Survival after intestinal obstruction in patients with fatal ovarian cancer: Analysis of prognostic variables

Abstract

Gadducci A, Iacconi P, Fanucchi A, Cosio S, Miccoli P, Genazzani AR. Survival after intestinal obstruction in patients with fatal ovarian cancer: Analysis of prognostic variables. Int J Gynecol Cancer 1998; 8: 177–182. This study reviewed 67 ovarian cancer patients who developed progressive disease following initial treatment and who died with clinical evidence of tumor. Thirty-four (50.7%) patients developed an intestinal obstruction during the disease course, and 28 (41.8%) died of this complication. Median interval time from initial diagnosis to obstruction was 19.5 months (range, 6–77 months). Twenty-two patients were submitted to surgery, whereas 12 received conservative treatment. Median interval time from obstruction to death was 65.5 days (95% confidence interval, 45–99 days; range, 15–699 days). At univariate analysis, survival after obstruction was significantly related to the type of therapy (surgical vs nonsurgical; (P = 0.0011) and to the score based on the criteria proposed by Krebs and Goplerud (including age, nutritional status, tumor status, ascites, previous chemotherapy and previous irradiation; ≤6 vs >6, P = 0.0001), but not to interval time from diagnosis to obstruction, age, number of previous chemotherapy regimens or number of previous operations. Cox model showed that the score was the only independent prognostic variable (P = 0.0003). If a significant palliation from surgery is defined as a survival of at least two months, such benefit was obtained by 87.5% of the 16 patients with a score ≤6 compared to 16.7% of the six patients with a higher score. In conclusion, the decision regarding optimal management of bowel obstruction in ovarian cancer patients should be individualized; however, Krebs' and Goplerud's score seems to offer reliable eligibility criteria for those patients deemed surgical candidates at the time of obstruction.