Outcomes of secondary cytoreductive surgery for patients with platinum-sensitive recurrent ovarian cancer

Background Most women with advanced epithelial ovarian cancer develop recurrent disease despite maximal surgical cytoreduction and adjuvant platinum-based chemotherapy. In observational studies secondary cytoreductive surgery has been associated with improved survival, however its use is controversial, because there are concerns that the improved outcomes may reflect selection bias rather than the superiority of secondary surgery. Objective To compare the overall survival of women with platinum-sensitive recurrent ovarian cancer treated at National Cancer Institute-designated cancer centers who receive secondary surgery vs. chemotherapy. Study Design This retrospective cohort study included women from six National Cancer Institute-designated cancer centers diagnosed with platinum-sensitive recurrent ovarian cancer between January 1, 2004 and December 31, 2011. The primary outcome was overall survival. Propensity-score matching was used to compare similar women who received secondary surgery vs. chemotherapy. Additional analyses examined how these findings may be influenced by the prevalence of unobserved confounders at the time of recurrence. Results Among 626 women, 146 (23%) received secondary surgery and 480 (77%) received chemotherapy. In adjusted analyses, patients who received secondary surgery were younger (p=0.001), had earlier stage disease at diagnosis (p=0.002) and longer disease-free intervals (p Conclusions Patients with platinum-sensitive recurrent ovarian cancer who received secondary surgery had favorable surgical characteristics and were likely to have minimal residual disease following secondary surgery. These patients had a superior median overall survival compared with patients who received chemotherapy, although unmeasured confounders may explain this observed difference.