Volume 116, Issue 3 p. 372-380

The prediction of progression-free and overall survival in women with an advanced stage of epithelial ovarian carcinoma

CG Gerestein

Corresponding Author

CG Gerestein

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Daniel den Hoed/Erasmus MC University Medical Center, Rotterdam, the Netherlands

Dr CG Gerestein, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Erasmus MC/Daniel den Hoed University Oncology Center, Groene Hilledijk 301, 3075 AE Rotterdam, the Netherlands. Email [email protected]Search for more papers by this author
MJC Eijkemans

MJC Eijkemans

Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands

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D de Jong

D de Jong

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Princess Margaret Hospital UHN, Toronto, Canada

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MEL van der Burg

MEL van der Burg

Department of Medical Oncology, Erasmus MC University Medical Center, Rotterdam, the Netherlands

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RHM Dykgraaf

RHM Dykgraaf

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Daniel den Hoed/Erasmus MC University Medical Center, Rotterdam, the Netherlands

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GS Kooi

GS Kooi

Department of Obstetrics and Gynecology, Albert Schweitzer Hospital, Dordrecht, the Netherlands

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A Baalbergen

A Baalbergen

Department of Obstetrics and Gynecology, Reinier De Graaf Hospital, Delft, the Netherlands

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CW Burger

CW Burger

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Daniel den Hoed/Erasmus MC University Medical Center, Rotterdam, the Netherlands

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AC Ansink

AC Ansink

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Daniel den Hoed/Erasmus MC University Medical Center, Rotterdam, the Netherlands

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First published: 21 January 2009
Citations: 42

Abstract

Objective Prognosis in women with ovarian cancer mainly depends on International Federation of Gynecology and Obstetrics stage and the ability to perform optimal cytoreductive surgery. Since ovarian cancer has a heterogeneous presentation and clinical course, predicting progression-free survival (PFS) and overall survival (OS) in the individual patient is difficult. The objective of this study was to determine predictors of PFS and OS in women with advanced stage epithelial ovarian cancer (EOC) after primary cytoreductive surgery and first-line platinum-based chemotherapy.

Design Retrospective observational study.

Setting Two teaching hospitals and one university hospital in the south-western part of the Netherlands.

Population Women with advanced stage EOC.

Methods All women who underwent primary cytoreductive surgery for advanced stage EOC followed by first-line platinum-based chemotherapy between January 1998 and October 2004 were identified. To investigate independent predictors of PFS and OS, a Cox’ proportional hazard model was used. Nomograms were generated with the identified predictive parameters.

Main outcome measures The primary outcome measure was OS and the secondary outcome measures were response and PFS.

Results A total of 118 women entered the study protocol. Median PFS and OS were 15 and 44 months, respectively. Preoperative platelet count (P = 0.007), and residual disease <1 cm (P = 0.004) predicted PFS with a optimism corrected c-statistic of 0.63. Predictive parameters for OS were preoperative haemoglobin serum concentration (P = 0.012), preoperative platelet counts (P = 0.031) and residual disease <1 cm (P = 0.028) with a optimism corrected c-statistic of 0.67.

Conclusion PFS could be predicted by postoperative residual disease and preoperative platelet counts, whereas residual disease, preoperative platelet counts and preoperative haemoglobin serum concentration were predictive for OS. The proposed nomograms need to be externally validated.