Prognostic factors for high‐risk early‐stage epithelial ovarian cancer

Abstract

BACKGROUND. The purpose was to identify the factors predictive of recurrence and survival in patients with high‐risk (stage I, grade 3; stage IC, stage II, or clear cell) epithelial ovarian cancer after adjuvant therapy. METHODS. Data was extracted from patients who underwent primary surgery followed by adjuvant therapy in 2 randomized trials by the Gynecologic Oncology Group (Protocols 95 and 157). Kaplan‐Meier survival estimates and Cox proportional hazards model adjusted for covariates were used for analyses. RESULTS. Of 506 patients (median age = 56.2 years), 347 (68.6%) had stage I and 159 (31.4%) had stage II cancers. The 5‐year recurrence‐free (RFS) and overall survivals (OS) were 75.5% and 81.7%, respectively. On multivariate analysis, older age, higher stage, higher grade, and malignant cytology were independent prognostic factors predictive for recurrence and poorer survival. The risk of recurrence was higher for those ≥60 versus < 60 years (hazards ratio [HR] = 1.57, 95% confidence interval [CI], 1.12–2.19), stage II (stage II: HR = 2.70, 95% CI, 1.41–5.16) versus stage IA or IB, grade 2 (HR = 1.84, 95% CI, 1.04–3.27) and grade 3 (HR = 2.47, 95% CI, 1.39–4.37) versus grade 1, and positive versus negative cytology (HR = 1.72, 95% CI, 1.21–2.45). By using these factors in a prognostic index, those with low‐risk (no or 1 risk factor), intermediate‐risk (2 factors), and high‐risk (3–4 risk factors) disease had survivals of 88%, 82%, and 75%, respectively (P < .05). CONCLUSIONS. Age, stage, grade, and cytology are important prognostic factors in high‐risk early‐stage epithelial ovarian cancer. This information may be used in the design of future clinical trials. Cancer 2008. © 2008 American Cancer Society.

The apoptosis regulators p53, bax and PUMA: Relationship and impact on outcome in early stage (FIGO I-II) ovarian carcinoma after post-surgical taxane-based treatmen

“…FIGO-stage was the strongest predictive factor for recurrent disease in this study and this has been confirmed by studies on patients in FIGO-stages I-II both after complete surgical staging (1,27) and apparent staging (5). However, the fact, that p53 status and p53/bax status both were independent prognostic factors for DFS in multivariate analysis was the most striking finding noted in our study.…”

Clinicopathological Perspectives on Endometrioid Epithelial Ovarian Carcinoma in Indian Women

“…Thirteen percent cases were well-differentiated tumours and the rest were either moderately or poorly differentiated which correlates well with other studies. Studies in the published literature differ on the prognostic importance of tumour grade as a predictor of survival [2,16]. Tumour grade was not an independent predictor of survival in our study.…”

“…Nulliparity was an independent predictor in various studies [16]. This was true of our study as 78 % of these cases were nulliparous.…”

Ovarian, fallopian tube and peritoneal cancer staging: Rationale and explanation of new FIGO staging 2013

“…However, disagreement will always exist on tumors with borderline grades and, unless a tumor is judged unquestionably within a grade, the grade assigned is an This is controversial. Whereas some studies found that intraoperative capsule rupture portends a higher risk of disease recurrence [22,24], others did not [17,18,21,25,26]. In a multivariable analysis, capsule rupture and positive cytologic washings remained M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 12 independent predictors of worse disease-free survival [24].…”