The prediction of progression-free and overall survival in women with an advanced stage of epithelial ovarian carcinoma

Authors

  • CG Gerestein,

    Corresponding author
    1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Daniel den Hoed/Erasmus MC University Medical Center, Rotterdam, the Netherlands
      Dr CG Gerestein, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Erasmus MC/Daniel den Hoed University Oncology Center, Groene Hilledijk 301, 3075 AE Rotterdam, the Netherlands. Email c.gerestein@erasmusmc.nl
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  • MJC Eijkemans,

    1. Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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  • D de Jong,

    1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Princess Margaret Hospital UHN, Toronto, Canada
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  • MEL van der Burg,

    1. Department of Medical Oncology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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  • RHM Dykgraaf,

    1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Daniel den Hoed/Erasmus MC University Medical Center, Rotterdam, the Netherlands
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  • GS Kooi,

    1. Department of Obstetrics and Gynecology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
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  • A Baalbergen,

    1. Department of Obstetrics and Gynecology, Reinier De Graaf Hospital, Delft, the Netherlands
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  • CW Burger,

    1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Daniel den Hoed/Erasmus MC University Medical Center, Rotterdam, the Netherlands
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  • AC Ansink

    1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Daniel den Hoed/Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Dr CG Gerestein, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Erasmus MC/Daniel den Hoed University Oncology Center, Groene Hilledijk 301, 3075 AE Rotterdam, the Netherlands. Email c.gerestein@erasmusmc.nl

Abstract

Objective  Prognosis in women with ovarian cancer mainly depends on International Federation of Gynecology and Obstetrics stage and the ability to perform optimal cytoreductive surgery. Since ovarian cancer has a heterogeneous presentation and clinical course, predicting progression-free survival (PFS) and overall survival (OS) in the individual patient is difficult. The objective of this study was to determine predictors of PFS and OS in women with advanced stage epithelial ovarian cancer (EOC) after primary cytoreductive surgery and first-line platinum-based chemotherapy.

Design  Retrospective observational study.

Setting  Two teaching hospitals and one university hospital in the south-western part of the Netherlands.

Population  Women with advanced stage EOC.

Methods  All women who underwent primary cytoreductive surgery for advanced stage EOC followed by first-line platinum-based chemotherapy between January 1998 and October 2004 were identified. To investigate independent predictors of PFS and OS, a Cox’ proportional hazard model was used. Nomograms were generated with the identified predictive parameters.

Main outcome measures  The primary outcome measure was OS and the secondary outcome measures were response and PFS.

Results  A total of 118 women entered the study protocol. Median PFS and OS were 15 and 44 months, respectively. Preoperative platelet count (P = 0.007), and residual disease <1 cm (P = 0.004) predicted PFS with a optimism corrected c-statistic of 0.63. Predictive parameters for OS were preoperative haemoglobin serum concentration (P = 0.012), preoperative platelet counts (P = 0.031) and residual disease <1 cm (P = 0.028) with a optimism corrected c-statistic of 0.67.

Conclusion  PFS could be predicted by postoperative residual disease and preoperative platelet counts, whereas residual disease, preoperative platelet counts and preoperative haemoglobin serum concentration were predictive for OS. The proposed nomograms need to be externally validated.

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