AIM: This study aims to identify independent risk factors for tumor recurrence and postoperative complications in platinum-resistant ovarian cancer patients undergoing cytoreductive surgery. METHODS: This study retrospectively included 96 patients with platinum-resistant ovarian cancer who underwent cytoreductive surgery between January 2020 and December 2022. Of these, 76 patients were in the recurrence group, and 20 patients were in the non-recurrence group. Among them, 84 patients developed postoperative complications and 12 did not. Recurrence was defined as disease progression evidenced by radiological findings according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, or tumor recurrence confirmed by histopathology. Complications within 30 days were graded using the Clavien–Dindo system (grade ≥II). Collected clinicopathological variables included surgical duration, peritoneal cancer index (PCI), surgical complexity score (SCS), and postoperative cancer antigen 125 (CA125), the latter measured after two cycles of adjuvant chemotherapy to assess recurrence. Variables with p < 0.05 in univariate analysis were included in a multivariate logistic regression model to identify independent risk factors. Receiver operating characteristic (ROC) curve analysis was used to assess the discriminative power of the identified predictors. RESULTS: Recurrence was significantly associated with longer surgical duration, elevated postoperative CA125, increased PCI, fewer chemotherapy cycles, and suboptimal cytoreductive surgery (all p < 0.05). Multivariate analysis identified surgical duration (odds ratio (OR) = 2.076), postoperative CA125 (OR = 1.193), and PCI (OR = 1.247) as independent risk factors for recurrence. Exploratory ROC analysis suggested moderate discriminative ability of the combined factors (area under the curve (AUC): 0.84), although no model validation was performed. Surgical duration, CA125, and PCI each demonstrated moderate predictive values, with AUCs of 0.77, 0.66, and 0.67, respectively. Complications were independently associated with elevated postoperative CA125; however, the complication model demonstrated only modest discriminative ability (AUC = 0.71). These results should be interpreted as exploratory. CONCLUSIONS: Prolonged surgical duration, elevated postoperative CA125 levels, and higher PCI scores were independently associated with recurrence in patients with platinum-resistant ovarian cancer, while elevated postoperative CA125 levels were also associated with postoperative complications. These factors demonstrated moderate discriminative ability and may serve as potential markers for postoperative risk stratification. However, these findings are exploratory in nature and require external validation.
Wang et al. (Tue,) studied this question.