Prognosis and conditional disease-free survival among patients with ovarian cancer.
OBJECTIVE
Traditional disease-free survival (DFS) does not reflect changes in prognosis over time. Conditional DFS accounts for elapsed time since achieving remission and may provide more relevant prognostic information for patients and clinicians. This study aimed to estimate conditional DFS among patients with ovarian cancer and to evaluate the impact of patient characteristics.


METHODS
Patients were recruited as part of the Hormones and Ovarian Cancer Prediction case-control study and were included in the current study if they had achieved remission after a diagnosis of cancer of the ovary, fallopian tube, or peritoneum (N = 404). Demographic and lifestyle information was collected at enrollment; disease, treatment, and outcome information was abstracted from medical records. DFS was calculated using the Kaplan-Meier method. Conditional DFS estimates were computed using cumulative DFS estimates.


RESULTS
Median DFS was 2.54 years (range, 0.03-9.96 years) and 3-year DFS was 48.2%. The probability of surviving an additional 3 years without recurrence, conditioned on having already survived 1, 2, 3, 4, and 5 years after remission, was 63.8%, 80.5%, 90.4%, 97.0%, and 97.7%, respectively. Initial differences in 3-year DFS at time of remission between age, stage, histology, and grade groups decreased over time.


CONCLUSIONS
DFS estimates for patients with ovarian cancer improved dramatically over time, in particular among those with poorer initial prognoses. Conditional DFS is a more relevant measure of prognosis for patients with ovarian cancer who have already achieved a period of remission, and time elapsed since remission should be taken into account when making follow-up care decisions.
Michelle L. Kurta, Marnie Bertolet, Joel L. Weissfeld, Janet M. Catov, Francesmary Modugno, Clareann H. Bunker, Brenda Diergaarde, Graduate School of Public Health; Marnie Bertolet, Clinical & Translational Science Institute, University of Pittsburgh; Robert P. Edwards, Kathleen McDonough, Joel L. Weissfeld, Brenda Diergaarde, University of Pittsburgh Cancer Institute; Robert P. Edwards, Janet M. Catov, Francesmary Modugno, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine; Robert P. Edwards, Francesmary Modugno, Magee-Womens Research Institute Ovarian Cancer Center of Excellence, Pittsburgh, PA; Kirsten B. Moysich, Roswell Park Cancer Institute, Buffalo, NY; and Roberta B. Ness, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX.
Michelle L
ML
Kurta
Michelle L. Kurta, Marnie Bertolet, Joel L. Weissfeld, Janet M. Catov, Francesmary Modugno, Clareann H. Bunker, Brenda Diergaarde, Graduate School of Public Health; Marnie Bertolet, Clinical & Translational Science Institute, University of Pittsburgh; Robert P. Edwards, Kathleen McDonough, Joel L. Weissfeld, Brenda Diergaarde, University of Pittsburgh Cancer Institute; Robert P. Edwards, Janet M. Catov, Francesmary Modugno, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine; Robert P. Edwards, Francesmary Modugno, Magee-Womens Research Institute Ovarian Cancer Center of Excellence, Pittsburgh, PA; Kirsten B. Moysich, Roswell Park Cancer Institute, Buffalo, NY; and Roberta B. Ness, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX.
Robert P
RP
Edwards
Michelle L. Kurta, Marnie Bertolet, Joel L. Weissfeld, Janet M. Catov, Francesmary Modugno, Clareann H. Bunker, Brenda Diergaarde, Graduate School of Public Health; Marnie Bertolet, Clinical & Translational Science Institute, University of Pittsburgh; Robert P. Edwards, Kathleen McDonough, Joel L. Weissfeld, Brenda Diergaarde, University of Pittsburgh Cancer Institute; Robert P. Edwards, Janet M. Catov, Francesmary Modugno, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine; Robert P. Edwards, Francesmary Modugno, Magee-Womens Research Institute Ovarian Cancer Center of Excellence, Pittsburgh, PA; Kirsten B. Moysich, Roswell Park Cancer Institute, Buffalo, NY; and Roberta B. Ness, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX.
Kirsten B
KB
Moysich
Michelle L. Kurta, Marnie Bertolet, Joel L. Weissfeld, Janet M. Catov, Francesmary Modugno, Clareann H. Bunker, Brenda Diergaarde, Graduate School of Public Health; Marnie Bertolet, Clinical & Translational Science Institute, University of Pittsburgh; Robert P. Edwards, Kathleen McDonough, Joel L. Weissfeld, Brenda Diergaarde, University of Pittsburgh Cancer Institute; Robert P. Edwards, Janet M. Catov, Francesmary Modugno, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine; Robert P. Edwards, Francesmary Modugno, Magee-Womens Research Institute Ovarian Cancer Center of Excellence, Pittsburgh, PA; Kirsten B. Moysich, Roswell Park Cancer Institute, Buffalo, NY; and Roberta B. Ness, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX.
Kathleen
K
McDonough
