title: Staging procedures, clinical management, and survival outcome for ovarian carcinoma.
abstract: OBJECTIVE
  To evaluate the relationship between survival and patterns of clinical management for ovarian carcinoma.
  
  
  METHODS
  Retrospective analysis of cancer registry data including follow-up, operative reports, and pathology reports.
  
  
  METHODS
  Seventy-seven Illinois hospitals with active cancer registries.
  
  
  METHODS
  A total of 2669 women with newly diagnosed ovarian carcinoma from 1983 through 1988.
  
  
  METHODS
  Frequency of use of specific staging procedures and treatment options. Survival was estimated using the Kaplan-Meier product-limit method.
  
  
  RESULTS
  Thirty percent of 632 stage I patients, 31% of 233 stage II patients, and 45% of 516 stage III patients underwent hysterectomy, bilateral salpingo-oophorectomy, omentectomy, sampled peritoneal washings, and node biopsy. Five-year survival for those receiving this extensive surgery (who were therefore pathologically staged) was as follows: stage I, 80%; stage II, 63%; and stage III, 28%. For those not receiving this extensive surgery (who were therefore clinically staged), the 5-year survival at these stages was 76%, 62%, and 21%, respectively. The overall survival curves were not significantly different between those who were pathologically staged and those who were clinically staged for stage I patients (P = .27) or stage II patients (P = .47), but were for stage III patients (P = .01). Platinum-based combination chemotherapy was given to 76% of 221 patients with pathological stage III disease. Their 5-year survival--50% for the group with no residual disease and 20% for the group with residual disease--was better than for those receiving regimens without platinum--37% and 5%, respectively, for the two groups--and the overall survival curves were significantly better for those receiving platinum (P < .0005 for both groups). The groups receiving platinum had younger patients.
  
  
  CONCLUSIONS
  Extensive surgery for pathological staging was not usually done for management of ovarian cancer, while platinum-based chemotherapy was commonly used. Failure to undergo extensive surgery had little impact on survival for stage I and II patients. However, use of extensive surgery and platinum-based chemotherapy improved survival for stage III patients. The improved survival for this group receiving platinum-based chemotherapy may be explained in part by selection of younger patients for this treatment.
authors.affiliation: Cancer Incidence and End Results Committee of American Cancer Society, Illinois Division, Chicago 60603-3170.
authors.forename: R
authors.initials: R
authors.lastname: Hand
authors.forename: A
authors.initials: A
authors.lastname: Fremgen
authors.forename: J S
authors.initials: JS
authors.lastname: Chmiel
authors.forename: W
authors.initials: W
authors.lastname: Recant
authors.forename: R
authors.initials: R
authors.lastname: Berk
authors.forename: J
authors.initials: J
authors.lastname: Sylvester
authors.forename: S
authors.initials: S
authors.lastname: Sener
mesh_terms: D005260:Female; D006801:Humans; D007087:Illinois; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis