A retrospective study demonstrating improvement in 5-year and post-relapse survival in ovarian cancer patients over a 24-year period


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Katharine Herbert, Tzyvia Rye, Paul Mitchell, Moira Stewart, Melanie Mackean, Charlie Gourley

University of Edinburgh Cancer Research Centre, UK

Abstract

Background

Ovarian cancer is the fourth most common malignancy affecting women in the UK, accounting for 6% of female cancer deaths. However, ovarian cancer is not a homogenous disease; survival figures which consider it a single entity are misleading. A more accurate picture of survival trends can be produced by considering previously established independent prognostic indicators in analysis of survival data.

Aim

To establish how survival has changed over a 24 year period in ovarian cancer patients treated by a cancer network serving 1.25 million people.

Method

Clinicopathological details of 2359 women diagnosed with ovarian malignancy between 01/01/1981 and 31/12/04 were extracted from a prospectively collected ovarian cancer database. Data were analysed by χ2 tests and the Kaplan-Meier method using SPSS 14.0 and GraphPad Prism 4.0.

Results

1946 women with epithelial ovarian cancer were included in the analysis. 5-year survival increased from 30.21% to 33.31% (p=0.009). Subgroup analysis demonstrated variations in survival improvement depending on clinicopathological features. Clinically significant increases in 5-year survival were seen for patients with advanced stage serous (10.12% to 18.81%), endometrioid (17.63% to 27.52%) and clear-cell (3.20% to 17.43%, p<0.05) cancers. Patients who received partial debulking also had an improved 5-year survival (5.24% to 22.79%, p<0.001).

1210 patients were included in an analysis of relapsed disease. Survival at 3 years post-relapse increased (9.14% to 14.50%, p=0.003); most notably in late stage tumours (7.26% to 15.08%, p<0.001), and those with serous and endometrioid histology (9.62% to 15.39%, p=0.0025 and 15.39% to 23.90%, p=0.013).

Conclusion

5-year overall survival has increased, particularly in subgroups of patients with poor risk disease. Post-relapse survival has also increased. Preliminary analysis shows no change in the number of lines of chemotherapy received by patients; analysis of how changes in chemotherapy regimes relate to survival is ongoing.