Survival after recurrence in early-stage high-risk epithelial ovarian cancer: A Gynecologic Oncology Group study
Introduction
In 2009, it is estimated that there will be approximately 21,550 new epithelial ovarian cancers (EOC) diagnosed in the United States, and nearly 30% will present with stage I-II disease [1]. Although the 5-year survival in this group is favorable at 70–90%, nearly one-third of patients initially diagnosed with early-stage ovarian cancer will recur [2], [3]. Patients at risk for recurrence include those with stage IA–IB, grade 3; stage IC and II, all grades; and all clear cell carcinomas. In a prior analysis of early-stage high-risk EOC treated on two Gynecologic Oncology Group (GOG) prospective randomized trials, Chan et al. found that older age, higher stage, higher grade, and positive cytology are important prognostic factors for recurrence and poorer survival [4].
Given that the majority of patients with early-stage ovarian cancer are cured, it is challenging to study the outcomes of women with recurrent early-stage ovarian cancer. Although it is well recognized that those with recurrent stage III–IV ovarian cancer have a poor prognosis, it remains unclear if those with recurrent stage I–II ovarian cancer have similar outcomes. There are few studies that have reported on the outcomes of patients with recurrent early-stage ovarian cancer. Kolomainen et al. reported on 61 patients with recurrent stage I EOC who did not receive adjuvant chemotherapy during primary treatment and found that only some patients can be successfully treated with chemotherapy after recurrence [5]. However, there is a lack of information on the outcomes of early-stage high-risk EOC that have relapsed after complete surgical staging followed by adjuvant therapy.
In this current study, we analyzed a cohort of early-stage high-risk ovarian cancer patients from GOG study 157, a randomized clinical trial that evaluated the difference between 6 versus 3 cycles of paclitaxel and carboplatin. We propose to determine the outcomes of these patients with recurrent disease after adjuvant therapy to identify the clinicopathologic factors important for survival after recurrence.
Section snippets
Methods
All women enrolled in GOG study 157 who underwent complete surgical staging and had recurrent disease were included in our analysis. Patients provided written informed consent consistent with all federal, state, and local requirements prior to enrolling in the protocols. Details regarding eligibility criteria, treatment, and outcome for this protocol have been previously published [6]. Based on the study entry criteria, early-stage high-risk EOC was defined as stage IA–IB, grade 3; stage IC and
Results
Of 301 evaluable patients who underwent complete surgical staging followed by adjuvant chemotherapy, 74 had recurrent disease. The demographic and clinicopathologic characteristics of these patients at initial diagnosis are presented in Table 1. The median age at recurrence was 63 years. Recurrence was diagnosed clinically in 46% of patients and radiographically in 54%. The median TFI was 21 months. More specifically, 22% of women recurred within 1 year and 35% recurred within 12–24 months. The
Discussion
Early-stage ovarian cancer is relatively uncommon. Therefore, there are limited reports on the outcomes of this group of patients. Over the last two decades, the GOG has performed two randomized clinical trials on early-stage high-risk ovarian cancer. In a recent review of these two trials consisting of 506 patients, we found a 5-year recurrence-free and overall survival (OS) of 75.5% and 81.7%, respectively. On multivariable analysis, older age, higher stage, higher grade, and malignant
Conflict of interest
The authors have no conflicts of interest to declare.
Acknowledgments
This study was sponsored by a career development award from the Gynecologic Oncology Group to J.K.C.
This study was supported by a grant from the American Board of Obstetrics and Gynecology/American Association of Obstetricians and Gynecologists Foundation and National Cancer Institute grants to the Gynecologic Oncology Group Administrative Office (CA 27469) and the Gynecologic Oncology Group Statistical and Data Center (CA 37517).
The following Gynecologic Oncology Group member institutions
References (20)
- et al.
Carcinoma of the ovary
Int. J. Gynaecol. Obstet.
(2003) - et al.
Randomized phase III trial of three versus six cycles of adjuvant carboplatin and paclitaxel in early stage epithelial ovarian carcinoma: a Gynecologic Oncology Group study
Gynecol. Oncol.
(2006) - et al.
Analysis of prognostic factors in stage I epithelial ovarian carcinoma: importance of degree of differentiation and deoxyribonucleic acid ploidy in predicting relapse
Am. J. Obstet. Gynecol.
(1993) - et al.
Randomized study on adjuvant chemotherapy in stage I high-risk ovarian cancer with evaluation of DNA-ploidy as prognostic instrument
Ann. Oncol.
(2000) - et al.
Treatment of relapsed carcinoma of the ovary with cisplatin or carboplatin following initial treatment with these compounds
Gynecol. Oncol.
(1990) - American Cancer Society. Cancer facts and figures 2007. Available at:...
- et al.
Epithelial ovarian cancer
- et al.
Prognostic factors for high-risk early-stage 439 epithelial ovarian cancer: a Gynecologic Oncology Group study
Cancer
(2008) - et al.
Can patients with relapsed, previously untreated, stage I epithelial ovarian cancer be successfully treated with salvage therapy?
J. Clin. Oncol.
(2003) - D. Collett, Modelling Survival Data In Medical Research (2nd Ed). Chapman and Hall/CRC...
Cited by (52)
Long-term survival following definitive radiation therapy for recurrence or oligometastases in gynecological malignancies: A landmark analysis
2022, Gynecologic OncologyCitation Excerpt :Despite incremental increases in progression-free survival, 5-year survival rates for metastatic patients remain low: 17.6% for cervical cancer, 17.8% for uterine cancer, and 30.3% for ovarian cancer [2,3]. Novel targeted systemic agents have shown promise for metastatic gynecological cancer, with several studies demonstrating extended survival in patients receiving these treatments [1,4,5]. Advanced radiation therapy (RT) techniques similarly show promise for patients with metastatic gynecological cancer, however no prospective studies exist to demonstrate their effects on survival.
Post-recurrence survival in patients with cervical cancer
2022, Gynecologic OncologyHigh amplification of PVT1 and MYC predict favorable prognosis in early ovarian carcinoma
2020, Pathology Research and PracticeThe effect of adjuvant chemotherapy on survival in patients with FIGO stage I high-grade serous ovarian cancer
2019, Gynecologic OncologyCitation Excerpt :To minimize toxicity associated with paclitaxel, single-agent carboplatin, fewer courses, and the use of coldcap can be considered. The Gynecologic Oncology Group (GOG 157) compared the recurrence rate of high-risk FIGO stage I-II EOC after either three or six cycles of carboplatin and paclitaxel, and evaluated which patient would benefit most from more cycles of chemotherapy based on clinical and histological characteristics [29–32]. For patients with high-risk serous FIGO stage I-II, a significant improved RFS was demonstrated with six cycles of combination chemotherapy, compared with three cycles.