Advanced epithelial ovarian carcinoma: long-term survival experience at the community hospital

The purpose of this study was to determine prognostic factors that could be altered to increase survival of patients with advanced ovarian cancer treated at the community hospital.

This study is a retrospective analysis of 101 patients with stage III and IV epithelial ovarian carcinoma who underwent primary surgery at two private hospitals from 1970 to 1990.

Primary laparotomy was done by a general surgeon in 54 cases. The tumors in 23% of stage IIIC cases were debulked to less than or equal to 2 cm residuum. The survival rate decreased as stage or postoperative tumor residual increased. Patients with stage IIIA and IIIB disease had similar survival rates, significantly better than those with stage IIIC disease. Cytoreduction of stages IIIB and IIIC to microscopic disease resulted in a survival curve equal to the "natural optimal" stage IIIA. Patients with cytoreduction of stage IIIC disease to less than or equal to 2 cm did not obtain survival rates equal to those with stage IIIB disease with visible tumor remaining. Patients with stage IIIC disease achieved a significant increase in survival rate if their tumors were cytoreduced to microscopic disease. Platinum-based combination chemotherapy compared with alkylating agents improved survival in patients with stage IIIC disease who had greater than 2 cm tumor residual. Seven patients survived greater than 5 years, with three patients currently free of disease. Three prognostic categories predict decreasing survival: (1) stage IIIC if tumor is cytoreduced to no visible residual, stage IIIA or stage IIIB; (2) stage IIIC with visible tumor residual; (3) stage IV.

Survival of community hospital-treated advanced ovarian carcinoma patients can be improved by early diagnosis, adjuvant platinum-based combination chemotherapy, and surgical cytoreduction to minimal disease. This treatment requires a team approach and education of the medical staff, including nongynecologists.