Surgery in platinum-resistant recurrent epithelial ovarian carcinoma

Table 1 Patient baseline characteristics

Characteristic	Patients (n = 38)
Age, n (%)
< 50 yrs	18 (47.4)
≥ 50 yrs	20 (52.6)
Pathological type, n (%)
High-grade serous carcinoma	26 (68.4)
Endometrioid carcinoma	5 (13.2)
Clear cell carcinoma	5 (13.2)
Mucinous carcinoma	1 (2.6)
Mixed type	1 (2.6)
Pathological classification, n (%)
Highly differentiated	3 (7.9)
Moderately differentiated	3 (7.9)
Poorly differentiated	32 (84.2)
Number of previous surgery, n (%)
0	1 (2.6)
1	32 (84.2)
2	4 (10.6)
3	1 (2.6)
Number of previous chemotherapy lines, n (%)
1	24 (63.1)
2	8 (21.1)
≥ 3	6 (15.8)
FIGO staging of the first surgery, n (%)
I	2 (5.3)
II	12 (31.5)
III	22 (57.9)
IV	2 (5.3)
Residual lesions of the first surgery, n (%)
R0	20 (52.6)
R1	10 (26.3)
R2	8 (21.1)
Neoadjuvant chemotherapy, n (%)	9 (23.7)
Remission time of chemotherapy before this secondary surgery, n (%)
≤ 3 mo	16 (42.1)
3-6 mo	22 (57.9)
Type of platinum resistance, n (%)
Secondary	27 (71.1)
Primary	11 (28.9)

FIGO: International federation of gynecology and obstetrics.

Table 2 Data of secondary surgery for platinum-resistant recurrent epithelial ovarian carcinoma

Characteristic	Patients (n = 38)
Preoperative ECOG score, n (%)
0-1	33 (86.8)
2	5 (13.2)
Location of recurrent lesions, n (%)
Pelvic cavity	7 (18.4)
Abdominopelvic cavity	16 (42.1)
Pelvic/abdominal cavity + retroperitoneal	15 (39.5)
Residual lesions of the secondary surgery, n (%)
R0	25 (65.8)
R1-R2	13 (34.2)
Intraoperative organ resection, n (%)
No	13 (34.2)
Yes	25 (65.8)
Bleeding amount (mL), n (%)
≤ 400	20 (52.6)
401-800	12 (31.6)
> 801	6 (15.8)
Perioperative complications, n (%)
No	29 (76.3)
Yes	9 (23.7)
Postoperative chemotherapy, n (%)
No	2 (5.3)
Yes	36 (94.7)
Postoperative use of targeted drugs, n (%)
No	33 (86.8)
Yes	5 (13.2)
Postoperative hospital stay, n (%)
≤ 10 d	24 (63.2)
11-20 d	12 (31.6)
> 20 d	2 (5.2)

ECOG: Eastern collaborative oncology group.

