The treatment and outcomes of early-stage epithelial ovarian cancer: have we made any progress?
The objective of this study is to determine the progress and trends in the treatment and survival of women with early-stage (I-II) epithelial ovarian cancer. Data were obtained from the SEER database between 1988 and 2001. Kaplan-Meier and Cox regressions methods were employed for statistical analyses. Of the 8372 patients, the median age was 57 years (range: 12-99 years). A total of 6152 patients (73.4%) presented with stage I and 2220 (26.5%) with stage II disease. Over the periods 1988--1992, 1993--1997, and 1998-- 2001, 3-year disease-specific survivals increased from 86.1 to 87.2 to 88.8% (P=0.076). The number of patients that underwent lymphadenectomy has increased significantly from 26.2 to 38.7 to 54.2% over the study period (P<0.001). Of those patients who underwent staging procedures with lymphadenectomy, there was no improvement in survival over the three study periods (from 93.2 to 93.5 to 93.1%; P=0.978). On multivariate analysis, younger age, nonclear cell histology, earlier stage, lower grade, surgery, and lymphadenectomy were significant independent prognostic factors for improved survival. After adjusting for surgical staging with lymphadenectomy, the year of diagnosis was no longer an important prognostic factor. In conclusion, the use of lymphadenectomy during surgery for early-stage ovarian cancer has doubled over the last 14 years. The marginal improvement in survival demonstrated over time is potentially attributed to the increased use of staging procedures with lymphadenectomy.
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Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco School of Medicine, 1600 Divisadero Street, Box 1702, San Francisco, CA 94143, USA. chanjohn@obgyn.ucsf.edu
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D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D018450:Disease Progression; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000639:trends; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000401:mortality*; D010051:Ovarian Neoplasms / Q000401:mortality*; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome