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Surgery in Recurrent Ovarian Cancer: The Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR Trial

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Abstract

Background

The role of cytoreductive surgery in relapsed ovarian cancer is not clearly defined. Therefore, patient selection remains arbitrary and depends on the center’s preference rather than on established selection criteria. The Descriptive Evaluation of preoperative Selection KriTeria for OPerability in recurrent OVARian cancer (DESKTOP OVAR) trial was undertaken to form a hypothesis for a panel of criteria for selecting patients who might benefit from surgery in relapsed ovarian cancer.

Methods

The DESKTOP trial was an exploratory study based on data from a retrospective analysis of hospital records. Twenty-five member institutions of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Committee (AGO OC) and AGO-OVAR boards collected data on their patients with cytoreductive surgery for relapsed invasive epithelial ovarian cancer performed in 2000–2003.

Results

Two hundred and sixty-seven patients were included. Complete resection was associated with significantly longer survival compared with surgery leaving any postoperative residuals [median 45.2 vs. 19.7 months; hazard ratio (HR) 3.71; 95% confidence interval (CI) 2.27–6.05; P < .0001]. Variables associated with complete resection were performance status (PS) [Eastern Cooperative Oncology Group (ECOG) 0 vs. > 0; P < .001], International Federation of Gynecology and Obstetrics (FIGO) stage at initial diagnosis (FIGO I/II vs. III/IV, P = .036), residual tumor after primary surgery (none vs. present, P <.001), and absence of ascites > 500 ml (P < .001). A combination of PS, early FIGO stage initially or no residual tumor after first surgery, and absence of ascites could predict complete resection in 79% of patients.

Conclusions

Only complete resection was associated with prolonged survival in recurrent ovarian cancer. The identified criteria panel will be verified in a prospective trial (AGO-DESKTOP II) evaluating whether it will render a useful tool for selecting the right patients for cytoreductive surgery in recurrent ovarian cancer.

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Acknowledgment

*Further members of the study coordinating group of the AGO OVAR and/or the AGO OC who contributed to this study are (in alphabetic order): U. Canzler (Dresden), V. Heilmann (Ulm), C. Jackisch (Marburg), W. Kuhn (Bonn), H.J. Lueck (Hannover), O. Ortmann (Regensburg), B. Richter (Radebeul), I. Runnebaum (Jena), P. Wimberger (Essen).

The authors thank S. Eichner, A. Krüger, M. Schulze (AGO-OVAR study office Kiel, Germany), and C. Ackermann, G. Elser (AGO-OVAR central unit Wiesbaden, Germany) for data management and technical support, and J. Rochon and C. Schade-Brittinger (KKS Marburg, Germany) for statistical support. This work is dedicated to Helge Prinz who was recently deceased. He was a mentor and statistical consultant for the AGO DESKTOP series, and we will continue this series in his memory.

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Authors and Affiliations

  1. Department of Gynecology & Gynecologic Oncology, HSK, Dr. Horst Schmidt Klinik Wiesbaden, Ludwig-Erhard-Strasse 100, Wiesbaden, D-65199, Germany

    Philipp Harter & Andreas du Bois

  2. Coordinating Center for Clinical Trials, Marburg University, Robert-Koch-Strasse 5, Marburg, Germany

    Maik Hahmann

  3. Department of Gynecology & Obstetrics, Freiburg University, Hugstetter Strasse 49, Freiburg, Germany

    Annette Hasenburg

  4. Department of Gynecology & Obstetrics, University of Muenchen - Grosshadern, Marchioninistr. 15, Munich, Germany

    Alexander Burges

  5. Department of Gynecology & Obstetrics, Frankfurt University, Theodor-Stern-Kai 7, Frankfurt, Germany

    Sibylle Loibl

  6. Department of Gynecology & Obstetrics, EVK Duesseldorf, Kirchfeldstrasse 40, Duesseldorf, Germany

    Martina Gropp

  7. Department of Gynecology & Obstetrics, Tuebingen University, Calwerstrasse 7, Tuebingen, Germany

    Jens Huober

  8. Department of Gynecology & Obstetrics, Zuerich University, Raemistrasse 100, Zuerich, Switzerland

    Daniel Fink

  9. Department of Gynecology & Obstetrics, Central Hospital Bremen, St. Jürgen-Strasse, Bremen, Germany

    Willibald Schröder

  10. Department of Gynecology & Obstetrics, Giessen University, Rudolph-Buchheim-Strasse 8, Giessen, Germany

    Karsten Muenstedt

  11. Department of Gynecology & Obstetrics, University of Muenchen r.d.I., Ismaninger-Strasse 22, Munich, Germany

    Barbara Schmalfeldt

  12. Department of Gynecology & Obstetrics, Goettingen University, Robert-Koch-Strasse 40, Goettingen, Germany

    Guenter Emons

  13. Department of Gynecology & Obstetrics, Universitätsklinikum Schleswig-Holstein Campus Kiel, Michaelisstrasse 16, Kiel, Germany

    Jacobus Pfisterer

  14. Department of Gynecology & Obstetrics, Magdeburg University, Gerhard-Hauptmann-Strasse 35, Magdeburg, Germany

    Kerstin Wollschlaeger

  15. Department of Gynecology & Obstetrics, St. Vincentius Hospital Karlsruhe, Suedendstrasse 32, Karlsruhe, Germany

    Hans-Gerd Meerpohl

  16. Department of Gynecology & Obstetrics, City Hospital Neunkirchen, Brunnenstrasse 20, Neunkirchen, Germany

    Georg-Peter Breitbach

  17. Department of Gynecology & Obstetrics, Mainz University, Langenbeckstrasse 1, Mainz, Germany

    Berno Tanner

  18. Department of Gynecology & Obstetrics, Berlin University Charite, Augustenburger Platz 1, Berlin, Germany

    Jalid Sehouli (for the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Committee (AGO OC), the AGO Ovarian Cancer Study Group (AGO-OVAR)*)

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  1. Philipp Harter
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  19. Jalid Sehouli
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Correspondence to Philipp Harter.

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Harter, P., Bois, A.d., Hahmann, M. et al. Surgery in Recurrent Ovarian Cancer: The Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR Trial. Ann Surg Oncol 13, 1702–1710 (2006). https://doi.org/10.1245/s10434-006-9058-0

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