Survival after recurrence in early-stage high-risk epithelial ovarian cancer: A Gynecologic Oncology Group study

Abstract

Objective

This study aimed to evaluate the clinical outcome of recurrent early-stage high-risk epithelial ovarian cancer patients.

Methods

Demographic and clinicopathological data were collected from women enrolled in GOG 157 who underwent surgical staging and had recurrent disease. Survival probability was estimated using Kaplan-Meier method, and hazard ratio of death was analyzed using Cox regression model.

Results

Of 74 women with recurrent early-stage high-risk ovarian cancer, the median age at recurrence was 63 years; 93% were White, 2.7% were Black, 2.7% were Asian, and 1.4% were Others. Fifty-eight percent had stage I, and the remainder had stage II disease. Clear cell, serous, endometrioid, mucinous, and other tumors consisted of 28.4%, 25.7%, 24.3%, 16.2%, and 5.4% of patients, respectively; in addition, 36.5% had ascites, 33.8% had positive cytology, and 43.2% had ruptured tumors. Fifty-eight percent underwent three cycles, and 42% had six cycles of adjuvant chemotherapy with paclitaxel and carboplatin. Recurrence was diagnosed clinically in 46% and radiographically in 54% of women. The median time from completion of primary chemotherapy to recurrence (treatment-free interval, TFI) was 21 months. Overall, median survival after recurrence was 24 months. Patients with longer (> 24 months) TFI had a higher median survival after subsequent treatment at 35 months compared to only 10 months in those who recurred ≤ 24 months (p = 0.003).

Conclusions

Although patients with primary early-stage high-risk ovarian cancer have an overall favorable prognosis, survival after recurrence is poor and comparable to those with recurrent advanced-stage disease. Novel therapeutic modalities are warranted in these high-risk patients.