Performance of AGO score for secondary cytoreduction in a high-volume U.S. center

Objectives Determine the predictive value of the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) score, and prognostic factors for survival, in patients undergoing secondary cytoreductive surgery (SCS) for recurrent ovarian cancer in a high-volume U.S. center. Methods Medical records of women undergoing SCS between 12/1/1998 and 12/31/2013 were reviewed. Women with no gross residual disease (RD0) at primary surgery, ECOG performance status (PS) ≤ 1 at recurrence, and no ascites on CT at recurrence were classified as AGO score positive. Women with incomplete information to determine the AGO score were excluded. Overall survival (OS) and progression-free survival (PFS) following SCS, respectively, were estimated from multivariable Cox proportional hazards models. Results 192 women met inclusion criteria. Median disease-free interval (DFI) was 1.9 years (IQR, 1.0-3.5). Of the 102 (53.1%) AGO score positive cases, 84.3% (95% CI, 77.3-91.4%) achieved RD0 at SCS. However, 64.4% of AGO score negative cases also reached RD0. Patients with RD0 after SCS survived longer (median OS, 5.4 years) vs. RD ≤ 1 cm (2.4 years) vs. RD > 1 cm (1.3 years) (p < 0.001). Median PFS was also longer in patients with RD0 (1.5 years) vs. RD ≤ 1 cm (0.9 years) vs. RD > 1 cm (1.0 years) (p = 0.001). Among those with RD0 at SCS, AGO score was not associated with survival benefit, however, number of disease sites at recurrence, ECOG PS at recurrence, and DFI were associated with OS and PFS. Conclusions AGO score can identify patients with a high likelihood of complete secondary cytoreduction and improved survival. However, most AGO score negative cases were also completed resected at SCS. Additional refinement of the score is needed to exclude women from SCS.