Twenty years treating early-stage epithelial ovarian carcinoma patients with adjuvant platinum-based chemotherapy. A single institution’s experience

Abstract

5167 Background: One-third of epithelial ovarian cancer (EOC) patients (pts) present with localized disease and have a 50–70% ten-year survival. Prognostic factors and adjuvant strategies have been explored. Platinum-based chemotherapy (QT) is the mainstay of therapy. Aims: To describe Disease-Free Survival (DFS) and Overall Survival (OS) in EOC stage I-II pts receiving adjuvant platinum-based QT at our institution in the last 20 years. To determine prognostic factors and the role of paclitaxel addition. Methods: Retrospective analysis including all incident early-stage EOC pts receiving adjuvant platinum-based QT from 1984 to 2003. Well differentiated FIGO stages I were excluded. Demographic-data, surgical procedures, histological features, toxicities, follow-up and outcome were recorded. Up to 1997 pts received QT: CDDP 80mg/m2-CTX 750mg/m2, CBDCA 300mg/m2-CTX 600mg/m2, CDDP 80mg/m2-ADM 50mg/m2-CTX 500 mg/m2, every 3–4 w x 6. From 1997: Paclitaxel 175 mg/m2 and CBDCA AUC5 every 3 w x 4–6. Results: 140 pts (40 with paclitaxel) were compiled. Median age: 53.7 years (19–81). Completed surgically staged patients: 67.1%. Medium follow-up: 82.5 months; DFS 75.7%, OS 79.3%. No survival difference was found between pts receiving or not paclitaxel. Statistically significant prognostic factors were: ECOG 0 (p<0,003; OR 0,29; 95% CI 0,13–0,67); FIGO I stage (p<0.0001; OR 0.11; 95% CI 0,04–0,32); I-II grade (p<0,003; OR 0,3; 95% CI 0,14–0,68); non-mucinous excluding clear cell histology (p<0,01; OR 0,27; 95% CI 0,09–0,79). Pts who underwent most comprehensive surgery were likely to have a better prognosis (liver inspection (p<0,048; OR 0,45; 95% CI 0,21–1,0); paracolic-gutters inspection (p<0,023; OR 0,40; 95% CI 0,18–0,89)). The multivariate analysis will be reported at the meeting. Conclusions: Our data represent an actual approach to the impact of platinum-adjuvant QT in early-stage EOC, and might serve for reference to future trials. Paclitaxel’s impact on the outcome cannot be addressed due to the number of patients. Effective therapies are required for stage II, undifferentiated and mucinous tumours. Quality of surgery carries prognostic value. No significant financial relationships to disclose.