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

¹ Department of Gynecology & Gynecologic Oncology, HSK, Dr. Horst Schmidt Klinik Wiesbaden, Ludwig-Erhard-Strasse 100, Wiesbaden, D-65199, Germany
² Coordinating Center for Clinical Trials, Marburg University, Robert-Koch-Strasse 5, Marburg, Germany
³ Department of Gynecology & Obstetrics, Freiburg University, Hugstetter Strasse 49, Freiburg, Germany
⁴ Department of Gynecology & Obstetrics, University of Muenchen - Grosshadern, Marchioninistr. 15, Munich, Germany
⁵ Department of Gynecology & Obstetrics, Frankfurt University, Theodor-Stern-Kai 7, Frankfurt, Germany
⁶ Department of Gynecology & Obstetrics, EVK Duesseldorf, Kirchfeldstrasse 40, Duesseldorf, Germany
⁷ Department of Gynecology & Obstetrics, Tuebingen University, Calwerstrasse 7, Tuebingen, Germany
⁸ Department of Gynecology & Obstetrics, Zuerich University, Raemistrasse 100, Zuerich, Switzerland
⁹ Department of Gynecology & Obstetrics, Central Hospital Bremen, St. Jürgen-Strasse, Bremen, Germany
¹⁰ Department of Gynecology & Obstetrics, Giessen University, Rudolph-Buchheim-Strasse 8, Giessen, Germany
¹¹ Department of Gynecology & Obstetrics, University of Muenchen r.d.I., Ismaninger-Strasse 22, Munich, Germany
¹² Department of Gynecology & Obstetrics, Goettingen University, Robert-Koch-Strasse 40, Goettingen, Germany
¹³ Department of Gynecology & Obstetrics, Universitä tsklinikum Schleswig-Holstein Campus Kiel, Michaelisstrasse 16, Kiel Germany
¹⁴ Department of Gynecology & Obstetrics, Magdeburg University, Gerhard-Hauptmann-Strasse 35, Magdeburg, Germany
¹⁵ Department of Gynecology & Obstetrics, St. Vincentius Hospital Karlsruhe, Suedendstrasse 32, Karlsruhe, Germany
¹⁶ Department of Gynecology & Obstetrics, City Hospital Neunkirchen, Brunnenstrasse 20, Neunkirchen, Germany
¹⁷ Department of Gynecology & Obstetrics, Mainz University, Langenbeckstrasse 1, Mainz, Germany
¹⁸ Department of Gynecology & Obstetrics, Berlin University Charite, Augustenburger Platz 1, Berlin, Germany

Correspondence: Address correspondence and reprint requests to: Philipp Harter; E-mail: p.harter{at}gmx.de

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.

Key Words: Ovarian cancer • Ovarian neoplasm • Recurrence • Secondary cytoreductive surgery

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