Ten-year conditional probability of survival for patients with ovarian cancer: A new metric for the new millennium (480)

Abstract

Objectives: To demonstrate the utility of conditional probability of survival (CPS) as a metric in analyzing survival outcomes for women with ovarian cancer. Methods: We analyzed the records of all patients (pts) with newly diagnosed high-grade epithelial ovarian cancer who underwent treatment at our institution from January 2001 to December 2009. Pts lost to follow-up were excluded if they had less than three years of follow-up. CPS was defined as the probability of surviving additional years (y) based on the condition that a patient had already survived at a given time (x): S(x + y)/S(x). Confidence intervals (CIs) were estimated using a variation of Greenwood’s formula. Results: A total of 916 pts met the inclusion criteria. The median age at diagnosis was 60 years (range: 25-95) with 37% (337/916) <65 years old (yo). FIGO stage was as follows: stage I 14% (132/916), stage II 6% (59/916), stage III 57% (519/916), and stage IV 23% (206/916). Histology was high-grade serous in 83% pts (759/916). Among the 907 pts who underwent surgical management, 64% (584/907) had a primary debulking surgery, 16% (143/907) had an interval debulking after neoadjuvant chemotherapy and 20% (180/907) underwent staging. A total of 84% (757/907) had an optimal cytoreduction (<1 cm of residual disease), whereas 49% (440/907) had a complete gross resection. The Median follow-up time for the entire cohort was 55 months, and the median overall survival (OS) was 57 months. Twenty percent (183/916) had an OS >10-years. Ten-year OS for pts aged <65 yo with early-stage I/II, stage III, and stage IV ovarian cancer was 48%, 24%, and 11%, respectively. For patients >65 yo, 10-year OS was 22%, 11%, and 4%, respectively. For patients <65 yo, the 10-year CPS for 5-year survivors was: early-stage I/II, 90.0 % (95% CI: 85.4%-94.6%); stage III, 56.8% (95%CI 51.0%-62.7%); stage IV, 38.8% (95% CI: 24.3%- 53.4%). For patients >65y, the 10-year CPS for 5-year survivors was: early-stage I/II, 63.1% (95% CI: 52.6%-73.5%); stage III, 43.8% (95% CI: 31.7%-55.9%); stage IV, 22.5% (95% CI: 6.6%-38.3%). Conclusions: For long-term 5-year survivors with advanced OC, CPS can provide a more representative estimate of future survival than conventional OS ratesl OS. Objectives: To demonstrate the utility of conditional probability of survival (CPS) as a metric in analyzing survival outcomes for women with ovarian cancer. Methods: We analyzed the records of all patients (pts) with newly diagnosed high-grade epithelial ovarian cancer who underwent treatment at our institution from January 2001 to December 2009. Pts lost to follow-up were excluded if they had less than three years of follow-up. CPS was defined as the probability of surviving additional years (y) based on the condition that a patient had already survived at a given time (x): S(x + y)/S(x). Confidence intervals (CIs) were estimated using a variation of Greenwood’s formula. Results: A total of 916 pts met the inclusion criteria. The median age at diagnosis was 60 years (range: 25-95) with 37% (337/916) <65 years old (yo). FIGO stage was as follows: stage I 14% (132/916), stage II 6% (59/916), stage III 57% (519/916), and stage IV 23% (206/916). Histology was high-grade serous in 83% pts (759/916). Among the 907 pts who underwent surgical management, 64% (584/907) had a primary debulking surgery, 16% (143/907) had an interval debulking after neoadjuvant chemotherapy and 20% (180/907) underwent staging. A total of 84% (757/907) had an optimal cytoreduction (<1 cm of residual disease), whereas 49% (440/907) had a complete gross resection. The Median follow-up time for the entire cohort was 55 months, and the median overall survival (OS) was 57 months. Twenty percent (183/916) had an OS >10-years. Ten-year OS for pts aged <65 yo with early-stage I/II, stage III, and stage IV ovarian cancer was 48%, 24%, and 11%, respectively. For patients >65 yo, 10-year OS was 22%, 11%, and 4%, respectively. For patients <65 yo, the 10-year CPS for 5-year survivors was: early-stage I/II, 90.0 % (95% CI: 85.4%-94.6%); stage III, 56.8% (95%CI 51.0%-62.7%); stage IV, 38.8% (95% CI: 24.3%- 53.4%). For patients >65y, the 10-year CPS for 5-year survivors was: early-stage I/II, 63.1% (95% CI: 52.6%-73.5%); stage III, 43.8% (95% CI: 31.7%-55.9%); stage IV, 22.5% (95% CI: 6.6%-38.3%). Conclusions: For long-term 5-year survivors with advanced OC, CPS can provide a more representative estimate of future survival than conventional OS ratesl OS.