title: Relapse and survival in early-stage ovarian cancer.
abstract: OBJECTIVE
  To analyze the prognostic influence of patient characteristics, diagnostic markers or therapeutic procedures in women diagnosed with early ovarian cancer based on relapse and survival in long term follow-up.
  
  
  METHODS
  All women diagnosed and treated for early ovarian cancer at our institution between 1992 and 2006 were included in this retrospective study. Patient characteristics, clinical data including operative procedure, serum markers, stage and histology at first diagnosis as well as follow-up data were analyzed with regard to survival times and relapse rates.
  
  
  RESULTS
  Altogether, 116 patients were included. Mean follow-up time was 7.0 +/- 3.3 years (range 2-14 years). Histology revealed a serous tumor in 64.7% (75/116), mucinous in 19.0% (22/116) and endometiroid tumors in 7.8% (9/116) of all cases. TNM classification was pT1a in 49.1% (57/116), pT1b in 6% (7/116), pT1c in 32.8% (38/116) and pT2a in 12.1% (14/116). Lymph node involvement (N1) was found in 3.4% of all patients. 17 deaths and 17 relapses (each 14.7%) were documented during follow-up time with a mean time to recurrence of 3.3 +/- 2.1 years (range 1-7 years). The general 1-, 2-, 5- and 10-year survival rates were 99, 95.7 and 88.9 and 81.0%, respectively. Patients with tumor stage pT1a and pT1b had a significantly better survival (P = 0.0003) and significantly lower risk of recurrence (P = 0.0138) compared to higher tumor stages. Moreover, patients who experienced recurrent disease or presented with ascites at primary diagnosis had a significantly worse overall survival (recurrence: hazard ratio 0.17, 95% confidence interval 0.0155-0.2182, P = 0.0001; ascites: HR 2.84, CI 1.1919-10.1131, P = 0.0225). The risk for recurrent disease was significantly elevated for patients with low grade (G3) tumors (P = 0.0330). Interestingly, there was neither a worse survival rate nor a higher relapse rate for patients with primary laparoscopic surgical access.
  
  
  CONCLUSIONS
  Patients with early ovarian cancer stage pT1c and pT2a or low grade tumor have to be monitored closely in oncologic follow-up as they bare a significant risk for disease recurrence. Ascites at primary diagnosis, pT1c or pT2a tumor stage or recurrent disease are associated with a poor survival even in early ovarian cancer.
authors.affiliation: Department of Obstetrics and Gynecology, Ludwig-Maximilians-University Munich, Campus Grosshadern, Marchioninistrasse 15, Munich 80337, Germany. miriam.lenhard@med.uni-muenchen.de
authors.forename: S Miriam
authors.initials: SM
authors.lastname: Lenhard
authors.forename: A
authors.initials: A
authors.lastname: Bufe
authors.forename: C
authors.initials: C
authors.lastname: Kümper
authors.forename: P
authors.initials: P
authors.lastname: Stieber
authors.forename: D
authors.initials: D
authors.lastname: Mayr
authors.forename: L
authors.initials: L
authors.lastname: Hertlein
authors.forename: A
authors.initials: A
authors.lastname: Kirschenhofer
authors.forename: K
authors.initials: K
authors.lastname: Friese
authors.forename: A
authors.initials: A
authors.lastname: Burges
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites; D014408:Biomarkers, Tumor / Q000097:blood; D018394:CA-125 Antigen / Q000097:blood; D016009:Chi-Square Distribution; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen