Objectives. The aim of this study was to evaluate long-term results and to
assess prognostic factors which have an impact on overall survival in patie
nts with epithelial ovarian cancer.
Methods. A retrospective analysis of 287 patients treated between 1975 and
1995 was performed. All operations mere performed by senior surgeons. Histo
logic sections were reviewed by the same pathologist. Successive adjuvant c
hemotherapy regimens are described. Survival was evaluated in 1997. Follow-
up lasted 25-260 months (median 90). Statistical methods included Kaplan-Me
ier survival curves, log-rank test, and multivariate analysis.
Results. The 5-year survival rates were 76, 42, 21, and 6% for patients wit
h stage I, II, III, and IV disease, respectively. Age, FIGO stage, cytology
of ascites, histologic type and grade, extent of surgery, and number of re
sidual tumors were significant prognostic indicators in univariate analysis
. Multivariate analysis showed that the risk of mortality according to FIGO
stage was 2.8, 95% CI [1.2-6.3], P = 0.01 for FIGO II, 5.6, 95% CI [2.9-10
.8], P < 0.001 for FIGO III, and 10.5, 95% CI [4.9-22.1], P < 0.001 for FIG
O TV in comparison with FIGO I. Patients with a serous epithelial carcinoma
had a 1.7-fold higher risk of mortality than patients with other histologi
c types: RR = 1.7, 95% CI [1.1-2.8], P < 0.001. Patients whose tumors distr
ibution permitted optimal surgery had a 2.3-fold lower risk of mortality th
an patients treated with sub- or nonoptimal surgery: RR = 0.43, 95% CI [0.2
9-0.64], P < 0.001. The risk of mortality for patients treated with alkylat
ing agents, platinum-based combination chemotherapy without taxanes, or car
boplatin plus paclitaxel regimens compared with patients who did not receiv
e treatment was reduced by 47%, 95% CI [8-69%], P = 0.025, 55%, 95% CI [22-
74%], P = 0.005, and 70%, 95% CI [35-86%], P = 0.002, respectively.
Conclusion. Our study confirms the benefit of cytoreductive surgery and the
efficacy of platinum plus paclitaxel first-line chemotherapy which has rec
ently been recognized as the standard treatment for advanced epithelial ova
rian cancer. (C) 2000 Academic Press.