Predictive Factors for Postrecurrence Survival in Epithelial Ovarian Cancer-a Consecutive Series of 368 Patients and Review of the Literature

Abstract

Purpose: Ovarian cancer is usually diagnosed at advanced stage. Thus, recurrences are common. The aim of this retrospective study was to analyze the prognostic value of selected clinical and biological factors with regard to overall survival after first recurrence. Methods: A total of 368 evaluable patients with primary epithelial cancer of the ovary, fallopian tube or peritoneum were included. Carcinosarcomas, sarcomas and borderline tumors of the ovary, the fallopian tube and the peritoneum were excluded. Patient and tumor characteristics were extracted from hospital records. Recurrence was defined as the first clinical manifestation of tumor progression after an interval of no clinical evidence of disease following primary surgery. Patients with an elevated tumor marker CA125 alone and those who had clinically evident tumor after primary surgery were not eligible for this study. Results: In the multivariate cox regression analysis, five parameters were identified as independent favourable prognostic factors for survival after first recurrence: Time to recurrence ≥ 2 years (p=0.000), Karnofsky status ≥ 80% at the time of recurrence (p=0.008), use of adjuvant chemotherapy (p=0.013), residual disease ≤ 1 cm at primary surgery (p=0.044), and isolated peripheral or paraaortic lymph nodes as localization of first recurrence (p<0.05). Conclusions: Prolonged interval to recurrence seems to be of utmost importance for longer postrecurrence survival. In addition, small or no residual tumor after primary surgery, administration of adjuvant chemotherapy, higher performance status at recurrence and metastases in the peripheral or paraaortic nodes are predictive for improved overall survival.