Metastatic sites and surgical management in stage IV ovarian cancer: Is there a place for debulking surgery in FIGO stage IVB patients? A retrospective study from the ESME national cohort

To evaluate the surgical management and oncologic outcomes of patients with FIGO stage IV ovarian cancer, using data from the French national ESME cohort. This retrospective multicenter study included patients diagnosed with FIGO stage IV ovarian cancer between January 2011 and December 2016, treated in 18 French Comprehensive Cancer Centers participating in the ESME-OVR program. Clinical characteristics, treatment strategies, metastatic site patterns, and survival outcomes (overall survival [OS], progression-free survival [PFS]) were analyzed and compared between FIGO IVA and IVB stages. A total of 159 patients were identified, of whom 107 (67.3 ​%) had FIGO stage IVB disease. Regardless of metastatic stage, surgical strategies and were comparable. Complete debulking surgery was achieved in 75 ​% of cases. Most of FIGO stage IVB patients (88.8 ​%) presented a single metastatic site including extra-abdominal lymph nodes (50.5 ​%), liver (20.6 ​%), and lungs (10.3 ​%); 15.9 ​% of patient with distant metastases underwent local treatment and predominantly targeted nodal disease. Complete debulking surgery was significantly associated with improved OS and PFS (p ​= ​0.002 and p ​< ​0.001, respectively), while local treatment of metastases did not provide survival benefit. The number of metastatic sites did not significantly influence prognosis. Complete debulking surgery is the critical factor from a progronostic point of view, whether in FIGO stage IVA or IVB. Feasibility of local treatment for distant metastases is observed, its impact on oncologic outcomes remains unclear and we need further prospective investigation. Surgical strategies should be integrated into a personalized approach to optimize management in advanced-stage disease.