Long-term results and prognostic factors in patients with epithelial ovarian cancer

The aim of this study was to evaluate long-term results and to assess prognostic factors which have an impact on overall survival in patients with epithelial ovarian cancer.

A retrospective analysis of 287 patients treated between 1975 and 1995 was performed. All operations were performed by senior surgeons. Histologic sections were reviewed by the same pathologist. Successive adjuvant chemotherapy regimens are described. Survival was evaluated in 1997. Follow-up lasted 25-260 months (median 90). Statistical methods included Kaplan-Meier survival curves, log-rank test, and multivariate analysis.

The 5-year survival rates were 76, 42, 21, and 6% for patients with stage I, II, III, and IV disease, respectively. Age, FIGO stage, cytology of ascites, histologic type and grade, extent of surgery, and number of residual tumors were significant prognostic indicators in univariate analysis. Multivariate analysis showed that the risk of mortality according to FIGO stage was 2.8, 95% CI [1.2-6.3], P = 0.01 for FIGO II, 5.6, 95% CI [2.9-10.8], P < 0.001 for FIGO III, and 10.5, 95% CI [4.9-22. 1], P < 0.001 for FIGO IV in comparison with FIGO I. Patients with a serous epithelial carcinoma had a 1.7-fold higher risk of mortality than patients with other histologic types: RR = 1.7, 95% CI [1.1-2. 8], P < 0.001. Patients whose tumors distribution permitted optimal surgery had a 2.3-fold lower risk of mortality than patients treated with sub- or nonoptimal surgery: RR = 0.43, 95% CI [0.29-0.64], P < 0.001. The risk of mortality for patients treated with alkylating agents, platinum-based combination chemotherapy without taxanes, or carboplatin plus paclitaxel regimens compared with patients who did not receive treatment was reduced by 47%, 95% CI [8-69%], P = 0.025, 55%, 95% CI [22-74%], P = 0.005, and 70%, 95% CI [35-86%], P = 0.002, respectively.

Our study confirms the benefit of cytoreductive surgery and the efficacy of platinum plus paclitaxel first-line chemotherapy which has recently been recognized as the standard treatment for advanced epithelial ovarian cancer.