STAGING PROCEDURES, CLINICAL MANAGEMENT, AND SURVIVAL OUTCOME FOR OVARIAN-CARCINOMA

Objective.-To evaluate the relationship between survival and patterns of clinical management for ovarian carcinoma. Design.-Retrospective analysis of cancer registry data including follow-up, operative reports, and pathology reports. Setting.-Seventy-seven Illinois hospitals with active cancer registries. Patients.-A total of 2669 women with newly diagnosed ovarian carcinoma from 1983 through 1988. Main Outcome Measures.-Frequency of use of specific staging procedures and treatment options. Survival was estimated using the Kaplan-Meier product-limit method. Results.-Thirty percent of 632 stage I patients, 31% of 233 stage II patients, and 45% of 516 stage III patients underwent hysterectomy, bilateral salpingo-oophorectomy, omentectomy, sampled peritoneal washings, and node biopsy. Five year survival for those receiving this extensive surgery (who were therefore pathologically staged) was as follows: stage I, 80%; stage II, 63%; and stage III, 28%. For those not receiving this extensive surgery (who were therefore clinically staged), the 5-year survival at these stages was 76%, 62%, and 21%, respectively. The overall survival curves were not significantly different between those who were pathologically staged and those who were clinically staged for stage I patients (P=.27) or stage II patients (P=.47), but were for stage III patients (P=.01). Platinum-based combination chemotherapy was given to 76% of 221 patients with pathological stage III disease. Their 5-year survival-50% for the group with no residual disease and 20% for the group with residual disease-was better than for those receiving regimens without platinum-37% and 5%, respectively, for the two groups-and the overall survival curves were significantly better for those receiving platinum (P<.0005 for both groups). The groups receiving platinum had younger patients. Conclusions.-Extensive surgery for pathological staging was not usually done for management of ovarian cancer, while platinum-based chemotherapy was commonly used. Failure to undergo extensive surgery had little impact on survival for stage I and II patients. However, use of extensive surgery and platinum-based chemotherapy improved survival for stage III patients. The improved survival for this group receiving platinum-based chemotherapy may be explained in part by selection of younger patients for this treatment.