Treatment and survival for women with Fallopian tube carcinoma: a population-based study

OBJECTIVE: The objective of this study was to evaluate treatment and survival for women with fallopian tube carcinoma in a population-based data set. METHODS: Using the National Cancer Institute's Surveillance, Epidemiology, and End Results program, we identified 416 women with fallopian tube carcinoma diagnosed between 1990 and 1997. We analyzed treatment and 5-year relative survival. We also compared survival to that of 9032 women with epithelial ovarian cancer diagnosed between 1991 and 1997. RESULTS: Almost half of those diagnosed with stage I/II disease did not undergo surgical evaluation of lymph nodes. Most women with stage I/II disease were treated with surgery alone, while most women with stage III/IV disease were treated with surgery and chemotherapy. Five-year relative survival by FIGO stage was as follows: stage I (N = 102), 95%; stage II (N = 29), 75%; stage III (N = 52), 69%; stage IV (N = 151), 45%. CONCLUSIONS: We observed better survival, stage by stage, for women with fallopian tube carcinoma than for women with epithelial ovarian cancer in this population-based data set. It is possible that some patients with advanced, bulky carcinoma arising in the fallopian tube may have been classified as having ovarian or primary peritoneal cancer. Women with fallopian tube cancer should be treated in accordance with the same guidelines for surgical staging, debulking, and adjuvant chemotherapy as for women with epithelial ovarian cancer. Further studies, both laboratory and clinical, are needed to delineate the differences between fallopian and ovarian cancers.     

Effectiveness of platinum-based chemotherapy among elderly patients with advanced ovarian cancer

BACKGROUND: Platinum-based chemotherapy is the standard of care for women with advanced ovarian cancer based on the results of randomized trials. We previously showed that only about half of women over the age of 65 years with this disease received platinum-based chemotherapy, and that the likelihood of receiving it decreases with age. METHODS: We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify women diagnosed from 1/1/92 to 12/31/96 with stage III or IV ovarian cancer who survived > or =120 days beyond diagnosis, and were > or =65 years of age. Cox proportional hazards models and propensity scores were used to control for known predictors of receiving treatment and to estimate the relative effectiveness of different platinum-based regimens. RESULTS: Of the 1759 patients in the sample who met our eligibility criteria, 53% received platinum-based therapy. For this sample, the Cox proportional hazard ratio was 0.72 (95% CI, 0.62-0.91) for mortality associated with the use of any platinum-based therapy, and 0.59 (95% CI, 0.45-0.76) for combination platinum/paclitaxel therapy. Similar results were obtained using propensity score modeling. CONCLUSIONS: In this population-based study, we found that only about half of women with advanced ovarian cancer over age 65 were treated with platinum-based chemotherapy; however, survival improved by 38% in treated women, similar to the benefits described in randomized controlled trials among younger patients, and were greatest when platinum was combined with paclitaxel. An effort to increase the utilization of platinum combination therapy among older patients with advanced ovarian cancer is justified.     

Patterns of care,predictors, and outcomes of chemotherapy in elderly women with early-stage uterine carcinosarcoma: A population-based analysis

Objective

To examine the patterns of care, predictors, and impact of chemotherapy on survival in elderly women diagnosed with early-stage uterine carcinosarcoma.

Methods

The Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used to identify women 65 years or older diagnosed with stage I–II uterine carcinosarcomas from 1991 through 2007. Multivariable logistic regression and Cox-proportional hazards models were used for statistical analysis.

Results

A total of 462 women met the eligibility criteria; 374 had stage I, and 88 had stage II uterine carcinosarcomas. There were no appreciable differences over time in the percentages of women administered chemotherapy for early stage uterine carcinosarcoma (14.7% in 1991–1995, 14.9% in 1996–2000, and 17.9% in 2001–2007, P = 0.67). On multivariable analysis, the factors positively associated with receipt of chemotherapy were younger age at diagnosis, higher disease stage, residence in the eastern part of the United States, and lack of administration of external beam radiation (P < 0.05). In the adjusted Cox-proportional hazards regression models, administration of three or more cycles of chemotherapy did not reduce the risk of death in stage I patients (HR: 1.45, 95% CI: 0.83–2.39) but was associated with non-significant decreased mortality in stage II patients (HR: 0.83, 95% CI: 0.32–1.95).