Table 3 Univariable Cox regression analysis of various outcomes

Characteristics	PFS			OS			CFI
	HR	95%CI	P value	HR	95%CI	P value	HR	95%CI	P value
Age
< 50 yrs	0.929	(0.469, 1.839)	0.832	0.684	(0.276, 1.694)	0.412	1.06	(0.538, 2.092)	0.866
≥ 50 yrs	Reference			Reference			Reference
Pathological type
High-grade serous carcinoma	Reference			Reference			Reference
Endometrioid carcinoma	0.523	(0.178, 1.543)	0.241	0.697	(0.199, 2.439)	0.572	0.32	(0.107, 0.956)	0.041
Clear cell carcinoma	1.107	(0.417, 2.942)	0.838	0.788	(0.224, 2.769)	0.71	0.991	(0.368, 2.67)	0.985
Mucinous carcinoma	0.491	(0.065, 3.706)	0.491	1.957	(0.249, 15.399)	0.524	0.238	(0.031, 1.849)	0.17
Mixed type	6.929	(0.803, 59.809)	0.078	11.285	(1.157, 110.099)	0.037	2.559	(0.327, 20.016)	0.371
Pathological classification
Highly differentiated	0.822	(0.249, 2.713)	0.748	1.427	(0.413, 4.931)	0.574	0.644	(0.193, 2.154)	0.475
Moderately differentiated	0.583	(0.137, 2.474)	0.464	0.878	(0.198, 3.881)	0.863	0.348	(0.082, 1.477)	0.152
Poorly differentiated	Reference			Reference			Reference
Number of previous surgery
0	3.676	(0.464, 29.112)	0.218	6.505	(0.755, 56.05)	0.088	8.71	(0.969, 78.245)	0.053
1	Reference			Reference			Reference
2	0.807	(0.276, 2.358)	0.696	0.961	(0.223, 4.151)	0.958	1.02	(0.351, 2.964)	0.97
3	0.922	(0.124, 6.864)	0.937	/	/	/	1.251	(0.167, 9.374)	0.827
Number of previous chemotherapy lines
1	Reference			Reference			Reference
2	0.639	(0.272, 1.504)	0.305	0.573	(0.165, 1.987)	0.381	0.974	(0.426, 2.229)	0.951
≥ 3	0.81	(0.307, 2.142)	0.672	1.863	(0.592, 5.865)	0.288	1.182	(0.476, 2.935)	0.719
FIGO staging of the first surgery
I	1.507	(0.345, 6.58)	0.586	1.634	(0.358, 7.466)	0.526	2.678	(0.577, 12.437)	0.209
II	0.752	(0.352, 1.606)	0.462	1.244	(0.512, 3.027)	0.63	0.672	(0.319, 1.415)	0.295
III	Reference			Reference			Reference
IV	0.419	(0.097, 1.819)	0.246	/	/	/	0.525	(0.12, 2.285)	0.39
Residual lesions of the first surgery
R0	Reference			Reference			Reference
R1	1.122	(0.505, 2.49)	0.778	0.936	(0.355, 2.469)	0.894	1.059	(0.484, 2.32)	0.885
R2	1.071	(0.461, 2.489)	0.874	0.422	(0.119, 1.492)	0.181	1.055	(0.454, 2.456)	0.9
Neoadjuvant chemotherapy	0.629	(0.278,1.423)	0.266	1.081	(0.394, 2.965)	0.879	0.717	(0.329, 1.56)	0.401
Remission time of chemotherapy before this secondary surgery
≤ 3 mo	1.338	(0.68, 2.631)	0.399	0.767	(0.322, 1.827)	0.549	1.022	(0.519, 2.014)	0.95
3-6 mo	Reference			Reference			Reference
Type of platinum resistance
Secondary	Reference			Reference			Reference
Primary	0.982	(0.471, 2.048)	0.962	0.843	(0.281, 2.529)	0.761	1.354	(0.647, 2.833)	0.421
Preoperative ECOG score
0-1	Reference			Reference			Reference
2	0.643	(0.226, 1.830)	0.408	0.654	(0.184, 2.323)	0.511	0.575	(0.221, 1.497)	0.257
Location of recurrent lesions
Pelvic cavity	0.799	(0.305, 2.091)	0.648	0.981	(0.314, 3.062)	0.973	0.661	(0.239, 1.827)	0.425
Abdominopelvic cavity	Reference			Reference			Reference
Pelvic/abdominal cavity + retroperitoneal	0.818	(0.391, 1.711)	0.594	0.728	(0.279, 1.9)	0.516	0.867	(0.422, 1.78)	0.697
Residual lesions of this secondary surgery
R0	Reference			Reference			Reference
R1-R2	3.29	(1.511, 7.162)	0.003	2.65	(1.115, 6.298)	0.027	2.777	(1.108, 4.679)	0.025
Intraoperative organ resection	1.251	(0.616, 2.542)	0.536	1.19	(0.485, 2.921)	0.705	1.586	(0.772, 3.257)	0.21
Bleeding amount
≤ 400 mL	Reference			Reference			Reference
401-800 mL	0.668	(0.309, 1.444)	0.305	0.634	(0.222, 1.807)	0.393	0.963	(0.459, 2.021)	0.92
> 800 mL	2.862	(1.048, 7.813)	0.04	2.422	(0.83, 7.072)	0.106	1.601	(0.623, 4.111)	0.328
Perioperative complications	0.669	(0.289, 1.548)	0.348	1.355	(0.527, 3.478)	0.528	0.713	(0.307, 1.656)	0.432
Postoperative chemotherapy
No	5.027	(1.061, 23.828)	0.042	57.66	(5.099, 651.995)	0.001	/	/	/
Yes	Reference			Reference			/	/	/
Postoperative use of targeted drugs	0.518	(0.178, 1.504)	0.226	0.436	(0.101, 1.887)	0.267	0.745	(0.277, 2.003)	0.56
Postoperative hospital stay
≤ 10 d	Reference			Reference			Reference
11-20 d	1.212	(0.573, 2.567)	0.615	2.411	(0.963, 6.037)	0.06	1.104	(0.524, 2.328)	0.795
> 20 d	1.911	(0.44, 8.308)	0.388	3.98	(0.853, 18.563)	0.079	3.246	(0.695, 15.154)	0.134

OS: Overall survival; PFS: Progression-free survival; CFI: Chemotherapy-free interval; HR: Hazard ratio; CI: Confidence interval; FIGO: International federation of gynecology and obstetrics; ECOG: Eastern collaborative oncology group.