PUB - Publikationen an der Universität Bielefeld

Introduction/Background Three randomized trials evaluating the role of secondary cytoreductive surgery (SCS) in recurrent ovarian cancer (ROC) have provided partially contradictory results while significantly differing with respect to selection criteria, post-randomization intervention, systemic therapy, surgical protocols and quality assurance. Aim of the SurROCCon project is to define the role of SCS in a multicenter setting with homogenous and standardized surgical quality. Methodology The SurROCCon consortium established a comprehensive database of all consecutive patients with ROC presenting to five dedicated centers of excellence for ovarian cancer. All centers maintain a prospective tumor registry that includes all patients with standardized and regular follow-up protocols. Eligibility criteria included first ROC with a platinum-free interval (TFI-p) ≥6 months treated with either SCS and/or platinum-based chemotherapy within 2004-2022. Results Of 3109 patients, 1212 (38.7%) underwent SCS. Complete gross resection (CGR) rate was 83.6% with a 30-day perioperative mortality rate of 0.3%. The positive predictive value for CGR of the AGO, iMODEL and MSK criteria were 86.5, 85.7 and 84.3, respectively. Median overall survival (OS) reached 81 versus 39 months in patients without versus with residual disease at SCS (p<0.001). The timing of initial surgery (primary versus interval) did not have any significant impact on the benefit derived from SCS. BRCA mutations had a positive impact on progression-free survival (PFS) (27.4 versus 21.3 months, p<0.0021) but not on OS and did not diminish the prognostic value of CGR. Front-line maintenance treatment with bevacizumab had no prognostic impact in this cohort. Patients who underwent SCS had a significantly higher OS (70 versus 34 months) and PFS compared to those with chemotherapy alone (22.3 versus 13.2 months). Conclusion SCS performed at expert ovarian cancer centers conferred a significant and clinically meaningful survival benefit. The achievement of CGR at SCS was the most crucial prognostic factor, irrespective of BRCA mutation or timing of surgery at initial diagnosis.