Conclusions

Approximately 15–18% of elderly patients diagnosed with early-stage uterine carcinosarcoma were treated with chemotherapy. This trend remained stable over time, and chemotherapy was not associated with any significant survival benefit in this patient population.     

Specialist gynaecologists and survival outcome in ovarian cancer: a Scottish national study of 1866 patients.

OBJECTIVE: To determine whether specialist gynaecological surgeons improved survival in women with ovarian cancer when compared with general gynaecologists. DESIGN: Retrospective case note review. POPULATION: All women diagnosed with ovarian cancer in Scotland in 1987, 1992, 1993 and 1994. METHODS: Data on prognostic factors and surgical and post-operative management was extracted from case notes. Surgeons were classified as specialist gynaecologists, general gynaecologists or general surgeons by an independent committee with no knowledge of an individual's outcome. Cox's proportional hazards model was used to determine the relative risk of a patient dying, if managed by specialist and general gynaecologists, after adjustment for age, histology, tumour differentiation, presence of ascites and socio-economic status. Analysis was performed separately for each FIGO stage. MAIN OUTCOME MEASURES: Relative hazard ratios for survival up to three years. RESULTS: Survival benefit for specialists varied according to the stage of the disease. The greatest benefit was observed among women with Stage III disease (44% of women presented at this stage) where there was a 25% (relative hazard ratio = 0.75, P = 0.005) reduction in the rate of dying for women operated on by specialist gynaecologists, compared with women operated on by general gynaecologists. Differential use of platinum chemotherapy did not explain this survival advantage. Specialist gynaecologists more often debulked tumour to < 2 cm than general gynaecologists in Stage III cases (36.3% vs 28.7%, P = 0.07). In women with Stage III carcinoma with > 2 cm remaining, survival was significantly improved for women treated by specialist gynaecologists (relative hazard ratio = 0.71, P = 0.007). No significant differences were observed for patients with Stages I, II and IV disease, although there were fewer deaths in women with early stage disease. CONCLUSIONS: Specialist gynaecologists improve survival for some women with ovarian cancer.     

Consolidation radiotherapy after carboplatin-based chemotherapy in radically operated advanced ovarian cancer

OBJECTIVE: The aim of the study was to evaluate the effect of additional radiotherapy after chemotherapy on the relapse-free and overall survival rates of patients with advanced ovarian cancer. METHODS: Between 1985 and 1992 64 patients with radically operated ovarian cancers (4 stage IC, 2 stage II, 54 stage III, and 4 stage IV) were enrolled in a randomized study. Radical surgery comprised total abdominal hysterectomy and bilateral salpingo-oophorectomy, omentectomy, and pelvic and paraaortic lymphadenectomy. All patients received adjuvant chemotherapy with carboplatin IV 400 mg/m2, epirubicin IV 70 mg/m2 on day 1 and prednimustine orally 100 mg/m2 on days 3 to 7 at 1-month intervals. Thirty-two patients without residual disease were randomized to whole abdominal radiation (30 Gy, administered over 4 weeks). An additional 21.6 Gy were delivered to the pelvis and 12 Gy to the paraaortic region up to the diaphragm for total doses of 51.6 and 42 Gy, respectively. Cancer-related survival was calculated with the Kaplan-Meier and Cox proportional hazards methods. RESULTS: The relapse-free and overall survival rates of patients who received adjuvant chemoradiotherapy were significantly higher than those of patients who received adjuvant chemotherapy only (68% vs 56% at 2 years and 49% vs 26% at 5 years, P = 0.013, and 87% vs 61% at 2 years and 59% vs 33% at 5 years, P = 0.029). The differences were most pronounced in patients with stage III disease (77% vs 54% at 2 years and 45% vs 19% at 5 years, P = 0. 0061, and 88% vs 58% at 2 years and 59% vs 26% at 5 years, P = 0. 012). Toxicities were acceptable. CONCLUSION: Sequential combination of platinum-based chemotherapy with open-field abdominal radiotherapy is a promising adjuvant regimen for patients with advanced ovarian cancer.     

