PROGNOSIS OF OVARIAN CANCERS TODAY

Background - At present, in Japan, conventional chemotherapy consistin g of cyclophosphamide, adriamycin and cisplatin (so called CAP) is pei -formed for advanced ovarian cancer while in Europe and the United Sta tes a combination of paclitaxel and cisplatin (TP) is used as first-li ne chemotherapy. Paclitaxel has now become available for clinical use in Japan. Therefore, in the present study, we attempted to determine p rognostic factors after CAP therapy to select rational indications for use of paclitaxel. Methods - Prognostic factors of 173 patients with primary epithelial ovarian cancer initially treated with CAP therapy w ere analyzed using Cox's proportional hazards modeling and the Kaplan- Meier method for analysis of the survival curves. Results - Taking all stages together, the response of clear-cell carcinoma to CAP therapy was the worst,showing only 22.2%, whereas all other histological types showed more than 50%. In early stage, serous adenocarcinoma with high grade showed a better prognosis. In advanced stage, multivariate anal ysis revealed that clear-cell and mucinous types, as compared to serou s and endometrioid type, and >2 cm residual tumor were significant ind ependent prognostic factors.Conclusion - In the present study, we have demonstrated that histological types showing: unresponsiveness to CAP therapy had a great impact on prognosis. Accordingly, patients with h istological type which can be presumed to have intrinsic resistance or be refractory to cisplatin may be treated initially with paclitaxel-b ased chemotherapy instead of CAP therapy.