Treatment experience in patients with recurrent ovarian cancer

Abstract

BACKGROUND: In patients experiencing recurrence of ovarian cancer, the choice of treatment strategy is crucial—whether to perform secondary cytoreduction followed by chemotherapy or to administer chemotherapy alone.

AIM: The analysis aimed to assess the effectiveness of treatment strategies based on clinicopathological factors in patients with a first recurrence of ovarian cancer.

MATERIAL AND METHODS: A retrospective analysis was conducted on medical records of 446 female patients with first recurrent ovarian cancer treated at the Primorsky Regional Oncology Center. Among them, 53 (11.9%) had platinum-refractory recurrence, 110 (24.7%) had platinum-resistant recurrence, and 283 (63.5%) had platinum-sensitive recurrence. BRCA1/2 mutation testing was performed in 197 patients, revealing mutations in 62 (31.5%) cases, while 135 (68.5%) had no detected mutations. The primary endpoints were overall survival and progression-free survival. The impact of clinicopathological factors was assessed using univariate and multivariate analyses and Kaplan–Meier survival curves.

RESULTS: In patients with first recurrence of ovarian cancer, overall survival and progression-free survival were significantly improved in cases of platinum-sensitive recurrence (p = 0.0010 for both overall and progression-free survival), stage I disease (p = 0.0030 for overall survival; p = 0.0010 for progression-free survival), the presence of BRCA1/2 mutations (p = 0.0010 for overall survival; p = 0.0070 for progression-free survival), secondary cytoreduction followed by chemotherapy (p = 0.0010 for both overall and progression-free survival), a single recurrent tumor (p = 0.0010 for overall survival; p = 0.0040 for progression-free survival), and complete primary cytoreduction (p = 0.0010 for both overall and progression-free survival), with the extent of initial cytoreduction being a significant factor (p = 0.0100 for overall survival; p = 0.0010 for progression-free survival). According to multivariate analysis, the risk of progression decreased by 30% in the presence of BRCA1/2 mutations (p = 0.0160) and by 30% in cases of a single recurrent tumor (p = 0.0040). Independent risk factors for progression included tumor histological type, the extent of primary cytoreduction, platinum-free interval duration, treatment strategy for the first recurrence, chemotherapy regimen, and maintenance therapy approach.

CONCLUSION: Complete secondary cytoreduction followed by antitumor drug therapy significantly improves overall survival and progression-free survival in patients with platinum-sensitive recurrence, increasing the likelihood of subsequent platinum-sensitive recurrences.

Keywords

ovarian cancer / first recurrence / secondary cytoreduction / overall survival / progression-free survival

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