Objectives: To compare positron emission computarized tomography (PET CT) in epithelial recurrent ovarian cancer (ROC) with the validated AGO score to predict the feasibility of secondary cytoreductive surgery (SCS) and to determine predictive factors of complete cytoreductive surgery and survival.
Material and methods: We conducted a retrospective multi centric study in Curie Institute (2 sites) between January 1st, 1998 and February 28th, 2018. We screened all the patients treated for an epithelial ROC. Patients were included if they underwent a PET CT before treatment of the ROC. Three groups of management were distinguished according to their type of management after recurrence. The results of the PET CT were compared with the results of the validated AGO score to predict resecability. An AGO score equal to 3 was considered to support the feasibility of surgery. We created a PET-CT score assessment that rejected surgery if one of the following items was reported:, diffuse carcinomatosis, extra-abdominal lesions, supra-renal lymph nods.
Results: Altogether, 546 patients were treated for an epithelial recurrent ovarian cancer during the study period, among them 216 underwent a PET CT before any treatment. Sixty-five patients underwent SCS: complete cytoreduction was achieved in 58 patients (89.2%) and no case of mortality was reported within 60 days post-surgery. In univariate analysis, the following TEP items were statistically different between the 3 groups: ascitis (0/0/10 p=0, 0005), diffuse carcinomatosis (8/19/102 p=0, 0006), extra abdominal lesion (7/8/82 p=0,0001) and sus-diaphragmatic nodes (4/4/69 p<0,0001). Progression free survival and overall survival was higher in complete cytoreduction group than for the rest of the patient.
Conclusion: This multicenter study is the first to compare PET-CT and AGO score ability for complete resection in epithelial ROC. We found that complete cytoreductive surgery remains the best prognostic factor at recurrence as for initial diagnostic, however patients with AGO score < 3 at recurrence can be operated initially or after "pseudo-neoadjuvant" chemotherapy and reach complete cytoreductive surgery. PET-CT seems to be a more accurate predictor of surgical resection than the AGO score.