title: Prognostic factors of stage IV epithelial ovarian cancer: a multicenter retrospective study.
abstract: OBJECTIVE
  In the present study, we conducted a multicenter retrospective analysis to elucidate the prognostic factors of stage IV epithelial ovarian cancer.
  
  
  METHODS
  In November 1999, 24 Japanese institutions received questionnaires regarding stage IV epithelial ovarian cancer patients. Eligibility criteria included all patients with stage IV epithelial ovarian cancer who were surgically confirmed and initially treated in each institution between January 1990 and December 1997. Data were collected regarding age, performance status, tumor histologic subtype, site of metastasis, preoperative CA125, cytoreductive surgery, residual disease after cytoreductive surgery, and response to primary chemotherapy. Survival analysis and comparisons were performed by univariate and multivariate methods.
  
  
  RESULTS
  Two hundred twenty-five patients with stage IV ovarian cancer were identified. The median age of the patients was 54 years. The most common site of extraperitoneal disease was malignant pleural effusion (39.6%). Of the 225 patients who underwent an attempt at surgical debulking, 70 (31.1%) were optimally cytoreduced. Most patients received platinum-based combination chemotherapy for primary chemotherapy. In multivariate analysis, performance status, histology, and residual disease after cytoreductive surgery were independent prognostic predictors of outcome. The overall median survival for optimally debulked patients was 32 months compared to 16 months for suboptimally debulked patients (P < 0.0001, hazard ratio: 0.415).
  
  
  CONCLUSIONS
  Optimal surgical debulking, performance status, and histology appear to be important prognostic factors of survival in patients with stage IV epithelial ovarian cancer.
authors.affiliation: Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai 980-8574, Japan.
authors.forename: J I
authors.initials: JI
authors.lastname: Akahira
authors.forename: H
authors.initials: H
authors.lastname: Yoshikawa
authors.forename: Y
authors.initials: Y
authors.lastname: Shimizu
authors.forename: R
authors.initials: R
authors.lastname: Tsunematsu
authors.forename: T
authors.initials: T
authors.lastname: Hirakawa
authors.forename: H
authors.initials: H
authors.lastname: Kuramoto
authors.forename: K
authors.initials: K
authors.lastname: Shiromizu
authors.forename: K
authors.initials: K
authors.lastname: Kuzuya
authors.forename: T
authors.initials: T
authors.lastname: Kamura
authors.forename: Y
authors.initials: Y
authors.lastname: Kikuchi
authors.forename: S
authors.initials: S
authors.lastname: Kodama
authors.forename: K
authors.initials: K
authors.lastname: Yamamoto
authors.forename: S
authors.initials: S
authors.lastname: Sato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate