Can recurrence pattern predict complete resection in secondary cytoreductive surgery in patients with epithelial ovarian cancer?

Background: This study aims to identify parameters predicting complete resection (CR) in patients undergoing SCS and to evaluate the impact of CR on survival, particularly in relation to the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) score. Methods: A total of 326 patients diagnosed with epithelial ovarian cancer between 2006 and 2020 at the Gynecologic Oncology Clinic of Etlik Zübeyde Hanım Women’s Diseases Training and Research Hospital were retrospectively analyzed. All patients had completed primary treatment and had documented recurrence. Those who underwent SCS at first recurrence were included. Patients were classified into two groups based on SCS outcomes: those who achieved CR and those with residual tumor. A comparative analysis was performed between these groups, assessing demographic characteristics, intraoperative findings from initial surgery, epithelial ovarian cancer (EOC) diagnosis, Cancer Antigen-125 (CA-125) levels at recurrence, and recurrence patterns. Additionally, patients were categorized according to their compliance with the AGO scoring system, and its influence on survival outcomes was analyzed. Results: Among 42 patients included in the study, CR was achieved in 29 (69%). Factors negatively affecting CR rates included splenectomy during initial surgery, presence of more than three lymph nodes on preoperative imaging, and intraoperative metastases or diffuse disease. No significant difference in CR rates was observed between patients classified based on AGO score compliance. However, patients who achieved CR had a 38-month survival advantage. Conclusions: While the AGO score can assist in predicting CR following SCS, it is not sufficient as the sole determinant. In our clinic, SCS candidates are selected based on a multidisciplinary gynecologic oncology board evaluation, independent of the AGO score, incorporating clinical and surgical expertise. Recurrence patterns may serve as a useful guide in patient selection. Further studies with larger cohorts are needed to refine predictive parameters for optimal patient selection in SCS.

Epithelial ovarian cancer; Cytoreductive surgery; Complete resection

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