Outcomes for systemic therapy in women with ovarian cancer

OBJECTIVES: To describe the association of systemic therapy delivery with overall survival for ovarian cancer. METHODS: This population-based cohort study included all newly diagnosed ovarian cancer patients treated from 1996 to 2002 in Ontario, Canada. Hospitalization and surgical billing databases were used. Multivariate analysis was used to evaluate the importance of hospital volume of first-line chemotherapy for ovarian cancer, hospital type, prescribing physician volume and that physician's specialty on overall survival. RESULTS: There were 2502 women who received systemic therapy as part of their management. The three management strategies were surgery followed by chemotherapy (64.9%), chemotherapy followed by interval surgery (14.4%) and chemotherapy alone (20.6%). There has been a shift over time to chemotherapy followed by interval surgery from 5.5% in 1996 to 26% in 2001. Rates for surgery followed by chemotherapy have remained constant. Of those treated with first line chemotherapy, approximately 66.25% of women receive combination chemotherapy and 20% of patients receive single agent platinum. When potential confounders were taken into account (age, comorbidity, and metastatic versus nonmetastatic disease) factors involved in the delivery of systemic therapy were not associated with survival. Survival was improved for those that are younger, with no comorbidities, no metastasis and surgery followed by chemotherapy. CONCLUSION: In Ontario, multimodality therapy with surgery followed by chemotherapy is associated with improved survival.     

Body weight and composition changes in ovarian cancer patients during adjuvant chemotherapy

OBJECTIVE: To prospectively examine body weight changes in women with newly diagnosed ovarian cancer receiving surgery and adjuvant chemotherapy. Body composition was examined in a subset of these women. METHODS: Body weight (BW) and body composition, using bioelectrical impedance (RJL Systems Inc.), were prospectively measured pre- and post-operatively, and at 3, 6, and 12 months. RESULTS: Mean age of 42 women was 59 years and did not differ by stage of disease. Nine women with early stage disease did not receive adjuvant chemotherapy. Mean BW of 33 patients receiving chemotherapy decreased from the pre- to post-operative visit and then returned to baseline levels by 12 months (F = 8.70, P = 0.003). Nine patients who did not receive chemotherapy demonstrated a similar pattern (F = 7.0, P = 0.002). Women receiving chemotherapy with stage I/II cancer had a 2.8 +/- 2.0 kg weight gain over the year, and women with stage III/IV cancer had a 1.5 +/- 1.5 kg weight loss (t = 1.72, P = 0.096). A subset of women with stage I/II (n = 6) and stage III/IV (n = 6) ovarian cancer receiving chemotherapy had body composition measured at three time points. Absolute body fat changes paralleled changes in BW (F = 9.95, P = 0.002). CONCLUSIONS: Our study is the first prospective evaluation of body weight and composition in women undergoing surgery and chemotherapy for ovarian cancer. These results demonstrate that women undergoing surgery for ovarian cancer lost weight following surgery and regained it slowly over the following year. Further investigations of weight changes during adjuvant chemotherapy are indicated to assess potential changes in different stages of disease.     

Long-term survival and patterns of care in women with ovarian tumors of low malignant potential

OBJECTIVES: The objectives of this study were to ascertain long-term survival and patterns of care among women diagnosed with ovarian tumors of low malignant potential (LMP) in a population-based data set. METHODS: Using the NCI's Surveillance, Epidemiology, and End Results (SEER) database, we identified 2818 women diagnosed with ovarian tumors of low malignant potential between 1988 and 1997. RESULTS: By FIGO stage, 10-year relative survival was as follows: stage I, 99%; stage II, 98%; stage III, 96%; and stage IV 77%. One-quarter of women with stage I disease underwent partial or unilateral oophorectomy only, while women with more advanced disease commonly underwent omentectomy, unilateral or bilateral oophorectomy, and hysterectomy. Adjuvant chemotherapy was given to about 30% of women with stage III and IV disease. Radiation therapy was rarely used. We observed no significant changes in primary surgery or adjuvant treatment over time. CONCLUSIONS: The diagnosis of an ovarian tumor of LMP conveys a relatively benign prognosis. Conservative surgery should be considered in younger women with early-stage disease. There are insufficient data to support a role for adjuvant chemotherapy for women with advanced disease.     

