Chan JK, Tian C, Monk BJ, Herzog T, Kapp DS, Bell J, Young RCPrognostic factors for high-risk early-stage epithelial ovarian cancer: a Gynecologic Oncology Group Study. Cancer (in press)

Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco School of Medicine, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California 94143-1702, USA.
Cancer (Impact Factor: 4.89). 05/2008; 112(10):2202-10. DOI: 10.1002/cncr.23390
Source: PubMed


The purpose was to identify the factors predictive of recurrence and survival in patients with high-risk (stage I, grade 3; stage IC, stage II, or clear cell) epithelial ovarian cancer after adjuvant therapy.
Data was extracted from patients who underwent primary surgery followed by adjuvant therapy in 2 randomized trials by the Gynecologic Oncology Group (Protocols 95 and 157). Kaplan-Meier survival estimates and Cox proportional hazards model adjusted for covariates were used for analyses.
Of 506 patients (median age = 56.2 years), 347 (68.6%) had stage I and 159 (31.4%) had stage II cancers. The 5-year recurrence-free (RFS) and overall survivals (OS) were 75.5% and 81.7%, respectively. On multivariate analysis, older age, higher stage, higher grade, and malignant cytology were independent prognostic factors predictive for recurrence and poorer survival. The risk of recurrence was higher for those >/=60 versus < 60 years (hazards ratio [HR] = 1.57, 95% confidence interval [CI], 1.12-2.19), stage II (stage II: HR = 2.70, 95% CI, 1.41-5.16) versus stage IA or IB, grade 2 (HR = 1.84, 95% CI, 1.04-3.27) and grade 3 (HR = 2.47, 95% CI, 1.39-4.37) versus grade 1, and positive versus negative cytology (HR = 1.72, 95% CI, 1.21-2.45). By using these factors in a prognostic index, those with low-risk (no or 1 risk factor), intermediate-risk (2 factors), and high-risk (3-4 risk factors) disease had survivals of 88%, 82%, and 75%, respectively (P < .05).
Age, stage, grade, and cytology are important prognostic factors in high-risk early-stage epithelial ovarian cancer. This information may be used in the design of future clinical trials.

1 Follower
15 Reads
  • Source
    • "Cases of large mucinous cystadenocarcinomas in teenagers are characterized by a poor prognosis. Chan et al. [11] reported that age, stage, grade, and cytology are important prognostic factors for high-risk early-stage EOC. Although these data are based on a very small amount of retrospective data, the strategy of surgical treatment and adjuvant therapy chosen are important for teenage patients with early-stage EOC. "
    [Show abstract] [Hide abstract]
    ABSTRACT: We present the case of a 13-year-old patient who underwent right salpingo-oophorectomy and was diagnosed with stage Ia ovarian mucinous cystadenocarcinoma. Nine years after complete resection, she was diagnosed with metastasis of the previously resected carcinoma. Despite receiving combination chemotherapy, the patient died of the disease. Long-term follow-up of teenage patients with stage Ia ovarian mucinous cystadenocarcinoma is important.
    Journal of Pediatric Surgery Case Reports 07/2013; 1(7):174–176. DOI:10.1016/j.epsc.2013.05.010
  • Source
    • "Several factors, such as age, stage, grade, histological subtype, ascites, intra-operatorial adhesions, and cyst rupture, have been identified as potential risk factors. There are numerous biases concerning early-stage ovarian cancer studies, such as sample size [31, 32], inclusion of borderline tumours [7], inadequacy of surgical staging [6], presence of microscopic metastasis not initially recognised [18, 19], and collection of data from many countries [2]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to identify the main prognostic factors in patients with early-stage epithelial ovarian cancer. Data were extracted from 222 patients with initial stage (I–IIA) invasive epithelial ovarian cancer treated with primary surgery followed or not followed by adjuvant therapy, from 1 January 1980 to 31 December 2008, at the Division of Obstetrics and Gynecology, Spedali Civili, Brescia, Italy; the median follow-up was 79 months (SD ± 35,945, range 20–250 months). The negative prognostic factors that were statistically significant (p<0.050) in univariate analysis were grade 2, 3, and X (clear cell in our study); stage IB, IC, IIA; positive peritoneal cytology, age equal to/greater than 54; dense adhesions; capsule rupture (pre-operative or intra-operative) and endometrioid histotype (only for disease-free survival (DFS)). Positive cytology was strongly associated with peritoneal relapses, while adhesions were associated with pelvic relapses. A positive prognosis was associated with the mucinous histotype. Conservative treatment had been carried out in 52% of patients under 40 years of age, and we detected only two relapses and three completions of surgery after a few weeks among 31 women in total. Our study indicated a possible execution in patients with patients with cancer stage IA G1–G2 (p=0.030) or IC G1 (p=0.050), provided well staged. Adjuvant chemotherapy improved the survival of cancers that were not IA G1. The positive prognostic role of taxanes must be emphasised, when used in combination with platino.
    ecancermedicalscience 06/2013; 7(1):325. DOI:10.3332/ecancer.2013.325 · 1.20 Impact Factor
  • Source
    • "According to recent reports comparing survival of CCC patients with that of SAC cases, there have been no significant difference of OS between those two histologic subtypes among stage I carcinomas of ovary demonstrated [9,11,15]. On the other hand, a study based on Surveillance, Epidemiology and End Results (SEER) database suggested that the patients with stage I CCC had poorer OS than patients with SAC [4]. However, other clinicopathologic factors such as peritoneal cytology, chemotherapy, and extent of surgical staging were not available in the data from SEER, although the independent poor prognostic factors of pT1M0 CCC were positive peritoneal cytology [23]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Compared with serous adenocarcinoma (SAC), clear cell carcinoma (CCC) often shows chemo-resistance, which would potentially lead to a poor prognosis. On the other hand, there have been arguments over prognoses of CCC and SAC disease. In the present study, multivariate analysis to compare prognosis of CCC patients with that of SAC was aimed for the patients selected from central pathologic review. Between 1984 and 2009, a total of 500 ovarian cancer patients were treated at our university hospital. Among them, 111 patients with CCC and 199 patients with SAC were identified through central pathological review. Overall survival and progression-free survival were compared using Kaplan-Meier method, and prognostic factors were investigated by multiple regression analyses. Median age was 52 years for CCC and 55 years for SAC (p=0.03). The ratio of stage I patients were significantly higher in CCC compared with SAC (55% vs. 13%, p<0.01). Among evaluable cases, response rate was significantly lower in CCC than that in SAC (32% vs. 78%, p<0.01). No significant differences of progression-free survival and overall survival were observed in stage I patients; however, prognoses of CCC were significantly poorer than those of SAC in advanced-stage disease. In stage II-IV patients, not only residual tumors and clinical stages, but also clear cell histology were identified as predictors for poor prognosis. Clear cell histology was identified as a prognostic factor for advanced-stage ovarian cancers. Histologic subtypes should be considered in further clinical studies, especially for advanced epithelial ovarian cancers.
    Journal of Gynecologic Oncology 01/2013; 24(1):37-43. DOI:10.3802/jgo.2013.24.1.37 · 2.49 Impact Factor
Show more