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Prognostic factors for high‐risk early‐stage epithelial ovarian cancer
Author(s) -
Chan John K.,
Tian Chunqiao,
Monk Bradley J.,
Herzog Thomas,
Kapp Daniel S.,
Bell Jeffrey,
Young Robert C.
Publication year - 2008
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.23390
Subject(s) - medicine , stage (stratigraphy) , confidence interval , proportional hazards model , hazard ratio , risk factor , oncology , multivariate analysis , adjuvant therapy , cancer , gastroenterology , gynecology , paleontology , biology
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.