Survival Dynamics in Advanced Ovarian Cancer: R2 Resection Versus No-Surgery Paths Explored.

Pitsikakis, K.; DeJong, D.; Kitsos-Kalyvianakis, K.; Mamalis, ME.; Quaranta, M.; Shavee, A.; Wahab, A.; Thangavelu, A.; Broadhead, T.; Nugent, D.; Kalampokis, E.; Laios, A.

Survival Dynamics in Advanced Ovarian Cancer: R2 Resection Versus No-Surgery Paths Explored.

All Authors

Pitsikakis, K.

DeJong, D.

Kitsos-Kalyvianakis, K.

Mamalis, ME.

Quaranta, M.

Shavee, A.

Wahab, A.

Thangavelu, A.

Broadhead, T.

Nugent, D.

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LTHT Author

Pitsikakis, Konstantinos
DeJong, Diederick
Kitsos-Kalyvianakis, Konstantinos
Quaranta, Michela
Thangavelu, Amudha
Broadhead, Timothy
Nugent, David
Laios, Alexandros

LTHT Department

Oncology
Gynaecology

Publication Date

2024

Item Type

Journal Article

Abstract

BACKGROUND: Cytoreductive surgery is critical for optimal tumor clearance in advanced epithelial ovarian cancer (EOC). Despite best efforts, some patients may experience R2 (>1 cm) resection, while others may not undergo surgery at all. We aimed to compare outcomes between advanced EOC patients undergoing R2 resection and those who had no surgery. METHODS: Retrospective data from 51 patients with R2 resection were compared to 122 patients with no surgery between January 2015 and December 2019 at a UK tertiary referral centre. Progression-free survival (PFS) and overall survival (OS) were the study endpoints. Principal Component Analysis and Term Frequency - Inverse Document Frequency scores were utilized for data discrimination and prediction of R>2 cm from computed tomography pre-operative reports, respectively. RESULTS: No statistical significance was observed, except for age (73 vs 67 years in the no- surgery vs R2 group, P: .001). Principal Components explained 34% of data variances. Reasons for no surgery included age, co-morbidities, patient preference, refractory disease, patient deterioration or disease progression, and absence of measurable intra- abdominal disease). The median PFS and OS were 12 and 14 months for no-surgery, vs 14 and 26 months for R2 (P: .138 and P: .001, respectively). Serous histology and performance status independently predicted PFS in both no-surgery and R2 cohorts. In the no-surgery cohort, serous histology independently predicted OS, while in the R2 cohorts, both serous histology and adjuvant chemotherapy were independent prognostic features for OS. The bi-grams "abdominopelvic ascites" and "solid omental" were amongst those best discriminating between R>2 cm and R1-2 cm. CONCLUSIONS: R2 resection and no-surgery cohorts displayed unfavourable prognosis with a notable degree of uniformity. When cytoreduction results in suboptimal results, the survival benefit may still be higher compared to those who underwent no surgery.