Michelle L. Kurta, Marnie Bertolet, Joel L. Weissfeld, Janet M. Catov, Francesmary Modugno, Clareann H. Bunker, Brenda Diergaarde, Graduate School of Public Health; Marnie Bertolet, Clinical & Translational Science Institute, University of Pittsburgh; Robert P. Edwards, Kathleen McDonough, Joel L. Weissfeld, Brenda Diergaarde, University of Pittsburgh Cancer Institute; Robert P. Edwards, Janet M. Catov, Francesmary Modugno, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine; Robert P. Edwards, Francesmary Modugno, Magee-Womens Research Institute Ovarian Cancer Center of Excellence, Pittsburgh, PA; Kirsten B. Moysich, Roswell Park Cancer Institute, Buffalo, NY; and Roberta B. Ness, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX.
Marnie
M
Bertolet
Michelle L. Kurta, Marnie Bertolet, Joel L. Weissfeld, Janet M. Catov, Francesmary Modugno, Clareann H. Bunker, Brenda Diergaarde, Graduate School of Public Health; Marnie Bertolet, Clinical & Translational Science Institute, University of Pittsburgh; Robert P. Edwards, Kathleen McDonough, Joel L. Weissfeld, Brenda Diergaarde, University of Pittsburgh Cancer Institute; Robert P. Edwards, Janet M. Catov, Francesmary Modugno, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine; Robert P. Edwards, Francesmary Modugno, Magee-Womens Research Institute Ovarian Cancer Center of Excellence, Pittsburgh, PA; Kirsten B. Moysich, Roswell Park Cancer Institute, Buffalo, NY; and Roberta B. Ness, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX.
Joel L
JL
Weissfeld
Michelle L. Kurta, Marnie Bertolet, Joel L. Weissfeld, Janet M. Catov, Francesmary Modugno, Clareann H. Bunker, Brenda Diergaarde, Graduate School of Public Health; Marnie Bertolet, Clinical & Translational Science Institute, University of Pittsburgh; Robert P. Edwards, Kathleen McDonough, Joel L. Weissfeld, Brenda Diergaarde, University of Pittsburgh Cancer Institute; Robert P. Edwards, Janet M. Catov, Francesmary Modugno, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine; Robert P. Edwards, Francesmary Modugno, Magee-Womens Research Institute Ovarian Cancer Center of Excellence, Pittsburgh, PA; Kirsten B. Moysich, Roswell Park Cancer Institute, Buffalo, NY; and Roberta B. Ness, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX.
Janet M
JM
Catov
Michelle L. Kurta, Marnie Bertolet, Joel L. Weissfeld, Janet M. Catov, Francesmary Modugno, Clareann H. Bunker, Brenda Diergaarde, Graduate School of Public Health; Marnie Bertolet, Clinical & Translational Science Institute, University of Pittsburgh; Robert P. Edwards, Kathleen McDonough, Joel L. Weissfeld, Brenda Diergaarde, University of Pittsburgh Cancer Institute; Robert P. Edwards, Janet M. Catov, Francesmary Modugno, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine; Robert P. Edwards, Francesmary Modugno, Magee-Womens Research Institute Ovarian Cancer Center of Excellence, Pittsburgh, PA; Kirsten B. Moysich, Roswell Park Cancer Institute, Buffalo, NY; and Roberta B. Ness, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX.
Francesmary
F
Modugno
Michelle L. Kurta, Marnie Bertolet, Joel L. Weissfeld, Janet M. Catov, Francesmary Modugno, Clareann H. Bunker, Brenda Diergaarde, Graduate School of Public Health; Marnie Bertolet, Clinical & Translational Science Institute, University of Pittsburgh; Robert P. Edwards, Kathleen McDonough, Joel L. Weissfeld, Brenda Diergaarde, University of Pittsburgh Cancer Institute; Robert P. Edwards, Janet M. Catov, Francesmary Modugno, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine; Robert P. Edwards, Francesmary Modugno, Magee-Womens Research Institute Ovarian Cancer Center of Excellence, Pittsburgh, PA; Kirsten B. Moysich, Roswell Park Cancer Institute, Buffalo, NY; and Roberta B. Ness, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX.
Clareann H
CH
Bunker
Michelle L. Kurta, Marnie Bertolet, Joel L. Weissfeld, Janet M. Catov, Francesmary Modugno, Clareann H. Bunker, Brenda Diergaarde, Graduate School of Public Health; Marnie Bertolet, Clinical & Translational Science Institute, University of Pittsburgh; Robert P. Edwards, Kathleen McDonough, Joel L. Weissfeld, Brenda Diergaarde, University of Pittsburgh Cancer Institute; Robert P. Edwards, Janet M. Catov, Francesmary Modugno, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine; Robert P. Edwards, Francesmary Modugno, Magee-Womens Research Institute Ovarian Cancer Center of Excellence, Pittsburgh, PA; Kirsten B. Moysich, Roswell Park Cancer Institute, Buffalo, NY; and Roberta B. Ness, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX.
Roberta B
RB
Ness
Michelle L. Kurta, Marnie Bertolet, Joel L. Weissfeld, Janet M. Catov, Francesmary Modugno, Clareann H. Bunker, Brenda Diergaarde, Graduate School of Public Health; Marnie Bertolet, Clinical & Translational Science Institute, University of Pittsburgh; Robert P. Edwards, Kathleen McDonough, Joel L. Weissfeld, Brenda Diergaarde, University of Pittsburgh Cancer Institute; Robert P. Edwards, Janet M. Catov, Francesmary Modugno, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine; Robert P. Edwards, Francesmary Modugno, Magee-Womens Research Institute Ovarian Cancer Center of Excellence, Pittsburgh, PA; Kirsten B. Moysich, Roswell Park Cancer Institute, Buffalo, NY; and Roberta B. Ness, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX. diergaardeb@upmc.edu.
Brenda
B
Diergaarde
D000328:Adult; D000368:Aged; D018394:CA-125 Antigen / Q000097:blood; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000097:blood / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models
D018394:CA-125 Antigen