LONG-TERM SURVIVAL AND PROGNOSTIC FACTORS IN ADVANCED EPITHELIAL OVARIAN-CANCER WITH SPECIAL EMPHASIS UPON THE EFFECTS OF PROTOCOL INCLUSION

The Danish Ovarian Cancer Study Group registered 722 patients in stage s III and IV during the period 1981-1986. The material included 85% of all ovarian cancer patients in the catchment area of the group and pa tients allocated to protocol as well as patients treated outside proto cols. Five and 10-year survival were: stage III 17%, and 8%, respectiv ely; and stage IV 4% and 2%. Patients allocated to protocol had a sign ificantly better survival than patients not included in protocols even when only patients younger than 70 years were compared. All non-proto col patients had a poorer prognosis irrespective of the reason for exc lusion. Five-year survival for stage III protocol patients was 25% vs. 9%, for non-protocol patients younger than 70 years. The 10-year surv ival was 11% and 4% for stage III protocol and non-protocol patients, respectively. A multivariate analysis showed that residual tumor, age, stage, and performance status had prognostic value. In non protocol p atients histologic grade had an additional marginal prognostic impact. In conclusion the study showed that the statement that long-term surv ival in advanced ovarian cancer has been increased could not be proven by comparison of survival from randomized studies performed in the ea rly eighties with survival of stage III and IV patients before the int roduction of cisplatinum chemotherapy. It is necessary to consider sur vival of all patients, protocol and non-protocol in a geographically w ell-defined region for evaluation of survival improvement.