Pattern of ovarian cancer recurrence and survival: final analysis of an extended cohort of 591 patients

Summary This study reports the results of the extended final analysis of the pattern of recurrence and factors influencing survival in 591 consecutive patients with recurrent primary ovarian cancer. Recurrence was arbitrarily defined as the first clinical manifestation of tumor progression by detecting a new lesion or new lesions after clinical remission following primary surgery ± chemotherapy. It was also defined as an increase in size of at least 30% of a residual lesion after primary surgery and chemotherapy. Recurrences were diagnosed primarily during the first 3 years after diagnosis; only 10% of recurrences were diagnosed beyond 5 years. The majority of first recurrences were located in the peritoneal cavity, the pelvis, the liver parenchyma, and the paraaortic region. Combinations of different locations of first recurrence were common. The median cancer antigen (CA) 125 value at first recurrence was 163 U/ml (range 7–14,187). In multivariate Cox regression analysis, isolated metastases in the paraaortic nodes, isolated extraabdominal metastases in the peripheral lymph nodes of the inguinal or supraclavicular region, macroscopic complete resection at primary cytoreductive surgery, and serous histology were independently associated with significantly improved survival after recurrence. In the present study, only a minority of these patients underwent surgery for recurrence. Thus, the better prognosis of patients with isolated lymph node metastases may only in part be explained by secondary cytoreductive surgery. The majority of patients with isolated nodal metastases underwent radiotherapy plus chemotherapy.