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: 4.9). 05/2008; 112(10):2202-10. DOI: 10.1002/cncr.23390
Source: PubMed

ABSTRACT 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.

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    • "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. "
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    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.
    07/2013; 1(7):174–176. DOI:10.1016/j.epsc.2013.05.010
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    ABSTRACT: Background: Research has identified key symptoms of ovarian cancer, although there are gaps in the knowledge about the pattern of symptom onset, severity and frequency. Previous studies are limited by use of non-validated questionnaires, recall bias and under-reporting bias in medical records. Aim: The aim of the research was to prospectively identify type, severity, frequency and duration of symptoms that precede ovarian cancer diagnosis in postmenopausal women. Methods: Questionnaire development methods described by the European Organisation for Research and Treatment of Cancer were utilised to develop a validated ovarian cancer symptoms questionnaire (OCSq). Interviews with 21 gynaecological oncology clinicians/nurses and 25 women with ovarian cancer guided development of the OCSq. The OCSq was piloted among 1,339 women and posted to 100,000. Results: A total of 829 women completed a pilot OCSq and baseline analysis of the finalised OCSq included 51,007. Symptoms were ubiquitous, with 89% of women reporting any symptoms, 55-56% symptoms at level 2-3 severity and 42-49% at ≥12 days frequency and <12 months duration. Abdominal/pelvic pain, increased abdominal size/bloating or feeling full at ≥12 days and <12 months was reported by 11-16%. There were 263 women who had an abnormal ovarian cancer screening result in the pilot and two women were diagnosed with ovarian cancer. No symptoms were consistently associated with abnormal results when severity, frequency and duration criteria were added to analyses. Multivariate analyses found age, pelvic pressure, tiredness/fatigue, pelvic bloating/fullness, shortness of breath, leg ache/pain and abdominal pressure independently predicted abnormal ovarian cancer screening results at various levels of analysis. However, odds ratios were low and confidence limits were wide. Symptom reporting was strongly correlated with previous awareness of the possibility of an ovarian lesion and depression screening status. Conclusion: The research is currently ongoing with follow-up analyses planned to commence in late 2010. Preliminary findings indicate that there is currently insufficient evidence to justify symptoms awareness campaigns based upon the results of previous retrospective research, and that such campaigns risk overwhelming primary care services with ‘worried-well’ women, increasing psychological morbidity, service costs, unnecessary investigations and potentially harmful surgery.
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