abstract:
Utilization and Outcomes of Chemotherapy in Women With Intermediate-Risk, Early-Stage Ovarian Cancer.
OBJECTIVE:
To examine utilization and efficacy of chemotherapy for stage I ovarian cancer.
METHODS:
We conducted a retrospective cohort study using the National Cancer Data Base to identify women with stage I ovarian cancer
treated from 1998 to 2012. Patients were classified into three groups
based on grade and stage: stage IA or IB grade 1 (low risk); stage IA or
IB grade 2 (intermediate risk); and stage IA or IB grade 3 or any stage
IC (high risk). Multivariable models were developed to examine
predictors of chemotherapy use and survival.
RESULTS:
We
identified 21,758 patients including 4,196 (19.3%) low-risk, 3,777
(17.4%) intermediate-risk, and 13,785 (63.4%) high-risk women. The
median follow-up of the cohort was 63.9 months. Use of chemotherapy
within the groups was 15.5%, 39.5%, and 69.8%, respectively (P<.001).
Among low-risk patients, chemotherapy was not associated with a change
in survival (adjusted hazard ratio [HR] 1.10, 95% confidence interval
[CI] 0.85-1.42), whereas chemotherapy was associated with reduced
mortality for high-risk patients (adjusted HR 0.78, 95% CI 0.71-0.85).
For intermediate-risk patients (stage IA-IB grade 2), chemotherapy was
associated with a 26% reduction in mortality (adjusted HR 0.74, 95% CI
0.62-0.89). The association between chemotherapy and improved survival
among intermediate-risk patients remained significant when limited to
patients who underwent staging lymphadenectomy (adjusted HR 0.77, 95% CI
0.62-0.97).
CONCLUSION:
There is widespread variation in the patterns of care for early-stage ovarian cancer. Chemotherapy was associated with improved survival for stage IA-IB grade 2 patients.
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