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Survival of Australian women with invasive epithelial ovarian cancer: a population‐based study
Author(s) -
Anuradha Satyamurthy,
Webb Penelope M,
Blomfield Penny,
Brand Alison H,
Friedlander Michael,
Leung Yee,
Obermair Andreas,
Oehler Martin K,
Quinn Michael,
Steer Christopher,
Jordan Susan J
Publication year - 2014
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja14.00132
Subject(s) - medicine , hazard ratio , proportional hazards model , ovarian cancer , cancer , oncology , cancer registry , epithelial ovarian cancer , cohort , population , stage (stratigraphy) , survival analysis , confidence interval , environmental health , paleontology , biology
Abstract Objective: To describe survival patterns in a nationally complete cohort of Australian women with epithelial ovarian cancer, by sociodemographic and clinical factors. Design, setting and participants: All 1192 women diagnosed with invasive epithelial ovarian cancer in 2005 were identified through state‐based cancer registries. We obtained detailed information from their medical records in 2009 and updated survival data in 2012. Main outcome measures: Crude 3‐year, 5‐year and 7‐year survival rates; 3‐year and 5‐year conditional survival; and hazard ratios (HRs) for the association of participant and cancer characteristics with survival, from multivariable Cox proportional hazards models. Results: Overall crude 5‐year survival was 35% (95% CI, 33%–38%). Conditional survival increased moderately for women who lived beyond a year from diagnosis, although for women alive 2 years after diagnosis, the probability of surviving a further 5 years was still only 53% (95% CI, 49%–57%). Increasing age and disease stage were most strongly associated with poor survival. After adjusting for these, survival was significantly worse for women with carcinosarcomas (HR adj , 2.1 [95% CI, 1.3–3.2]), clear cell (HR adj , 1.7 [95% CI, 1.2–2.3]) and mucinous (HR adj , 2.6 [95% CI, 1.6–4.0]) cancers than for women with serous cancers. Presence of ascites at diagnosis (HR adj , 1.5 [95% CI, 1.3–1.8]), Charlson comorbidity score ≥ 3 (HR adj , 1.5 [95% CI, 1.1–2.1]), relative socioeconomic disadvantage (HR adj , 1.2 [95% CI, 1.1–1.4]) and regional–remote residence (HR adj , 1.2 [95% CI, 1.0–1.4]) were also associated with poorer survival. Conclusions: Along with expected adverse effects of age and stage, we found survival differences by histological subtype, presence of ascites and comorbidities. Whether geographic and socioeconomic differences relate to treatment access or other factors warrants further investigation. Conditional survival estimates confirm the ongoing poor long‐term prognosis for women with ovarian cancer, reinforcing the need for prevention and better treatments.