Factors influencing peridd of time between negative second-look laparotorny and ovarian carcinoma recurrence. Multicenter study in Poland

Objective: The aim of our study was to evaluate factors such as primary clinical stage, presence of ascites, serum CA 125 antigen level, histological type of ovarian cancer, cell differentiation and number of chemotherapy cycles influencing the time of recurrence after negative second-look operations.

Material and methods: Having observed complete clinical remission in 356 patients with ovarian cancer, second-look laparotomy was performed. In 180 patients complete pathologic remission was detected and in 73 recurrence was observed. Correlation analysis between time of recurrence and the above-mentioned prognostic factors was carried out by means of the Mann-Whitney and Kruskal-Wallis tests.

Results: The time from the second-look operation till diagnosis of relapse ranged from 7 to 36 months (average 21 months). The statistical analysis showed a correlation between the presence of ascites, increased serum CA 125 antigen level, the administration of six chemotherapy courses and the time of recurrence. In all those cases relapse occurred earlier than in patients without ascites, with normal CA 125 antigen levels and after ten courses of chemotherapy.

Conclusion: Our findings suggest that the stage of clinical advancement and histologic grading do not influence the time of recurrence. The presence of ascites, increased serum CA 125 antigen level and the administration of fewer chemotherapy courses (6 versus 10) after primary surgery affects the earlier relapse of disease.

Ovarian cancer; Second-look operation; Recurrence

[1] Abu Rustum N. R., Bakarat R. R., Siegel P. L., Vencatraman E., Curtin J. P., Hoskins W. J.: "Second-look operation for epithelial ovarian cancer: laparoscopy or laparotomy?". Obstet. Gynecol., 1996, 88 /4), 549.

[2] ACOG Committee opinion: "Second-look laparotomy for epithelial ovarian cancer. No. 165, December 1995 (replaces no. 100, November I 991), Commiittee on Gynecologic Practice. American College of Obstetricians and Gynecologists". Int. J. Gynaecol Obstet., 1996, 53 /1), 81.

[3] Boente M. P., Yeh K., Hagan W. M., Ozols R. F.: "Current status of staging laparotomy in colorectal and ovarian cancer". Cancer Treat. Res., 1996, 82, 337.

[4] Boente M. P., Chi D. S., Hoskins W. J.: "The role of surgery in the management of ovarian cancer: primary and interval cytoreductive surgery". Semin. Oneal., 1998, 25 13), 326.

[5] Bolis G., Villa A., Quarnerio P., Ferraris C., Gavoni N., Giardma G., Melpignano M. et al.: "Survival of women with advanced ovarian cancer and complete pathologic response at second-look laparotomy". Cancer, 1996, 77 /I), 128.

[6] di Re F., Baiocchi G., Fontanelli R., Grosso G., Cobellis L., Raspagliesi F., di Re E.: "Systematic pelvic and paraaortic lymphadenectomy for advanced ovarian cancer: prognostic significance and node metastases". Gynecol. Oneal., 1996, 62 13), 360.

[7] Friedman R. L., Eisenkop S. M., Wang H. J.: "Second-look laparotomy for ovarian cancer provides reliable prognostic information and improves survival". Gynecol. Oneal., l 997, 67 (1), 88.

[8] Fujiwara K., Yamauchi H., Yoshida T., Suzuki S., Oda T., Kohno I.: "Relationship between peritoneal washing cytology through implantable port system (!PS-cytology) and second-look laparotomy in ovarian cancer patients with unmeasurable residual diseases". Gynecol. Oneal., 1998, 70 (2), 231.

[9] Gadducci A., Sartori E., Maggino T., Zola F., Landoni F., Fanucchi A., Palai N. et al.: "Analysis of failures after negative secondlook in patients with advanced ovarian cancer: an Italian multicenter study". Gynecol. Oneal., 1998, 68 (2), 150.

[10] Hempling R. E.,W esolowki J. A.,P iver M. S.: "Second-look laparotomy in advanced ovarian cancer: a critical a邓sessment of morbidity and impact on survival". Am. Surg. Oneal., 1997, 4 (4), 349.

[11] Hernadi Z., Sapy T., Lukacsko L., Borsos A.: "Second-look surgery (SLO) in the management of carcinoma of the ovary" Acta Chil: Hung., 1997, 36 (l-4), 128.

[12] Hogdall C. K., Hogdall E. Y., Hording U., Toftager-Larsen K., Arends J., Norgaard Peder、en B., Clemmensen I.: "Use of tetranectin, CA 125 and CASA to predict residual tumor and survival at second and third-look operations for ovarian cancer". Acta Oneal., 1996, 35 (1), 63.

[13] Katsoulis M., Vorgias G., Panagiotides J., Dertimas B., Zis J.: 'The prognostic significance of second-look laparotomy in advanced ovarian cancer". Eur. J. Gynaecol. Oncol., 1997. 18 (3), 200.

[14] Landoni F., Pellegrino A., Cormio G., Milani R., Maggioni A., Mangioni C.: "Platin-based chemotherapy and salvage surgery in recurrent ovarian cancer following negative second-look laparotomy". Acta Obstet. Gynecol. Scand., 1998, 77 (2), 233.

[15] Makar A., Kristensen G. B., B0rrmer 0. P., Trope C. G.: "CA 125 measured before second-look laparotomy is an independent prognostic factor for survival in patients with epithelial ovarian cancer". Gynecol. Oneal.,1992,15, 323.

[16] Ozols R. F.: "The role of therapy in ovarian cancer". International Symposium on Advanced Ovarian Cancer: optimal therapy update. Valencia, Spain. February 26th 1999, Abstract No. 8.

[17] Puls L. E., Duniho T., Hunter J. E., Kryscio R., Blackhurst D., Gallion H.: "The prognostic implication of ascites in advancedstage ovarian cancer". Gynecol. Oncol., 1996, 61 (1), 109.

[18] Sonnendecker E. W.: "Is routine second-look laparotomy for ovarian cancer justified?". Gynecol. Oncol., 1988, 31, 249.

[19] Tuxen M. K., Strauss G., Lund B., Hansen M.: "The role of second-look laparotomy in the long term survival in ovarian cancer". Ann. Oneal., 1997, 8 (7), 643.