Impact of maintenance chemotherapy on disease-free survival in patients with stage Ic and II epithelial ovarian cancer

PURPOSE OF INVESTIGATION: To evaluate the impact on disease free survival (DFS) with maintenance chemotherapy following complete surgery and adjuvant chemotherapy in patients with stage Ic and II epithelial ovarian cancer by a retrospective study. METHODS: One hundred and forty patients with stage Ic and stage II epithelial ovarian cancer were classified into three groups according to the modality of maintenance chemotherapy (no therapy, oral or intravenous administration of anti-cancer drugs). DFS was compared among the three groups, and independent predictive factors for relapse were analyzed. RESULTS: There were no statistically significant differences in DFS among the three groups for either stage Ic or II cancers, stage Ic and stage II. Multivariate analysis revealed that independent predictive factors for relapse were stage II (p = 0.004) in all patients and less than three cycles of adjuvant chemotherapy in stage II patients (p = 0.015). CONCLUSION: Maintenance chemotherapy had no impact on DFS in patients with stage Ic or II epithelial ovarian cancer.     

Clinical features and outcomes of uterine and ovarian carcinosarcoma

BACKGROUND: The objective of this study was to compare the clinical presentation and outcomes of women with ovarian and uterine carcinosarcoma (CS). METHODS: We performed a retrospective review of patients treated for uterine or ovarian CS from 1952 to 2003. Fisher's Exact Test was used to compare patient characteristics. Survival curves were estimated using the Kaplan-Meier method and compared using the log rank test. RESULTS: We identified 87 patients with uterine CS and 18 with ovarian CS. There was no difference in age, body mass index, parity, menopausal status, family history of cancer, history of pelvic radiation, diabetes or hypertension between the two groups. 43% of women with uterine CS presented at stage I/II, compared to 28% of women with ovarian tumors (P = 0.0003). 82% of patients with ovarian tumors received adjuvant chemotherapy with or without radiation; 51% of the patients in the uterine CS group received adjuvant radiation therapy. The median length of follow-up was 13 months. There was no difference in the Kaplan-Meier estimates of overall survival between the two disease sites. The median survival for uterine CS patients was 16 months, compared to 11 months in the ovarian CS group; HR = 0.991 (95% CI = 0.534, 1.839). CONCLUSIONS: We found no differences in patient demographics between the two groups. Despite differences in stage and initial treatment, there was no difference in survival between women with uterine and ovarian CS.     

The role of pelvic and aortic lymphadenectomy at second look surgery in apparent early stage ovarian cancer after inadequate surgical staging followed by adjuvant chemotherapy

Background

Systematic aortic and pelvic lymphadenectomy (SAPL) is a milestone procedure in the treatment of early stage ovarian cancer. It defines staging and prognosis and helps in tailoring adjuvant chemotherapy. Only limited data are available about SAPL at second look surgery in patients with apparent early stage ovarian cancer who underwent inadequate surgical staging and adjuvant platinum based chemotherapy.

Methods

From January 1991 through January 2013, 66 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA–IIA epithelial ovarian carcinoma suboptimally surgically staged and treated with adjuvant chemotherapy, were referred to our center and underwent second look surgery including SAPL.

Results

Twenty-two women underwent bilateral and 44 unilateral SAPL. A total of 2168 nodes were removed and analyzed. The median number of lymph nodes dissected was 29 (range 14–73); in particular it was 29 (range 14–60) in case of unilateral and 37 (range 17–73) in case of bilateral SAPL. Only one woman had nodal metastasis (1.5%). After a median follow-up of 78 months, 10 women (15.2%) relapsed and 5 (7.6%) died of progressive disease. The 5-year disease-free survival and overall survival are 91.7% and 96%.

Conclusion

The risk of nodal metastases in stage I–IIA unstaged ovarian cancer after adjuvant chemotherapy is negligible. Our study suggests that SAPL at second look is not indicated in this subset of women.     

Ovarian immature teratoma: Treatment and outcome in a single institutional cohort

Objective

The aim of this study was to evaluate clinicopathologic characteristics, treatment outcome and reproductive function in women diagnosed with ovarian immature teratoma.

Methods

Thirty-four women with ovarian immature teratoma stages IA to IIIA were identified and included in this study. Patients were treated at one institution; Princess Margaret Hospital, Toronto, Canada between 1970 and 2005.

