Natural history of stage IV epithelial ovarian cancer

Purpose: in this report we present the natural history, prognostic factors, and therapeutic implications of stage IV epithelial ovarian cancer (EOC). Patients and Methods: We reviewed 192 patients with stage IV EOC as defined in 1985 by the International federation of Gynecology and Obstetrics. Results: The site of stage IV-defining disease was cytologically positive p leural effusion in 63 patients, river in 50 patients, lymph nodes in 26 pat ients, lung in six patients, other sites in 15 patients, and disease at mul tiple stage IV-defining metastatic sites in 32 patients. Surgery was perfor med before chemotherapy in 169 patients; 25 patients (14.8%) were left with only microscopic residual disease or less than 2 cm of macroscopic residua l disease. The overall response rate to chemotherapy was 56%; the complete response rate was 18%. The median progression-free survival was 7.1 months, and the median overall survival was 13.4 months. The median overall surviv al of patients with positive pleural effusions only was 13.4 months as comp ared with 10.5 months for patients with visceral disease only, but this dif ference was not statistically significant. The 5-year survival rate was 7.6 %, with only six patients surviving more than 5 years. Univariate and multi variate analysis showed that two parameters were associated with ct shorter survival time: visceral involvement (lung or liver) and diagnosis before 1 984. Conclusion: Patients with stage IV EOC initially respond to chemotherapy as often as those with less advanced disease, hut the long-term prognosis is very poor. The size of residual disease is not a prognostic factor in this group of patients, and, therefore, the role of debulking surgery in these p atients needs to be reconsidered. (C) 1999 by American Society of Clinical Oncology.