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Am Fam Physician. 2004;69(2):413-414

Of all the gynecologic cancers, ovarian cancer is the most common cause of mortality. More than 60 percent of patients with ovarian cancer do not present until they are at an advanced stage, and the average five-year survival rate is reported to be lower than 20 percent. Tingulstad and colleagues analyzed data on ovarian cancer in Norwegian women to identify factors that could distinguish women with the best prognosis for survival.

They studied records of 571 verified ovarian cancer cases in a Norwegian region and excluded patients who did not have laparotomy or had a doubtful diagnosis. They found that the incidence of around 12 cases per 100,000 increased with age up to 60 to 69 years. The follow-up time ranged from 60 to 178 months, with a median of 106 months. The crude five-year survival was around 40 percent, and the median survival was 32 months. In the initial statistical analysis, the significant predictors of death within five years were older age, higher International Federation of Gynecology and Obstetrics (FIGO) stage, and larger residual tumor after surgery. The hazard ratio in women older than 75 years was 2.8 times that in women younger than 45 years. Although ovarian cancer was relatively uncommon in women younger than 45 years, 71 percent were alive at five years compared with only 18 percent of women 75 years or older. Similarly, the hazard ratio for more than 1 cm of residual tumor was 1.72 times that for residual tumor of up to 1 cm. Only 9 percent of patients with more than 1 cm of residual tumor were alive at five years compared with 61 percent of those with more complete removal. The strongest risk factor was the FIGO stage of the tumor. The hazard ratio for stage IV was 11.75 times that of stage I. For FIGO stage I, the five-year survival was 86 percent compared with 11 percent for stage IV. Other variables, such as comorbidity, tumor histology, or CA125 level, were not significant in predicting five-year survival.

The authors believe these data can be applied to treatment and to counseling patients and families about prognosis. The significance of residual tumor should stimulate surgeons to maximize tumor removal. Although the results confirm the importance of detection at an earlier FIGO stage, effective screening for ovarian cancer has not been developed.

editor's note: Reports like this can be powerful tools in supporting the patient and her family through this devastating illness. First, ovarian cancer is not an immediate death sentence: the five-year survival rate has risen to nearly 40 percent. More importantly, one can look more closely at the subgroups and give patients much more specific information. For some patients, this will be cautious hope, as the five-year survival rates in some subgroups were more than 70 percent. For other patients, it provides a more realistic estimate of the seriousness and likely progression of the disease. Most families assume a painful death is imminent. We owe it to them to provide the best estimates of survival, to ensure the best possible care, and above all, to be available and reliable as they go through the process.—A.D.W.

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