Epithelial ovarian carcinoma in the reproductive age group

Abstract

BACKGROUND.A retrospective review of women age Յ 40 years with epithelial ovarian carcinoma was undertaken to determine whether patient age and tumor grade are independent prognostic factors for survival, to investigate the survival rate for young women with ovarian carcinoma, and to characterize these young women in terms of reproductive capability. METHODS.The tumor registry of the Massachusetts General Hospital was used to identify cases of ovarian carcinoma diagnosed between January 1980 and July 1996.Patient records and pathology were reviewed. Survival rates were calculated by the Kaplan-Meier method and Cox proportional hazards models were used to determine the independent effect of each variable on survival. RESULTS.Ninety-two tumors epithelial tumors were identified with 46 (50%) classified as borderline. In the univariate analysis, stage (P Ͻ 0.001), grade (P Ͻ 0.001), residual disease (Յ 2 cm vs. Ͼ 2 cm , P Ͻ 0.001), and age (Ͻ 30 years vs. 31-40 years; P ϭ 0.019) were found to be significant prognostic factors for survival.However, in the multivariate analysis only tumor grade (with borderline tumors assigned a grade of 0) and stage were significant predictors of survival (P Ͻ 0.01 for both). The 5-year survival rate for carcinoma patients with advanced disease was 22.9%. Patients with borderline tumors were more likely be diagnosed during an evaluation for infertility and were more likely to have successful live births after carcinoma treatment. CONCLUSIONS.Young women with advanced epithelial carcinoma have a 5-year survival rate similar to that quoted in the literature, despite the use of more aggressive chemotherapeutic regimens. Patients with borderline tumors of any stage have an excellent prognosis for preserving fertility options. Cancer 1999;85: 2623-9.

Ovarian cancer in younger vs older women: a population-based analysis

“…On the other hand, case-controlled studies from single academic institutions adjusting for the experience of surgeon, extent of surgery, and adjuvant chemotherapy, younger age remained a significant independent factor for improved survival (Duska et al, 1999;Chan et al, 2003). In addition, Chan et al (2003) showed that younger age was an important prognostic factor for improved survival independent of age-associated determinants such as performance status.…”

“…Although most reports have shown that younger women with ovarian cancer have an improved outcome compared to older women and have lower stage and more well-differentiated tumours (Smedley and Sikora, 1985;Plaxe et al, 1993;Thigpen et al, 1993;Rodriguez et al, 1994;Chan et al, 2003), others have found that age is not an independent prognostic factor after adjusting for tumour stage and grade (Massi et al, 1996;Duska et al, 1999). Moreover, the majority of these previous studies on ovarian cancer are based on single institution experiences, which contain inherent biases such as patient selection (Plaxe et al, 1993;Duska et al, 1999;Chan et al, 2003). In addition, owing to the low prevalence of young patients diagnosed with invasive ovarian cancer, these studies have also been limited by a small number of patients, inclusion of low malignant potential tumours, germ cell or sex cord stromal tumours, and unstaged cancers.…”

“…Some reports have indicated that younger age is not an independent prognostic factor for improved survival, suggesting that the survival advantage of the younger patients may be attributed to the increased frequency of early-stage, lower grade disease, and tumours of low malignant potential (Massi et al, 1996;Duska et al, 1999). Nonetheless, several other published studies have specified age as a significant prognostic factor, with older patients faring less well than younger women (Smedley and Sikora, 1985;Swenerton et al, 1985;Yancik et al, 1986;Omura et al, 1991;Gloecker-Ries, 1993;Thigpen et al, 1993;Kosary, 1994;Rodriguez et al, 1994;Lee et al, 1999;Brun et al, 2000;Schildkraut et al, 2000;Barnholtz-Sloan et al, 2003;Chan et al, 2003;O'Malley et al, 2003).…”

Prognostic Factors In Epithelial Ovarian Carcinoma: A Reference Institution Experience

“…Similarly, studies in the literature investigating the prognostic significance of age studied the survival time of patients as well, and emphasized that young age is an independent prognostic factor (15,16) . Another study in which only the reproductive period was evaluated revealed that age does not have a prognostic effect on survival (17) .…”

Clinical outcomes of fertility-sparing treatments in young patients with epithelial ovarian carcinoma

“…Nowadays, as lifestyles change, the onset age of EOC occurs at a much younger age. Several reports have estimated that women under 40 years of age comprise 3%-17% of all EOCs (Duska et al, 1999;Greenlee et al, 2001). As diagnostic and treatment techniques have improved over the past decade, there has been a gradual abandonment of radical surgical procedures in favor of more conservative treatments in an effort to decrease morbidity and preserve fertility, without affecting overall survival (OS) and disease-free survival (DFS) (Berman, 2003).…”