Minimal residual tumor and longer progression-free

interval were reported to indicate improving survival outcomes Akt inhibitor in most studies [5, 8, 30, 31]. On the other hand, some studies found residual tumor and progression-free interval had no impact of on prognosis in recurrent EOC underwent secondary CRS [4, 6, 7, 28, 32]. Our previous study found that CA-125 indicated asymptomatic recurrent cases will benefit from optimal secondary CRS [12]. Zang et al. emphasized the number of recurrent tumors. They stated those patients with solitary lesions, no ascites at recurrence, achieved initial optimal surgical outcomes and survival benefit more easily for secondary CRS and further confirmed it in a large population more than one thousand cases [20, 21, 33]. Berek et al. reported that recurrent tumor size had an impact on survival while Park et al. denied the relationship between the size of the recurrent tumor and survival outcomes [5, 29]. In our series, three major prognostic CYT387 factors affected survival after secondary CRS: optimal resection after initial CRS, asymptomatic recurrent status and longer PFS duration after primary treatment. Morbidity and mortality rates during perioperative period are also important issues when secondary CRS is considered in the management of recurrent ovarian cancer. Postoperative morbidity rates reported to be ranged from 5% to 35% in different trials [5, 23, 26, 34]. In general,

secondary CRS was considered to be a safe procedure in the management of recurrent EOC [5, 35, 36]. There was no operation related deaths in our series. There are limitations to the present study. Firstly, unavoidable VX-680 order selection biases inherent to its retrospective design. CRS status, chemotherapy regimens and some additional salvage therapy Hormones antagonist may have reflected certain selected factors that may influence prognosis, though we eliminate the influence of consolidation or maintenance treatment by inclusion criteria. Secondly, given the long

time follow up and the heterogeneity of therapy strategies used throughout the 23 years study period, including the emergence of new regimens such as paclitaxel based chemotherapy and targeted therapy and so on, it was impossible to unify the therapy strategy. Thirdly, the absence of unified recruited standard for secondary CRS and limited sample size were factors may also cause selection bias. Last but not nest, populations underwent secondary CRS was relatively young and healthy with a good performance status, and a high likelihood of endure postoperative chemotherapy. It cannot be translated to all recurrent EOCs until further studies with broader inclusion criteria are available. Evaluating patients from China with validation set from America may help to lessen this unfavorable effect. In summary, in this study including patients from two centers with same recruited standard, we found that secondary CRS has survival benefit to selected patients.