| Objective: Epithelial ovarian cancer (EOC) is the most lethal gynecologic cancer among women. Approximately 60% to 70% of epithelial ovarian cancers are diagnosed at an advanced stage. Current management for advanced.EOC is cytoreductive surgery followed by combination chemotherapy, usually a platinum-based (mostly carboplatin plus paclitaxel) regimen.Epidemiologic analysis reveals that mortality rates from ovarian cancer are continuously decreasing due to the improvement of surgery and chemotherapy. Overall response rates are high, ranging from 70–80%; Despite this progress in primary treatment of EOC in the past decade, most patients will relapse, highlighting the need for effective and well-tolerated regimens for recurrent disease. The main goals of second-line treatments are to control symptoms and maintain quality of life, and if possible, to prolong the disease-free interval (DFI) and improve overall survival (OS). This study aims to identify the influential factor 0f DFI in patients with recurrent epithelial ovarian carcinoma and examine the impact of secondary cytoreductive surgery on survival for patients with recurrent / resistant epithelial ovarian carcinoma.Methods: patients who were diagnosed as recurrent or resistant epithelial ovarian cancer between June 2004 and April 2007 were identified retrospectively from tumor registry databases. This study involves 33 patients with recurrent or resistant epithelial ovarian cancer.The influential factors on DFI were evaluated individually (univariate) by Mann-Whitney U rank sum test under the help of SPSS 13.0 for windows. Among the 33 patients,9 lost in the follow-up visit.Others were divided into 2 sets according to whether the secondary cytoreductive surgery was attainted . Survivals of the 2 groups were calculated using the Kaplan–Meier method and the log-rank test was used for testing differences in survival among patient groups.The estimated 1,2,3-year survival rates of the 2 sets were evaluated using the Fisher exact tests. Differences were considered to be statistically significant when P values were<0.05.Results: This study involves 33 patients . All patients received platinum-based chemotherapy following primary surgery. The median age at time of primary surgery for ovarian cancer was 53 years.The median time from completion of primary chemotherapy to recurrence was 10 months,ranging from 1 to 72 months. In the follow-up visit,9 patients lost, to date,10 survival,14 patients died. The relation between the overall survival time and DFI is shown by the scatter plot in figure 1. It shows that the overall survival of people with recurrent or resistant epithelial ovarian cancer is directly proportional to the time between completion of first-line chemotherapy and the confirmation of recurrent disease(disease-free interval, DFI),r =0.765,p<0.05. The age, Stage of disease and the number of prior platin combinations Chemotherapy were significantly different among patients with different DFIs. There were no significant differences in histologic type and gradzing(Table 1).24 patients up to visit were divided into 2 sets according to whether the secondary cytoreductive surgery(SCR) was attainted except the one who accepted SCR but refused the following up Chemotherapy. 11 patients after primary treatment underwent secondary cytoreductive surgery ,13 were treated with combined Chemotherapy without SCR. Estimated survival after secondary surgery of the 2 groups are showed by Kaplan Meier curve in fig. 2. Using the Fisher exact tests, the estimated 1,2-year survival rates have statistics significance(p<0.05),but the 3-years survival rates have no significant differences(p>0.05).Conclusion:1.The overall survival time after relapse is related to the disease-free intercal(DFI)of Epithelial ovarian cancer after initial treatment-free survival .The overall survival time will be longer if DFI is longer. 2.Epithelial ovarian cancer patients untreated age, clinical stage, the chemotherapy after initial cytoreductive surgery are associated with DFI, younger patients, clinical stage earlier, after the regular full course of chemotherapy, the DFI will be longer, the differences between pathological types need to be confirmed by further large-scale clinical studies3.In selected patients, secondary cytoreductive surgerty before initiation of chemotherapy may have some role in survival benefit for patients with recurrent or resistant epithelial ovarian cancer.
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