[Treatment and prognostic factors for stage IV epithelial ovarian cancer]

The aim of the study was to evaluate the influence of surgical debulking and chemotherapy on survival in patients with stage IV epithelial ovarian cancer.

Medical records and follow-up sheets were retrospectively reviewed for all women with International Federation of Gynecology and Obstetrics stage IV epithelial ovarian cancer treated between January, 1982 and December, 1997 in our hospital. Survival analysis and comparison were performed using Kaplan-Meier method and t-test. The COX proportional hazards regression model was used to identify independent variables associated with survival improvement.

Twenty-five women with stage IV epithelial ovarian cancer were available. Median age was 51 years (range 33-72 years). Papillary serous histology was found in 12/75 patients (48%). Thirteen patients (52%) had grade 3 tumors. Metastases by the International Federation of Gynecology and Obstetrics (FIGO) criteria were found in 7 cases in supraclavicular lymph node (28%), 6 cases in liver (24%) and 4 cases with malignant pleural effusion. All patients received surgical debulking with 9 cases (36%) having in optimal cytoreduction. Overall median survival of 15.0 months was achieved, while optimal debulked patients' median survival was 28.4 months compared to 14.7 months for the patients with bulky residual disease (P < 0.01). Median survival for the patients with 6 or more courses of chemotherapy postoperatively was 28.5 months, compared to 6.5 months for the patients with less than 6 courses (P < 0.01). Optimal debulking surgery and courses of chemotherapy retained significance as indepent predictors of survival based on multivariate analysis.

Optimal surgical debulking and active postoperative chemotherapy appear to improve the prognosis of the patients with stage IV epithelial ovarian cancer under the premise of keeping quality of life.