title: Survival of Australian women with invasive epithelial ovarian cancer: a population-based study.
abstract: OBJECTIVE
  To describe survival patterns in a nationally complete cohort of Australian women with epithelial ovarian cancer, by sociodemographic and clinical factors.
  
  
  METHODS
  All 1192 women diagnosed with invasive epithelial ovarian cancer in 2005 were identified through state-based cancer registries. We obtained detailed information from their medical records in 2009 and updated survival data in 2012.
  
  
  METHODS
  Crude 3-year, 5-year and 7-year survival rates; 3-year and 5-year conditional survival; and hazard ratios (HRs) for the association of participant and cancer characteristics with survival, from multivariable Cox proportional hazards models.
  
  
  RESULTS
  Overall crude 5-year survival was 35% (95% CI, 33%-38%). Conditional survival increased moderately for women who lived beyond a year from diagnosis, although for women alive 2 years after diagnosis, the probability of surviving a further 5 years was still only 53% (95% CI, 49%-57%). Increasing age and disease stage were most strongly associated with poor survival. After adjusting for these, survival was significantly worse for women with carcinosarcomas (HRadj, 2.1 [95% CI, 1.3-3.2]), clear cell (HRadj, 1.7 [95% CI, 1.2-2.3]) and mucinous (HRadj, 2.6 [95% CI, 1.6-4.0]) cancers than for women with serous cancers. Presence of ascites at diagnosis (HRadj, 1.5 [95% CI, 1.3-1.8]), Charlson comorbidity score ≥ 3 (HRadj, 1.5 [95% CI, 1.1-2.1]), relative socioeconomic disadvantage (HRadj, 1.2 [95% CI, 1.1-1.4]) and regional-remote residence (HRadj, 1.2 [95% CI, 1.0-1.4]) were also associated with poorer survival.
  
  
  CONCLUSIONS
  Along with expected adverse effects of age and stage, we found survival differences by histological subtype, presence of ascites and comorbidities. Whether geographic and socioeconomic differences relate to treatment access or other factors warrants further investigation. Conditional survival estimates confirm the ongoing poor long-term prognosis for women with ovarian cancer, reinforcing the need for prevention and better treatments.
authors.affiliation: Gynaecological Cancers Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia. Satyamurthy.Anuradha@qimrberghofer.edu.au.
authors.forename: Satyamurthy
authors.initials: S
authors.lastname: Anuradha
authors.affiliation: Gynaecological Cancers Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
authors.forename: Penelope M
authors.initials: PM
authors.lastname: Webb
authors.affiliation: Gynaecologic Oncology, Royal Hobart Hospital, Hobart, TAS, Australia.
authors.forename: Penny
authors.initials: P
authors.lastname: Blomfield
authors.affiliation: Department of Gynaecological Oncology, Westmead Hospital, University of Sydney, Sydney, NSW, Australia.
authors.forename: Alison H
authors.initials: AH
authors.lastname: Brand
authors.affiliation: Department of Medical Oncology, Prince of Wales Hospital, Sydney, NSW, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Friedlander
authors.affiliation: School of Women's and Infants' Health, University of Western Australia, Perth, WA, Australia.
authors.forename: Yee
authors.initials: Y
authors.lastname: Leung
authors.affiliation: Department of Gynaecological Oncology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
authors.forename: Andreas
authors.initials: A
authors.lastname: Obermair
authors.affiliation: Department of Gynaecological Oncology, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Martin K
authors.initials: MK
authors.lastname: Oehler
authors.affiliation: Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Quinn
authors.affiliation: Border Medical Oncology, Wodonga, NSW, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Steer
authors.affiliation: Gynaecological Cancers Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Jordan
mesh_terms: D000367:Age Factors; D000368:Aged; D001201:Ascites / Q000453:epidemiology; D001315:Australia / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000401:mortality* / Q000473:pathology; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000473:pathology; D016016:Proportional Hazards Models; D012042:Registries; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013383:Suburban Population / Q000706:statistics & numerical data