Prognostic value of radiological recurrence patterns in ovarian cancer

Objective: To study the prognostic value of CT assessed recurrence patterns on survival outcomes in women with epithelial ovarian cancer. Methods: CT scans were systematically re-evaluated on predefined anatomical sites for the presence of tumor in all 89 patients diagnosed with epithelial ovarian cancer between January 2008 and December 2013 who underwent cytoreductive surgery at our institution and developed a recurrence. A Cox proportional hazard analysis was used to test the effect of recurrence patterns on survival. Results: The median survival time for patients grouped as predominantly intraperitoneal (n = 62), hematogenous (n = 13) or lymphatic (n = 14) recurrence was 25.8 (95% CI 18.4–33.2), 27.6 (95% CI 18.5–36.6) and 52.9 months (95% CI 42.1–63.7), respectively. Univariate Cox regression analysis identified the following prognostic factors: lymphatic recurrence pattern (HR 0.42, 95% CI 0.21–0.85), ascites at diagnosis (HR 2.35, 95% CI 1.46–3.79), residual tumor at initial surgery (HR 2.16, 95% CI 1.36–3.44) and FIGO stage (I–IIIB: HR 0.59, 95% CI 0.33–1.06). The median time to recurrence was 19.5 month for patients after complete debulking surgery, 13.1 months for patients with residual disease ≤1 cm and 8.2 months for patients with residual disease >1 cm after surgery (P < 0.001). No differences in recurrence patterns between patients with complete and incomplete surgery were found. Conclusions: Prolonged survival rates were found in ovarian cancer patients with a predominantly lymphatic recurrence compared to patients with a predominantly peritoneal or hematogenous recurrence. Completeness of surgery was associated with time to recurrence. Classification of recurrence patterns can help counsel patients on their prognosis at the time of recurrence.