The prediction of progression‐free and overall survival in women with an advanced stage of epithelial ovarian carcinoma

Abstract

Objective Prognosis in women with ovarian cancer mainly depends on International Federation of Gynecology and Obstetrics stage and the ability to perform optimal cytoreductive surgery. Since ovarian cancer has a heterogeneous presentation and clinical course, predicting progression-free survival (PFS) and overall survival (OS) in the individual patient is difficult. The objective of this study was to determine predictors of PFS and OS in women with advanced stage epithelial ovarian cancer (EOC) after primary cytoreductive surgery and first-line platinum-based chemotherapy.Design Retrospective observational study.Setting Two teaching hospitals and one university hospital in the south-western part of the Netherlands.Population Women with advanced stage EOC.Methods All women who underwent primary cytoreductive surgery for advanced stage EOC followed by first-line platinumbased chemotherapy between January 1998 and October 2004 were identified. To investigate independent predictors of PFS and OS, a Cox' proportional hazard model was used. Nomograms were generated with the identified predictive parameters.Main outcome measures The primary outcome measure was OS and the secondary outcome measures were response and PFS.Results A total of 118 women entered the study protocol. Median PFS and OS were 15 and 44 months, respectively. Preoperative platelet count (P = 0.007), and residual disease <1 cm (P = 0.004) predicted PFS with a optimism corrected c-statistic of 0.63. Predictive parameters for OS were preoperative haemoglobin serum concentration (P = 0.012), preoperative platelet counts (P = 0.031) and residual disease <1 cm (P = 0.028) with a optimism corrected c-statistic of 0.67.Conclusion PFS could be predicted by postoperative residual disease and preoperative platelet counts, whereas residual disease, preoperative platelet counts and preoperative haemoglobin serum concentration were predictive for OS. The proposed nomograms need to be externally validated.

mice: Multivariate Imputation by Chained Equations inR

“…Applications of imputation by chained equations have now appeared in quite diverse fields: addiction (Schnoll et al 2006;MacLeod et al 2008;Adamczyk and Palmer 2008;Caria et al 2009;Morgenstern et al 2009), arthritis and rheumatology (Wolfe et al 2006;Rahman et al 2008;van den Hout et al 2009), atherosclerosis (Tiemeier et al 2004;van Oijen et al 2007;McClelland et al 2008), cardiovascular system (Ambler et al 2005;van Buuren et al 2006a;Chase et al 2008;Byrne et al 2009;Klein et al 2009), cancer (Clark et al 2001Royston et al 2004;Barosi et al 2007;Fernandes et al 2008;Sharma et al 2008;McCaul et al 2008;Huo et al 2008;Gerestein et al 2009), epidemiology (Cummings et al 2006;Hindorff et al 2008;Mueller et al 2008;Ton et al 2009), endocrinology (Rouxel et al 2004;Prompers et al 2008), infectious diseases (Cottrell et al 2005;Walker et al 2006;Cottrell et al 2007;Kekitiinwa et al 2008;Nash et al 2008;Sabin et al 2008;Thein et al 2008;Garabed et al 2008;Michel et al 2009), genetics …”

Impact of Prognostic Factors on Survival Rates in Patients with Ovarian Carcinoma

“…Thrombocytosis is frequently encountered especially in advanced stage cancers, and as a prognostic marker, it seems to be associated with increased tumor aggressivity (Gerestein et al, 2009). Li et al indicated preoperative thrombocytosis and advanced stage as poor prognostic factors (Li et al, 2004).…”

Treatment Decisions and Survival in Ovarian Cancer

“…For the total cohort, the median PFS and OS were 13.4 (IC95%= [9,[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Patients with no macroscopic residual disease after debulking surgery had superior OS (52.7 vs. 36.0 months; p = 0.002) (Figure 3), as well as those with non-advanced stage disease (52.5 vs. 37.1 months; p = 0.009). Moreover, patients with platinum-sensitive relapse (>6 months) had significantly superior OS (56.0 vs. 12.3 months; p = 0.000) (Figure 4), as compared to platinum resistant patients.…”

“…Many OC patient characteristics are associated with survival, like stage [9,10], histology [10][11][12][13][14], residual disease and debulking status after cytoreductive surgery [10,12,14,15], type of chemotherapy [6,10,13,16] and BRCA status [17,18]. Maximal surgery, even when total absence of residual disease cannot be obtained, seems to relate to survival advantage [19].…”