Staging Procedures, Clinical Management, and Survival Outcome for Ovarian Carcinoma

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Abstract
Objective. —To evaluate the relationship between survival and patterns of clinical management for ovarian carcinoma. Design. —Retrospective analysis of cancer registry data including follow-up, operative reports, and pathology reports. Setting. —Seventy-seven Illinois hospitals with active cancer registries. Patients. —A total of 2669 women with newly diagnosed ovarian carcinoma from 1983 through 1988. Main Outcome Measures. —Frequency of use of specific staging procedures and treatment options. Survival was estimated using the Kaplan-Meier product-limit method. Results. —Thirty percent of 632 stage I patients, 31% of 233 stage II patients, and 45% of 516 stage III patients underwent hysterectomy, bilateral salpingooophorectomy, omentectomy, sampled peritoneal washings, and node biopsy. Five-year survival for those receiving this extensive surgery (who were therefore pathologically staged) was as follows: stage I, 80%; stage II, 63%; and stage III, 28%. For those not receiving this extensive surgery (who were therefore clinically staged), the 5-year survival at these stages was 76%, 62%, and 21%, respectively. The overall survival curves were not significantly different between those who were pathologically staged and those who were clinically staged forstage I patients (P=.27) or stage II patients (P=.47), but were for stage III patients (P=.01). Platinum-based combination chemotherapy was given to 76% of 221 patients with pathological stage III disease. Their 5-year survival—50% for the group with no residual disease and 20% for the group with residual disease—was better than for those receiving regimens without platinum—37% and 5%, respectively, for the two groups—and the overall survival curves were significantly better for those receiving platinum (P<.0005 for both groups). The groups receiving platinum had younger patients. Conclusions. —Extensive surgery for pathological staging was not usually done for management of ovarian cancer, while platinum-based chemotherapy was commonly used. Failure to undergo extensive surgery had little impact on survival for stage I and II patients. However, use of extensive surgery and platinum-based chemotherapy improved survival for stage III patients. The improved survival for this group receiving platinum-based chemotherapy may be explained in part by selection of younger patients for this treatment. (JAMA. 1993;269:1119-1122)

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