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Prognostic Factors for Stage III Epithelial Ovarian Cancer: A Gynecologic Oncology Group Study

William E. Winter, III, G. Larry Maxwell, Chunqiao Tian, Jay W. Carlson, Robert F. Ozols, Peter G. Rose, Maurie Markman, Deborah K. Armstrong, Franco Muggia, William P. McGuire

From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brooke Army Medical Center, Ft Sam; Medical Oncology, The University of Texas M.D. Anderson, Houston, TX; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, DC; Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo; Departments of Medicine and Medical Oncology, Kaplan Cancer, Center, New York University Medical Center, New York, NY; Gynecologic Oncology of West Michigan, Grand Rapids, MI; Medical Science, Fox Chase Cancer Center, Philadelphia, PA; Division of Gynecologic Oncology, Case Western Reserve University; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cleveland Clinic Foundation, Cleveland, OH; Oncology, Gynecology, and Obstetrics, Johns Hopkins Kimmel Cancer Center; and the Harry and Jeanette Weinberg Cancer Institute, Franklin Square Hospital Center, Baltimore, MD

Address reprint requests to G. Larry Maxwell, MD, Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, DC 20307; e-mail: george.maxwell{at}na.amedd.army.mil

Purpose Conflicting results on prognostic factors for advanced epithelial ovarian cancer (EOC) have been reported because of small sample size and heterogeneity of study population. The purpose of this study was to identify factors predictive of poor prognosis in a similarly treated population of women with advanced EOC.

Patients and Methods A retrospective review of demographic, pathologic, treatment, and outcome data from 1,895 patients with International Federation of Gynecology and Obstetrics stage III EOC who had undergone primary surgery followed by six cycles of intravenous platinum/paclitaxel was conducted. A proportional hazards model was used to assess the association of prognostic factors with progression-free survival (PFS) and overall survival (OS).

Results Increasing age was associated with increased risks for disease progression (HR = 1.06; 95% CI, 1.02 to 1.11 for an increase every 10 years) and death (HR = 1.12; 95% CI, 1.06 to 1.18). Mucinous or clear-cell histology was associated with a worse PFS and OS compared with serous carcinomas. Patients with performance status (PS) 1 or 2 were at an increased risk for recurrence compared with PS 0 (HR = 1.12; 95% CI, 1.01 to 1.24). Compared with patients with microscopic residual disease, patients with 0.1 to 1.0 cm and > 1.0 cm residual disease had an increased risk of recurrence (HR = 1.96; 95% CI, 1.70 to 2.26; and HR = 2.36; 95% CI, 2.04 to 2.73, respectively) and death (HR = 2.11; 95% CI, 1.78 to 2.49; P < .001; and HR = 2.47; 95% CI, 2.09 to 2.92, respectively).

Conclusion Age, PS, tumor histology, and residual tumor volume were independent predictors of prognosis in patients with stage III EOC. These data can be used to identify patients with poor prognosis and to design future tailored randomized clinical trials.

Supported by National Cancer Institute grants to the Gynecologic Oncology Group administrative office (CA 27469) and statistical office (CA 37517).

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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