Long-term survival of patients with apparent early-stage (FIGO I-II) epithelial ovarian cancer: a population-based study.
ABSTRACT 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.
- SourceAvailable from: Jan B Vermorken[show abstract] [hide abstract]
ABSTRACT: All randomized trials of adjuvant chemotherapy for early-stage ovarian cancer have lacked the statistical power to show a difference in the effect on survival between adjuvant chemotherapy and no adjuvant chemotherapy. They have also not taken into account the adequacy of surgical staging. We performed a prospective unblinded, randomized phase III trial to test the efficacy of adjuvant chemotherapy in patients with early-stage ovarian cancer, with emphasis on the extent of surgical staging. Between November 1990 and January 2000, 448 patients from 40 centers in nine European countries were randomly assigned to either adjuvant platinum-based chemotherapy (n = 224) or observation (n = 224) following surgery. Endpoints were overall survival and recurrence-free survival, and the analysis was on an intention-to-treat basis. The Kaplan-Meier method was used to perform time-to-event analysis, and the log-rank test was used to compare differences between treatment arms. Statistical tests were two-sided. After a median follow-up of 5.5 years, the difference in overall survival between the two trial arms was not statistically significant (hazard ratio [HR] = 0.69, 95% confidence interval [CI] = 0.44 to 1.08; P =.10). Recurrence-free survival, however, was statistically significantly improved in the adjuvant chemotherapy arm (HR = 0.63, 95% CI = 0.43 to 0.92; P =.02). Approximately one-third of patients (n = 151) had been optimally staged and two-thirds (n = 297) had not. Among patients in the observation arm, optimal staging was associated with a statistically significant improvement in overall and recurrence-free survival (HR = 2.31 [95% CI = 1.08 to 4.96]; P =.03 and HR = 1.82 [95% CI = 1.02 to 3.24] P =.04, respectively). No such association was observed in the chemotherapy arm. In the non-optimally staged patients, adjuvant chemotherapy was associated with statistically significant improvements in overall and recurrence-free survival (HR = 1.75 [95% CI = 1.04 to 2.95]; P =.03 and HR = 1.78 [95% CI = 1.15 to 2.77]; P =.009, respectively). In the optimally staged patients, no benefit of adjuvant chemotherapy was seen. Adjuvant chemotherapy was associated with statistically significantly improved recurrence-free survival in patients with early-stage ovarian cancer. The benefit of adjuvant chemotherapy appeared to be limited to patients with non-optimal staging, i.e., patients with more risk of unappreciated residual disease.JNCI Journal of the National Cancer Institute 02/2003; 95(2):113-25. · 14.34 Impact Factor
- International Journal of Gynecological Cancer 02/2000; 10(S1):8-11. · 1.94 Impact Factor
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ABSTRACT: Patients with well-differentiated epithelial ovarian cancer Stages Ia, Ib, Ic, and IIa (FIGO 1976) were observed after surgical treatment without adjuvant therapy. Careful surgical staging was required, and the extent of the staging procedure was assessed in each individual patient. There were 107 patients entered in the study by nine Dutch oncology centers. Of these 107, 21 did not fulfill all of the inlet criteria of the study and were excluded. Central pathologic review was performed in the remaining 86 cases, revealing that there was borderline tumor in seven patients, moderately or poorly differentiated tumor in nine patients, and tumor of nonepithelial histologic cell type in one patient. In two cases, no material for histologic review was available. After exclusion of these 19 cases, 67 patients were further analyzed. None of these 67 patients was lost during the follow-up period that ranged from 19 to 99 months (mean, 50 months). Tumor recurrence was found in four patients after 11, 25, 34, and 34 months of follow-up, all of whom died shortly after diagnosis of the recurrence without satisfactory response to secondary treatment. For the patients who underwent the most extensive staging procedure, disease-free 5-year survival was 100%. For the patients who were inaccurately staged, disease-free 5-year survival was 88%. It was concluded that welldifferentiated early stage (Ia-IIa) ovarian cancer carries an excellent prognosis after surgical treatment and complete surgical staging, with the possible exception of patients with Stage Ic disease with malignant peritoneal washings. Furthermore, it was considered that the application of more objective and consistent ways of assessing tumor grade should be encouraged. Surgical staging should be regarded as the golden standard in defining subsets of low-risk patients and should be included and clearly defined in future trials on early ovarian cancer.Cancer 01/1991; 67(3):597 - 602. · 5.20 Impact Factor