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Prognostic Factors for Outcome of and Survival After Second-Look Laparotomy in Patients With Advanced Ovarian Carcinoma

From the Department of Oncology, The Finsen Institute; Department of Internal Medicine C, Bispebjerg Hospital, University Hospitals of Copenhagen, Denmark; and the Department of Probability and Statistics, University of Sheffield, England

Abstract

In ovarian cancer stages IIB& IV, pre& treatment variables and variables obtained intraoperatively at second-look laparotomy were investigated for their prognostic influence on the outcome of 109 patients and survival after second-look laparotomy in 131 patients. The subjects came from a randomized trial of sequential versus alternating combination chemotherapy. The overall median survival after secondlook laparotomy was 62 months. Logistic regression analysis identified stage and hysterectomy plus bilateral salpingooophorectomy and omentectomy as significant prognostic covariates for second-look laparotomy outcome. Based on a Cox multivariate stepwise analysis, independent prognostic factors for survival after second-look laparotomy were secondary residual tumor size, pre& treatment histologic differentiation grade, and performance status. A high differentiation grade and a good performance status at the start of therapy thus still had a prolonging effect on survival after second-look laparotomy. The prognostic power of these pre-treatment variables was increased substantially by the addition of the secondary residual tumor size variable. The 3& year survival rate after second-look laparotomy for high and low& risk patients was 15 and 87% respectively. Second& look laparotomy thus provides prognostic information in patients with advanced ovarian carcinoma, but the benefit in terms of survival is still unclear.