Results

The median age at diagnosis was 25.0 years (range: 9.8–60.2 years). Twenty seven (79%) presented with stage IA disease, 5 (15%) with stage IC, 1 (3%) with stage 2B, and 1 (3%) with stage IIIA disease. Thirteen (38%) of the tumors were found to be grade 1, 12 (35%) grade 2, and 9 (27%) grade 3. Initial management was surgical for all patients: 22 (65%) unilateral oophorectomy, 7 (20%) cystectomy only, and 5 (15%) bilateral oophorectomy (4 with hysterectomy). Fourteen (41.8%) patients received adjuvant therapy. The median follow up was 4.8 years (range 0.2–24.3 years). Four patients recurred (histological grade 2 or 3) within 22 months (87.1% 2-year progression free survival). Only one clinical stage I patient who received adjuvant chemotherapy developed a recurrence. Three of the patients who recurred died from their disease.Eleven patients reported an attempt to conceive resulting in 11 pregnancies in 6 women (3 post chemotherapy).

Conclusion

The majority of patients diagnosed with an immature teratoma are cured of their disease. However, grade 2 or 3 tumors are associated with a greater chance of recurrence that can be fatal, predominantly within 2 years of diagnosis.     

Ⅳ期卵巢上皮性癌的治疗及预后影响因素

目的　评价肿瘤细胞减灭术及化学治疗对Ⅳ期卵巢上皮性癌生存的影响。方法　复习 1982年 1月至 1997年 12月间收治的Ⅳ期卵巢上皮性癌患者 2 5例的临床资料 ,生命统计采用KaplanMeier法及t检验 ,利用COX风险比例回归模型来判断其独立的预后影响因素并进行分析。结果　 2 5例患者的中位年龄为 5 1岁 (33～ 72岁 )。其中 12例 (48% )为浆液性乳头状囊腺癌 ;组织学分级为C3 者 13例 (5 2 % ) ;7例 (2 8% )有锁骨上淋巴结转移 ,6例 (2 4% )有肝转移 ,4例 (16 % )有恶性胸水。所有患者均接受了肿瘤细胞减灭术 ,其中 9例 (36 % )为理想的肿瘤细胞减灭术。 2 5例患者的中位生存时间为 15 .0个月 ,其中理想的肿瘤细胞减灭的中位生存时间为 2 8.4个月 ,而不理想者仅为14.7个月 (P <0 .0 1) ;术后化学治疗达到 6个疗程者的中位生存时间为 2 8.5个月 ,而不足 6个疗程者仅为 6 .5个月 (P <0 .0 1)。通过多因素分析发现 ,理想的肿瘤细胞减灭术和化学治疗疗程数是独立的预后影响因素。结论　在不影响生活质量的前提下 ,理想的肿瘤细胞减灭术及术后积极的化学治疗可以改善Ⅳ期卵巢上皮性癌的预后。     

Compliance to clinical guidelines for early-stage epithelial ovarian cancer in relation to patient outcome

OBJECTIVES: To assess compliance to current surgical staging and adjuvant treatment guidelines for patients with early-stage epithelial ovarian carcinoma and its impact on overall survival. METHODS: Patients diagnosed between 1991 and 1997 with early-stage ovarian cancer were recruited from the Regional Cancer Registry of the central region in the Netherlands. Demographic data, tumour characteristics, surgical findings and therapeutic data were abstracted from medical records. Patients were classified into optimal and non-optimal surgical staging. Overall survival was estimated using Kaplan-Meier method. To adjust for age hazard ratios for overall survival were estimated with a Cox Proportional Hazards model. RESULTS: One hundred and twenty-five patients were included in the study, 41 of them (32.8%) were optimally staged. Guidelines for adjuvant radio- or chemotherapy were adequately followed in all 62 grade I patients and in 44 out of 59 grade II and III patients (74.6%). During 734.6 person-years of follow up 31 patients died. Five-year overall survival figures were 97.6% in the optimally staged group and 68.5% in the non-optimally staged group. Patients who were non-optimally staged, had a significant higher risk to die than those who were optimally staged (HR: 7.4; 95% CI: 1.7-32.2). In patients with a grade II and III tumours, complete surgical staging still had a significant influence on survival (HR: 3.8; 95% CI 1.7-8.3). In women with grade II or III tumours, adjuvant radio- or chemotherapy administered in accordance to the guidelines did not improve overall survival regardless whether they were optimally staged or not. CONCLUSION: Incomplete staging in early-stage ovarian cancer leads to gross mis-classification in grade II and III tumours and to a lesser extent in grade I tumours. This leads to undertreatment in both surgical and adjuvant therapy. Subsequently unnecessary deaths may occur. More effort must be put in identifying obstacles interfering with compliance of guidelines.     

