Secondary cytoreductive surgery for ovarian cancer recurrence and first-line maintenance therapy: A multicenter retrospective study. in European journal of obstetrics, gynecology, and reproductive biology / Eur J Obstet Gynecol Reprod Biol. 2025 Mar;306:160-167. doi: 10.1016/j.ejogrb.2025.01.025. Epub 2025

2025
AO Cuneo

Tipo pubblicazione

Multicenter Study

Autori/Collaboratori (11)Vedi tutti...

Uccella S
Unit of Gynecology and Obstetrics, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, AOUI Verona, Verona, Italy.
Puppo A
Department of Obstetrics and Gynecology, Ospedale Santa Croce e Carle, Cuneo, Italy.
Garzon S
Unit of Gynecology and Obstetrics, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, AOUI Verona, Verona, Italy. Electronic address: simone.garzon@univr.it.

et alii...

Abstract

PURPOSE: To investigate surgical and oncologic outcomes of secondary cytoreductive surgery for ovarian cancer recurrence, considering the exposure to previous first-line maintenance therapy. METHODS: We retrospectively identified all women who underwent secondary cytoreductive surgery for ovarian cancer recurrence with cytoreductive intent at three Italian Gynecologic Oncology centers (1997-2022). Data on clinical, surgical, and pathological characteristics, neoadjuvant, adjuvant, and maintenance therapy, as well as follow-up information, were retrieved from prospectively collected databases and medical records. RESULTS: We identified 189 patients. Maintenance therapy in the first-line setting was implemented in 108/189 (57 %) cases: bevacizumab in 77.7 % (84/108), PARP inhibitors (Olaparib, Niraparib, or Rucaparib) in 15.7 % (17/108), and bevacizumab + PARP-inhibitors in 4.6 % (5/108). Complete cytoreduction rate and perioperative complications in secondary surgery were not associated with previous maintenance therapy. Complete cytoreduction was achieved in 75 % (140/189) of patients, and any residual tumor was the strongest predictor of poor progression-free (Hazard ratio [HR] 3.91, 95 %CI 2.48-6.16) and cause-specific survival (HR 4.27, 95 %CI 2.36-7.70). First-line bevacizumab was independently associated with worse progression-free survival among patients with any residual tumor at secondary surgery. First-line PARP inhibitors were independently associated with worse progression-free and cause-specific survival regardless of complete cytoreduction. Second-line maintenance therapies were independently associated with better survival regardless of residual tumor after secondary surgery. CONCLUSION: Complete cytoreduction during secondary surgery for ovarian cancer recurrence is the strongest predictor of prognosis. First-line maintenance therapies do not appear to affect the safety and feasibility of secondary cytoreduction, although they may influence prognosis after secondary surgery.

Accesso banca dati bibliografica

PMID : 39988402

DOI : 10.1016/j.ejogrb.2025.01.025

Keywords

Humans; Female; Cytoreduction Surgical Procedures; Retrospective Studies; Middle Aged; Ovarian Neoplasms/surgery/drug therapy/pathology; Neoplasm Recurrence, Local/surgery; Aged; Maintenance Chemotherapy; Adult; Bevacizumab/therapeutic use; Poly(ADP-ribose) Polymerase Inhibitors/therapeutic use; Bevacizumab; Ovarian cancer; PARP inhibitors; Perioperative complications; Recurrence; Secondary surgery;