The Role of Secondary Cytoreductive Surgery in Primary Platinum-sensitive Recurrent HGSOC Patients With Different BRCA1/2 Mutation Status: a Retrospective Study

Abstract Background: The value of secondary cytoreductive surgery (SCS) for platinum-sensitive recurrent high grade serous ovarian cancer (HGSOC) patients and the effect s of BRCA1/2 mutation status on the value of surgery are inconclusive. Methods: A retrospective analysis was conducted in HGSOC patients with primary platinum-sensitive recurrence who were admitted to the Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University and Shanghai General Hospital from January 2015 to August 2019. The DESKTOP Trial Score was used to assess whether patients could be included in the study. Relevant medical records were collected, including age at diagnosed, FIGO stage, germline BRCA1/2 mutations status, platinum-free interphase (PFI), recurrence characteristics, progression-free survival (PFS) and overall survival (OS). Results: A total of 195 HGSOC patients were included in the study, including 80 (41.0%) patients with BRCA1/2 germline mutation (BRCAmut) and 115 (59.0%) patients with germline BRCA1/2 wild-type (BRCAwt). SCS improved FPS in patients undergoing secondary cytoreductive surgery, regardless of BRCA1/2 mutation status (BRCAmut, median PFS, 16.3 vs 12.9 months, p = 0.003; BRCAwt, median PFS, 15.3 vs 11.0 months, p = 0.001). There was a significant survival benefit in BRCAwt patients undergoing SCS (median OS, 70.6 vs 52.5 months, p = 0.021), however, compared with chemotherapy alone, SCS in BRCAmut patients did not improve overall survival (median OS, 77.5 vs 76.8 months, p = 0.827). Conclusions: SCS is recommended for platinum-sensitive recurrent HGSOC patients with BRCAwt. BRCA1/2 genetic test for all HGSOC patients is necessary to specify appropriate post-recurrence treatment strategies.