PFS of 56 matched patients with platinum-sensitive recurrent ovarian cancer whose tumor reduction with unsatisfactory primary cytoreduction surgery was 9.0 months. The 0.5- and 1-year PFS rates were 67.9% and 25.0% respectively. The median OS of 56 patients was 57.5 months. The 3- and 5-year OS rates were 60.7% and 39.3% respectively. The median PFS was 10.5 months in the SCS+chemotherapy patients and 7.5 months in the chemotherapy alone patients，and the 0.5- and 1-year PFS rates were 82.1% vs. 57.1% and 32.1% vs. 21.4% respectively，with a statistically significant difference （χ²=3.88，P=0.049）. The median OS was 70.0 months in the SCS+chemotherapy patients，and 60.0 months in the chemotherapy alone patients，and the 3- and 5-year OS rates of the SCS+chemotherapy patients and chemotherapy alone patients were 88.5% vs. 64.3% and 70.0% vs. 53.0%，with no statistically significant difference （χ²=3.63，P=0.057）. Univariate analysis showed that International Federation of Gynecology and Obstetrics （FIGO） staging （HR=3.17，95%CI：1.32-7.59，P=0.010） and treatment-free interval from the last platinum （TFIp）（HR=0.35，95%CI：0.18-0.68，P=0.002） were independent influencing factors of PFS in patients with platinum-sensitive recurrent ovarian cancer whose tumor reduction with unsatisfactory primary cytoreduction surgery. Carbohydrate antigen 125 （HR=2.46，95%CI：1.21-5.00，P=0.013） was an independent influencing factor of OS in patients with platinum-sensitive recurrent ovarian cancer whose tumor reduction with unsatisfactory primary cytoreduction surgery. Multivariate analysis showed that FIGO staging （HR=2.95，95%CI：1.18-7.36，P=0.020） and TFIp （HR=0.33，95%CI：0.16-0.66，P=0.002） were independent prognostic factors of PFS. Conclusion For platinum-sensitive recurrent ovarian cancer patients who do not achieve satisfactory tumor reduction after primary cytoreduction surgery，but achieve clinical complete response after postoperative chemotherapy，SCS may prolong their PFS after treatment，and OS also shows a beneficial trend after treatment，but with no statistically significant difference. FIGO staging at initial treatment and TFIp before the first relapse are independent prognostic factors of PFS in patients with platinum-sensitive recurrent ovarian cancer whose tumor reduction with unsatisfactory primary cytoreduction surgery.

Key words: Ovarian neoplasms, Cytoreduction surgical procedures, Drug therapy, Prognosis