Evaluation of prognostic factors for advanced ovarian cancer treatment with an emphasis on optimal primary cytoreduction

Background: Initial surgical debulking followed by a systemic chemotherapy is the standard treatment sequence for advanced ovarian cancer (AOC) treatment. The purpose of this article is to evaluate prognostic factors that impact the success of AOC treatment. Methods: All patients with AOC (FIGO stage III and IV) who were surgically treated at the Division of Gynaecology, University Medical Centre of Ljubljana, in the period from 2003 to 2008 and further received cytotoxic chemotherapy at the Institute of Oncology in Ljubljana were included in this retrospective study. Women with advanced borderline ovarian cancer and patients who initially received neoadjuvant chemotherapy and those whose adjuvant chemotherapy was not platinum-based were excluded from the analysis. Results: A total of 159 women were enrolled in the study, while data were analyzed for 116 patients. Their median age was 59 years (23-80 years) and did not have a significant influence on the treatment outcome. Clear-cell histological type of AOC was an important risk factor for a disease-free interval (DFI) (HR = 2.41, CI 95 % 0.9-5.9; p = 0.08) and overall survival (OS) (HR 4.045; 95.0% CI 1.5-10.6; p = 0.003). Post-operative residual tumour larger than 2 cm represented a statistically independent risk factor for poor OS. Residual tumour in the upper abdomen did not represent a statistically significant risk factor either for DFI (HR = 1.93; CI 95 % 0.9-4.06; p = 0.08) or for OS (HR = 1.47; 95.0 % CI 0.5-3.8; p = 0.491). Median follow up time was 29.5 months, median DFI 18 months (95 % CI 16-20) and median OS 32 months (95 % CI 22-42). 74 (63.8 %) patients died. Conclusion: Clear-cell histological type of AOC and residual tumour larger than 2 cm are the most important risk factors for early progress of the disease and poor OS. Hence improvement of surgical treatment is crucial for better treatment outcomes for patients with AOC. The latter can be achieved by an interdisciplinary surgical approach.