Analysis of failures in patients with stage I ovarian cancer: an Italian multicenter study

Abstract

Gadducci A, Sartori E, Maggino T, Zola P, Landoni F, Fanucchi A, Stegher C, Alessi C, Buttitta F, Bergamino C. Analysis of failures in patients with stage I ovarian cancer: An Italian multicenter study. Int J Gynecol Cancer 1997; 7: 445-450.The objective of this retrospective multicenter study was to assess the rates, times, sites, and risk factors for recurrences in 224 patients with surgical stage I ovarian cancer. Postoperative adjuvant treatment was given to 153 of these patients. One hundred and eighty-two (81.3%) patients are currently alive with no clinical evidence of disease after a median time of 84 months (range, 4-191 months) from surgery, whereas 39 (17.4%) developed recurrent disease after a median time of 29 months (range, 5-112 months). The relapse involved the pelvis in 21 (53.8%) cases, abdomen in 19 (48.7%), pelvic and/or para-aortic lymph nodes in 5 (12.8%), and distant sites in 5 (12.8%). The risk of recurrence was significantly related to FIGO substage (P < 0.0001) and tumor grade (P < 0.0001), but not to histological subtype. However, the recurrence rate was lower in mucinous carcinomas (6/52, 11.5%) and higher in clear cell carcinomas (5/14, 35.7%). By log-rank test the disease-free survival was significantly related to FIGO substage (P = 0.0006) and grade (P = 0.0001). Cox proportional hazard model showed that grade was the only independent prognostic variable for disease-free survival, with a risk ratio for relapse of 2.831 (95% CI, 1.120-6.624) for grade 2 and 7.725 (95% CI, 3.290-18.140) for grade 3, compared to grade 1. In conclusion, tumor grade is the strongest predictor of recurrence in stage I ovarian cancer.

American Joint Committee on Cancer Prognostic Factors Consensus Conference

“…[15][16][17][18][19] However, the working group was hesitant to recommend the incorporation of this factor into the staging system because of the current lack of uniformly accepted criteria for grading epithelial ovarian carcinoma. This lack of criteria is strikingly different from endometrial carcinoma, in which a defined criteria for grading is established as part of the staging system.…”

Surveillance of patients after initial treatment of ovarian cancer

“…However, the effectiveness of adjuvant treatment in adequately staged cases is still debated and optimal adjuvant chemotherapy has not yet been established [9,10]. Data from the literature about analysis of failures in patients with early stage ovarian cancer revealed that the median time to recurrence ranges between 11 and 29 months and that relapse involves more frequently the pelvis or abdomen than retroperitoneal lymph nodes [5,[11][12][13][14][15]. It is noteworthy that isolated pelvic failures represent 26-47% of overall recurrences [5,14,15].…”

Adjuvant chemotherapy with carboplatin and taxane compared with single drug carboplatin in early stage epithelial ovarian carcinoma

“…Tumor grade was a prognostic factor only in a univariate analysis in the present study. However, tumor grade is the most powerful prognostic factor in the early stages of epithelial ovarian cancer and it is confirmed by many authors (23)(24)(25)(26)(27). However, since all patients in our study received postoperative adjuvant chemotherapy, neither FIGO-stage nor tumor grade were used to select patients to adjuvant treatment.…”