10-year survival in patients diagnosed with high-grade epithelial ovarian cancer: a new metric for a new millennium

Abstract

<h3>Objectives:</h3> To determine 10-year (yr) overall survival (OS) for patients (pts) diagnosed with high-grade epithelial ovarian cancer (HGEOC). <h3>Methods:</h3> We analyzed the records of all pts diagnosed with HGEOC who underwent primary treatment at our institution between 1/2001 and 12/2009. Patients lost to follow-up were excluded if they had less than 5 yrs of follow-up. All pts with a known date of death were included. Appropriate statistical methods were used. <h3>Results:</h3> During the study period, a total of 1100 pts had their primary treatment at our institution. Histology was high-grade serous in 891 pts (81%) and other high-grade histology in 209 (19%). FIGO Stage was as follows: I, 141 (13%); II, 63 (6%); III, 688 (63%); IV, 208 (19%). Initial treatment was: surgical staging (N=225)/debulking (N=651), 876 (80%); neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS), 187 (17%); chemotherapy alone with no surgery, 37 (3%). Of the 896 stage III or IV pts treated with PDS or NACT/IDS, 306 (36%) had complete gross resection (CGR), 360 (42%) had 1-10mm residual, and 172 (20%) had >10mm residual. Of the 343 pts (31%) tested, 53/343 (15%) were identified to have a germline <i>BRCA1</i> mutation, 29/343 (8%) a germline <i>BRCA2</i> mutation, and 8/343 (2%) a germline mutation in a moderate penetrance gene. The median follow-up for survivors was 135 mos. The 10-yr OS by stage was: I, 80.1%; II, 64.6; IIIA-B, 41.1%; IIIC, 21.3%; IV, 6.9% (p<0.001, Figure 1). Patients with advanced stage disease treated with PDS had a 10-yr OS of 21.1%, and those treated with NACT/IDS 13.1% (p<0.001). Patients in whom CGR was achieved during PDS or IDS had a 10-yr OS of 37.4% and 21.6%, respectively (p<0.001), while those with 1-10mm residual during PDS or IDS had a 10-yr OS of 16.4% and 4.5%, respectively (p<0.001). Overall, 241 pts (22%) had an OS of 10 years or greater, of whom 132 (55%) were originally diagnosed with stage III or IV disease. Of these long-term survivors with advanced stage disease, the majority, 104 (79%), were treated with PDS resulting in CGR (n=58, (56%)). Ten pts (8%) treated with PDS with >10mm residual were also long-term survivors. <h3>Conclusions:</h3> In our large 1100-pt cohort of women with HGEOC, 10-yr survival correlated with stage, ranging from 80% for stage I to 7% for stage IV. These data can be useful during patient counseling. The heterogeneity of these long-term survivors speaks to the differing underlying biologic drivers of this disease.