Nomogram for Predicting Individual Survival After Recurrence of Advanced-Stage, High-Grade Ovarian Carcinoma.
Obstetrics and gynecology
Aged; Antineoplastic Agents, Phytogenic; Carcinoma; Female; Humans; Middle Aged; Neoplasm Recurrence, Local; Nomograms; Ovarian Neoplasms; Paclitaxel; Platinum Compounds; Retrospective Studies; United States
OBJECTIVE: To analyze clinical prognostic factors for survival after recurrence of high-grade, advanced-stage ovarian-peritoneal-tubal carcinoma and to develop a nomogram to predict individual survival after recurrence.
METHODS: We retrospectively analyzed patients treated in multicenter Gynecologic Oncology Group protocols for stage III and IV ovarian-peritoneal-tubal carcinoma who underwent primary debulking surgery, received chemotherapy with paclitaxel and a platinum compound, and subsequently developed recurrence. Prognostic factors affecting survival were identified and used to develop a nomogram, which was both internally and externally validated.
RESULTS: There were 4,739 patients included in this analysis, of whom, 84% had stage III and 16% had stage IV ovarian carcinoma. At a median follow-up of 88.8 months (95% CI 86.2-92.0 months), the vast majority of patients (89.4%) had died. The median survival after recurrence was 21.4 months (95% CI 20.5-21.9 months). Time to recurrence after initial chemotherapy, clear cell or mucinous histology, performance status, stage IV disease, and age were significant variables used to develop a nomogram for survival after recurrence, which had a concordance index of 0.67. The time to recurrence alone accounted for 85% of the prognostic information. Similar results were found for patients who underwent second look laparotomy and had a complete pathologic response or received intraperitoneal chemotherapy.
CONCLUSION: For individuals with advanced-stage ovarian carcinoma who recur after standard first-line therapy, estimated survivals after recurrence are closely related to the time to recurrence after chemotherapy and prognostic variables can be used to predict subsequent survival.
CLINICAL TRIAL REGISTRATION: ClinialTrials.gov, NCT00002568, NCT00837993, NCT00002717, NCT01074398, and NCT00011986.
Women & Children
Rose, Peter G; Java, James J; Salani, Ritu; Geller, Melissa A; Secord, Angeles Alvarez; Tewari, Krishnansu S; Bender, David P; Mutch, David G; Friedlander, Michael L; Van Le, Linda; Method, Michael W; Hamilton, Chad A; Lee, Roger B; Wenham, Robert M; Guntupalli, Saketh R; Markman, Maurie; Muggia, Franco M; Armstrong, Deborah K; Bookman, Michael A; Burger, Robert A; and Copeland, Larry J, "Nomogram for Predicting Individual Survival After Recurrence of Advanced-Stage, High-Grade Ovarian Carcinoma." (2019). Articles, Abstracts, and Reports. 2549.