Adjuvant chemotherapy beneficial for select early-stage, low-grade serous ovarian cancer patients

Abstract

Objectives: Low-grade serous ovarian cancer (LGSC) is a rare subtype of ovarian serous carcinoma accounting for only 6% of all serous ovarian carcinoma. These tumors are considered to be relatively chemoresistant because of their tumor biology, making the role of adjuvant chemotherapy in early stage LGSC unclear. Herein, we sought to identify any chemotherapy benefit in overall survival among women with early-stage LGSC.Methods: The National Cancer Data Base was queried for all patients diagnosed from 1998 to 2012 with stage IA–IC LGSC. Only patients with nodal dissection were included for analysis. Χ2 test, logistic regression analysis, and log-rank test were used to analyze chemotherapy utilization and survival.Results: Of the 2,260 patients identified as having stage I LGSC, 1,481 had nodal dissection and were included for analysis. Chemotherapy was used in 15%, 21%, and 60% for stage IA, IB, and 1C, respectively. Age, insurance type (uninsured, private, Medicare/Medicaid), and stage were all associated with increased likelihood of receiving chemotherapy. Only age, Charlson-Deyo Comorbidity index, and insurance type were statistically significantly associated with survival on univariate and multivariable analysis. The 5-year overall survival (OS) for stage IA, IB, and IC without chemotherapy are 92%, 84%, and 88%, respectively. The 5-year OS for stage IA, IB, and IC with chemotherapy are 96%, 95%, and 94% respectively. A statistically significant difference in survival was seen in patients with stage IC receiving chemotherapy (P =.009).Conclusions: This is the largest dataset to date to look at the usefulness of adjuvant chemotherapy in stage I LGSC. Age, comorbidities, and type of insurance were associated with survival in this cohort, but the substages of stage I LGSC were not. However, adjuvant chemotherapy does confer a survival benefit in patients with stage IC LGSC. Although typically considered relatively chemoresistant with an overall good prognosis, adjuvant chemotherapy demonstrates a survival benefit of 6.8% and should be considered in these patients. Objectives: Low-grade serous ovarian cancer (LGSC) is a rare subtype of ovarian serous carcinoma accounting for only 6% of all serous ovarian carcinoma. These tumors are considered to be relatively chemoresistant because of their tumor biology, making the role of adjuvant chemotherapy in early stage LGSC unclear. Herein, we sought to identify any chemotherapy benefit in overall survival among women with early-stage LGSC. Methods: The National Cancer Data Base was queried for all patients diagnosed from 1998 to 2012 with stage IA–IC LGSC. Only patients with nodal dissection were included for analysis. Χ2 test, logistic regression analysis, and log-rank test were used to analyze chemotherapy utilization and survival. Results: Of the 2,260 patients identified as having stage I LGSC, 1,481 had nodal dissection and were included for analysis. Chemotherapy was used in 15%, 21%, and 60% for stage IA, IB, and 1C, respectively. Age, insurance type (uninsured, private, Medicare/Medicaid), and stage were all associated with increased likelihood of receiving chemotherapy. Only age, Charlson-Deyo Comorbidity index, and insurance type were statistically significantly associated with survival on univariate and multivariable analysis. The 5-year overall survival (OS) for stage IA, IB, and IC without chemotherapy are 92%, 84%, and 88%, respectively. The 5-year OS for stage IA, IB, and IC with chemotherapy are 96%, 95%, and 94% respectively. A statistically significant difference in survival was seen in patients with stage IC receiving chemotherapy (P =.009). Conclusions: This is the largest dataset to date to look at the usefulness of adjuvant chemotherapy in stage I LGSC. Age, comorbidities, and type of insurance were associated with survival in this cohort, but the substages of stage I LGSC were not. However, adjuvant chemotherapy does confer a survival benefit in patients with stage IC LGSC. Although typically considered relatively chemoresistant with an overall good prognosis, adjuvant chemotherapy demonstrates a survival benefit of 6.8% and should be considered in these patients.