Cisplatin-based chemotherapy for stage II ovarian adenocarcinoma: A preliminary report

We have performed three sequential trials in patients with FIGO stage II ovarian cancer in an attempt to improve long-term survival. The first trial utilized whole-abdomen radiation and a pelvic boost and the second study utilized pelvic radiation plus melphalan chemotherapy. These trials resulted in estimated 5-year survivals of 40 and 50%, respectively (Gynecol. Oncol. 23, 168-175, 1986). In the current study, 20 patients were treated with 6 months of adjuvant cisplatin-based chemotherapy. The estimated progression-free survival was only 45%. However, by tailoring salvage therapy to the findings at second-look laparotomy, the estimated 5-year survival was 77%. Notwithstanding the latter result of 77%, improved therapy is still required for the relatively rare patient who has stage II ovarian cancer.     

卵巢上皮性癌的腹膜后淋巴结切除对预后的影响

目的　探讨卵巢上皮性癌患者腹膜后淋巴结切除对预后的影响。方法　回顾性分析13 1例卵巢上皮性癌患者的临床资料 ,应用COX风险比例回归模型判断影响预后的因素。结果　多因素分析显示 ,年龄、临床分期、残留灶、腹膜后淋巴结切除术及术后化学药物治疗 (化疗 ) ,是影响预后的重要因素。行和未行腹膜后淋巴结切除术患者的 5年生存率分别为 66%和 41% (P <0 0 1)。对于早期和Ⅲ、Ⅳ期肿瘤残留灶直径 >2cm或黏液性癌患者 ,腹膜后淋巴结切除术并不能提高生存率。Ⅲ、Ⅳ期肿瘤残留灶直径≤ 2cm ,行与未行腹膜后淋巴结切除术患者的 5年生存率分别为 65 %、3 0 %(P <0 0 1)。卵巢浆液性癌 ,行与未行腹膜后淋巴结切除术患者的 5年生存率分别为 61%、3 1% (P<0 0 1)。结论　年龄、临床分期、残留灶大小、腹膜后淋巴结切除与否及术后化疗的疗程数 ,与卵巢上皮性癌患者的预后有关。腹膜后淋巴结切除术虽能提高患者生存率 ,但对肿瘤残留灶直径 >2cm的Ⅲ、Ⅳ期卵巢上皮性癌患者 ,可不必行腹膜后淋巴结切除术     

Prognostic significance of human epididymis protein 4 in epithelial ovarian cancer

Objective

The purpose of this study was to evaluate the prognostic significance of serum human epididymis protein 4 (HE4) level in patients with epithelial ovarian cancer.

Study design

A total of 78 women diagnosed with a pelvic mass and operated on in our institute comprised our cohort. Forty-five of these were diagnosed with epithelial ovarian cancer and treated with debulking surgery, followed by taxane and platinum-based chemotherapy as clinically indicated. Preoperatively obtained serum samples were analyzed for levels of HE4 and CA125.

Results

The elevated serum HE4 level was related to advanced stage and serous type of cancer. The median duration of the follow-up was 35.1 months. In advanced stage, the median progression-free survival (PFS) of patients with elevated serum HE4 levels was 20.1 months (95% CI, 15.7–24.6 months), whereas that of patients with normal serum HE4 level was 24.2 months (95% CI, 13.9–34.6 months) (p = 0.029). Independent predictors for PFS in patients with advanced stage EOC included serum HE4 level (hazard ratio 2.24; 95% CI, 1.14 to 6.84; p = 0.048).

Conclusions

Our results demonstrated that an elevated serum HE4 level was related to the advanced stage of epithelial ovarian cancer. An elevated serum level of HE4 is a poor prognostic factor for PFS in patients with epithelial ovarian cancer who were treated with debulking surgery and adjuvant taxane and platinum-based chemotherapy. The serum HE4 level is a promising indicator for the progression of cancer as well as a biomarker for the detection of epithelial ovarian cancer.     

Survival probability in ovarian clear cell adenocarcinoma.

