Prognostic impact of debulking surgery and residual tumor in patients with epithelial ovarian cancer FIGO stage IV

FIGO stage IV epithelial ovarian, fallopian tube and peritoneal cancer revisited

“…Complete resection gathered a 30 months median OS gain in patients with stage FIGO IV disease [44]. Further studies evaluating stage IV patients showed a significant superior OS after "optimal" (b 1 cm) or after complete resection (Table 3) [5,8,9,48,52,57,58]. Median OS rates for patients after PDS with complete tumor resection range between 50-72 months compared to patients with gross residual disease (N 1 cm) experiencing only 16-24 months.…”

“…Median OS rates for patients after PDS with complete tumor resection range between 50-72 months compared to patients with gross residual disease (N 1 cm) experiencing only 16-24 months. An improvement of complete resection rates by use of extensive upper abdominal surgical procedures and structured quality management program could be demonstrated in stage IV EOC patients [5,59,60]. Investigators reported a significant improvement of survival rates in stage IV patients by improving their complete resection rates by over 20% (observation period 2000-2005 versus 2010-2014: 38% versus 62%) [5].…”

“…Despite a significant increase of overall survival (OS) over the last decades as reported in the FIGO Annual Report in stage III and earlier disease, survival for stage IV patients did not grossly change, still remaining below a rate of 20% 5-year-OS [4]. This underscores the urgent clinical need for improved therapy strategies for the 12-33% of patients initially diagnosed with stage IV disease [4,5].…”

“…Survival of FIGO IV patients highly depends on the residual tumor burden and the response to chemotherapy and, therefore, 5-year-survival rates vary between 8% and 39% for suboptimally and optimally debulked patients, respectively [5,6].…”

“…The most common sites of extra-peritoneal disease qualifying for stage FIGO IV are malignant pleural effusion in 33-53%, liver in 14-26%, subcutaneous/abdominal wall in 10-41%, and extra-abdominal lymph nodes in 5-44% [5][6][7][8][9]; brain metastases (0.3-2.2% [10]) and bone involvement (b2% [11,12],) are uncommon (Table 1).…”