Women with presumed early-stage epithelial ovarian cancer (EOC) who have not received comprehensive surgical staging are at risk for recurrence. The aim of our study was to analyze the overall long term survival of EOC patients with a presumed early stage EOC.
A population-based cancer registry was used to identify patients with an early-stage EOC cancer diagnosed between 1989 and 1997. The area under study has no surgical gynecologic oncologist and no tertiary referral center. We categorized patients into two subgroups: low-risk (Ia-Ib well and moderately differentiated) and high-risk (Ia-Ib poorly differentiated or IC-II). Survival curves were calculated from the time of surgery using Kaplan-Meier methods and statistical comparisons were performed using the log-rank test and the Cox proportional hazards regression model.
Fifty patients having an apparent early-stage disease (FIGO I-II) were evaluated. Forty-one patients have been operated by obstetrician-gynecologists and 9 by general surgeons. Twenty-one (42%) have been categorized as low-risk and 29 (58%) as high-risk. An optimal, modified, minimal and inadequate surgical staging was performed in 6, 10, 26 and 58, respectively. The median follow-up time was 147 months (range: 2.5-165). The 5- and 10-year overall survival was 95 and 89% for low-risk and 72 and 33% for high-risk subgroups, respectively.
The surgical staging is frequently incomplete when performed in small hospitals with few patients by nonspecialists. Women in the high-risk group and incompletely staged have a less favorable prognosis than those reported in the literature.
[Show abstract][Hide abstract] ABSTRACT: Forensic medicine testimony often relies upon terms of probability to enhance the strength of the testimony. Such terms must have a demonstrably reliable and accurate basis; otherwise their use is speculative, unjustified, and potentially harmful. Forensic Epidemiology is introduced as a framework from which probabilistic testimony can be assessed in settings in which it is either proffered or encountered. In this paper, common forensic uses of probability are reviewed, appropriate methods for presenting such testimony are proposed, and inappropriate uses of probability and epidemiologic concepts and data, as well as a logical fallacies commonly observed in forensic settings are presented. A previously unpublished logical fallacy, the "Prior Odds" Fallacy, is also introduced.
Journal of Forensic and Legal Medicine 08/2008; 15(5):281-90. DOI:10.1016/j.jflm.2007.12.009 · 0.76 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This article reviews population-based studies addressing structures and processes influencing outcomes in women with ovarian, uterine, cervical, or vulvar cancer. Treatment of ovarian cancer in specialized high-volume centers improved outcomes. Structural and process variables did not significantly impact outcome for uterine cancer. Cervical cancer studies showed no significant association between structural variables and outcomes. Vulvar cancer studies suggested that high-volume surgeons were more likely to achieve adequate negative margins. Population-based data confirm the importance of centralized care for ovarian cancer, but currently do not support recommendations for or against centralizing care for women with uterine, cervical, and vulvar cancer.
Obstetrics and Gynecology Clinics of North America 06/2012; 39(2):107-29. DOI:10.1016/j.ogc.2012.02.003 · 1.38 Impact Factor
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