OBJECTIVE: The aim of this study was to evaluate the 5-year survival probability (SP) of patients treated for ovarian clear cell adenocarcinoma (OCCA) at a single tertiary institution and to compare it to the 5-year SP of patients with other histologic subtypes of epithelial ovarian cancer. METHODS: Sixty-four patients with pure OCCA treated at the Cleveland Clinic Foundation from 1981 to 1996 were retrospectively identified and clinical information was abstracted. All histologic materials were reviewed by a single gynecologic pathologist. SP was calculated by the Kaplan-Meier method. SPs for OCCA patients were compared to that of other high-grade epithelial ovarian cancer patients in the gynecologic tumor registry. Cox proportional hazards modeling was used to identify varibles associated with decreased SP. RESULTS: The FIGO stages of OCCA study patients were Stage I, 31 (50%), Stage II, 6 (10%), Stage III, 17 (27%), and Stage IV, 8 (13%) (2 patients unstaged). Forty-four patients had no gross residual cancer at the completion of initial surgery while 9 patients had 1 cm residual. Forty-five (73%) received postoperative chemotherapy. The median follow-up for surviving patients is 97 months (range 38 to 209 months). The overall 5-year SP of OCCA patients is 50% with limited disease (Stages I and II) patients having a 5-year SP of 72% versus 17% 5-year SP in patients with advanced disease (P < 0.001). FIGO stage was most predictive of outcome. The overall 5-year SP of OCCA patients (50%) differed significantly (P < 0.05) from that of other ovarian cancer registry patients (30%). OCCA patients with limited cancer survived similarly to registry patients (72 vs 72%) as did patients with advanced OCCA compared with registry patients (17 vs 22%). CONCLUSIONS: When controlled for grade and stage, the overall survival with OCCA is identical to that of other high-grade epithelial ovarian cancers. Factors that account for the better overall survival of OCCA patients are more favorable disease stage, younger age, and improved debulking status.     

Survival of Californian women with epithelial ovarian cancer, 1994-1996: a population-based study

OBJECTIVE: The objective was to identify demographic, clinical, and provider characteristics that might influence cancer survival in a cohort of Northern California women using a population-based cancer registry. METHODS: We used California Cancer Registry data to evaluate survival in 1051 Northern California women who were diagnosed with epithelial ovarian cancer between 1994 and 1996 and underwent a surgical procedure for their cancer. Chemotherapy data from the cancer registry were supplemented with a physician survey and medical record review. Database linkages with census and hospital discharge data provided socioeconomic and comorbidity measures. Kaplan-Meier method was used to generate survival curves and multivariate Cox proportional hazard models were used to evaluate the effect of different factors on survival. RESULTS: Crude 5-year survival was 82, 57, 28, and 10% for women with FIGO stage IC, II, III, and IV disease, respectively. Adverse survival was most strongly influenced by advanced stages III and IV with a hazards ratio ranging from 8 to 11.8 compared to stage IC disease. Multivariate analysis also identified other adverse factors including high grade and other adverse histologies, age over 45, and rural location. Chemotherapy decreased the risk of death by 50% if the patient had advanced-stage disease. Medical comorbidity increased the risk of death by 40%. Survival was not influenced by race/ethnicity, socioeconomic status, physician specialty, or hospital characteristics. CONCLUSION: Advanced age remains an adverse prognostic factor even after adjustment for treatment and comorbidity factors. These results also suggest that there may be important regional differences in ovarian cancer survival.     

Evaluation of risk factors after intraperitoneal chemotherapy in patients with ovarian cancer]

DESIGN: The authors sought to evaluate risk factors of patients with ovarian cancer treated with intraperitoneal cisplatin based chemotherapy (IPC). MATERIAL AND METHODS: From January 1996 to December 1998, 24 patients with recurrent or persistent ovarian cancer were treated. We divide them in two groups first beneath 65 year old (19 patients), second above 65 year (5 patients), and in three groups with residual microscopic diseases, residual below 0.5 cm, and between 0.5 and 2 cm in the time of the beginning of treatment with IPC. We also estimate stage (FIGO) as a risk factor. RESULTS: In the first group the study showed (CRP) among 9 patients (SD) among 2 patients PD in among patients. In the second group CRP were observed among 2 patients PD among 2 patients, and SD 1 patient. CONCLUSION: IPC is the valuable method of second line chemotherapy for ovarian cancer. Age is not a risk factor in IPC. IPC prolongs survival in ovarian cancer patients, progression free survival, and gives only slightly adverse effects.