Outcome of epithelial ovarian cancer in women under 40 years of age treated with platinum-based chemotherapy.
ABSTRACT We retrospectively investigated the outcome of ovarian cancer in women aged less than 40 years treated in three randomised phase III studies of platinum-based chemotherapy. 624 patients had invasive epithelial ovarian cancer. A Cox proportional hazard model was used to study prognostic variables. 29 women (5%) were under 40 years of age. Stage, histological grade and amount of residual disease were significantly worse in women aged > or = 40 years. Median follow-up was 66.7 months. At 5 years 65% of women below 40 years of age were alive compared with 20% of older women (95% confidence interval (CI) of the difference 27.1-63.0). The progression-free interval was 59% versus 16% (95% CI 24.3-60.8). No patient under 40 years of age relapsed after 18 months. Age > or = 40 years was a poor prognostic variable, particularly for serous tumours, the commonest subtype in younger women (hazard ratio (HR): 3.33). Other prognostic factors were Eastern Cooperative Oncology Group (ECOG) performance status (HR: 1.25), presence of residual disease (HR: 1.43), histological grade (HR: 1.36) and International Federation of Gynaecology and Obstetrics (FIGO) stage (HR: 1.47). These results suggest that there are biological differences in the behaviour of serous carcinoma of the ovary in women of reproductive age compared with older women.
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ABSTRACT: To compare the effectiveness of physician assessment with a new multivariate index assay in identifying high-risk ovarian tumors. The multivariate index assay was evaluated in women scheduled for surgery for an ovarian tumor in a prospective, multi-institutional trial involving 27 primary- care and specialty sites throughout the United States. Preoperative serum was collected, and results for the multivariate index assay, physician assessment, and CA 125 were correlated with surgical pathology. Physician assessment was documented by each physician before surgery. CA 125 cutoffs were chosen in accordance with the referral guidelines of the American College of Obstetricians and Gynecologists. The study enrolled 590 women, with 524 evaluable for the multivariate index assay and CA 125, and 516 for physician assessment. Fifty-three percent were enrolled by nongynecologic oncologists. There were 161 malignancies and 363 benign ovarian tumors. Physician assessment plus the multivariate index assay correctly identified malignancies missed by physician assessment in 70% of nongynecologic oncologists, and 95% of gynecologic oncologists. The multivariate index assay also detected 76% of malignancies missed by CA 125. Physician assessment plus the multivariate index assay identified 86% of malignancies missed by CA 125, including all advanced cancers. The performance of the multivariate index assay was consistent in early- and late-stage cancers. The multivariate index assay demonstrated higher sensitivity and lower specificity compared with physician assessment and CA 125 in detecting ovarian malignancies.Obstetrics and Gynecology 06/2011; 117(6):1289-97. DOI:10.1097/AOG.0b013e31821b5118 · 4.37 Impact Factor
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ABSTRACT: Ovarian cancer is the leading cause of gynecologic cancer death in the United States. Once an ovarian tumor is identified, a pelvic ultrasound is recommended, including tumor volume and tumor structure. Unilocular and simple septate tumors are unlikely to be malignant and when asymptomatic, can be safely followed conservatively without surgery. Complex ovarian tumors are at an increased risk for malignancy and secondary testing is recommended. Secondary testing may include CA125, OVA1, the RMI, ROMA, or the ACOG referral guidelines. When secondary testing indicates that an ovarian tumor is at high risk for malignancy, referral to a gynecologic oncologist is recommended.Clinical obstetrics and gynecology 03/2012; 55(1):52-64. DOI:10.1097/GRF.0b013e31824970cf · 1.53 Impact Factor
Obstetrics and Gynecology 11/2011; 118(5):1178-9. DOI:10.1097/AOG.0b013e3182358d98 · 4.37 Impact Factor