KEY TAKEAWAYS
- The study aimed to compare survival outcomes between patients with advanced EOC having R2 resection and those with no surgery.
- The primary endpoints were to determine PFS and OS.
- Researchers noticed that despite the uniformly unfavorable prognosis, R2 resection may still offer a survival advantage over no surgery.
Cytoreductive surgery is essential for effective tumor clearance in advanced epithelial ovarian cancer (EOC). However, some patients may only achieve R2 resection (with residual tumor >1 cm), while others might not undergo any surgical intervention.
Konstantinos Pitsikakis and the team aimed to compare the outcomes between patients with advanced EOC who received R2 resection and those who did not have surgery.
They performed an inclusive analysis of retrospective data from 51 patients with R2 resection and 122 patients with no surgery. Progression-free survival (PFS) and overall survival (OS) were the primary endpoints. Principal Component Analysis and Term Frequency – Inverse Document Frequency scores were employed to differentiate and predict R>2 cm from pre-operative computed tomography reports.
No statistical significance was found, except for age (73 years in the no-surgery group vs. 67 years in the R2 group, P: .001). Principal Components analysis accounted for 34% of the data variance. Reasons for not undergoing surgery included age, co-morbidities, patient preference, refractory disease, patient deterioration or disease progression, and lack of measurable intra-abdominal disease.
The median PFS and OS were 12 and 14 months for the no-surgery group, compared to 14 and 26 months for the R2 group (P: .138 and P: .001, respectively). Serous histology and performance status independently predicted PFS in both groups.
In the no-surgery group, serous histology independently predicted OS, whereas in the R2 group, both serous histology and adjuvant chemotherapy were independent predictors of OS. The bi-grams “abdominopelvic ascites” and “solid omental” were among the most effective in distinguishing between R>2 cm and R1-2 cm.
The study concluded that both R2 resection and no-surgery cohorts exhibited unfavorable prognosis with a notable degree of uniformity. However, even when cytoreduction results in suboptimal outcomes, the survival benefit may still be higher compared to those who did not undergo surgery.
The study received no funds.
Source: https://pubmed.ncbi.nlm.nih.gov/39283489/
Pitsikakis K, DeJong D, Kitsos-Kalyvianakis K, et al. (2024). “Survival Dynamics in Advanced Ovarian Cancer: R2 Resection Versus No-Surgery Paths Explored.” Cancer Control. 2024;31:10732748241285480. doi:10.1177/10732748241285480
