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abstract
Purpose Traditional
disease-free survival (DFS) does not reflect changes in prognosis over
time. Conditional DFS accounts for elapsed
time since achieving remission and may provide
more relevant prognostic information for patients and clinicians. This
study
aimed to estimate conditional DFS among patients
with ovarian cancer and to evaluate the impact of patient
characteristics.
Patients and Methods
Patients were recruited as part of the Hormones and Ovarian Cancer
Prediction case-control study and were included in the
current study if they had achieved remission
after a diagnosis of cancer of the ovary, fallopian tube, or peritoneum
(N =
404). Demographic and lifestyle information was
collected at enrollment; disease, treatment, and outcome information was
abstracted
from medical records. DFS was calculated using
the Kaplan-Meier method. Conditional DFS estimates were computed using
cumulative
DFS estimates.
Results Median DFS was
2.54 years (range, 0.03-9.96 years) and 3-year DFS was 48.2%. The
probability of surviving an additional 3
years without recurrence, conditioned on having
already survived 1, 2, 3, 4, and 5 years after remission, was 63.8%,
80.5%,
90.4%, 97.0%, and 97.7%, respectively. Initial
differences in 3-year DFS at time of remission between age, stage,
histology,
and grade groups decreased over time.
Conclusion DFS
estimates for patients with ovarian cancer improved dramatically over
time, in particular among those with poorer initial
prognoses. Conditional DFS is a more relevant
measure of prognosis for patients with ovarian cancer who have already
achieved
a period of remission, and time elapsed since
remission should be taken into account when making follow-up care
decisions.
Footnotes
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(6.29 minutes) Listen to the podcast by Dr. Iasonos at www.jco.org/podcasts
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