Long-term Survival for Ovarian Cancer Higher Than Thought

Fran Lowry

August 17, 2015

Nearly one-third of more than 11,000 patients diagnosed with epithelial ovarian cancer in California from 1994 to 2001 survived at least 10 years after diagnosis, according to a study published online on July 31 in the Journal of Obstetrics and Gynecology.

This finding, from an analysis of data from the California Cancer Registry, should give women diagnosed with ovarian cancer some hope that their prognosis might not be all that dire.

"Although ovarian cancer is a highly fatal cancer, there is considerable variability in survival, and there is hope. There is a substantial portion of women who live a long time after diagnosis," said lead author Rosemary D. Cress, DrPH, from the University of California (UC) Davis Medical Center in Sacramento.

"A woman, when she gets this diagnosis, does not have to think that she has received an immediate death sentence," she told Medscape Medical News. "This is not to play down the seriousness of the diagnosis, because in our paper, 30% lived 10 years or more, but 70% did not. But it does underline the importance of seeing a specialist and getting the best treatment."

Dr Rosemary Cress

Dr Cress and her team analyzed data on 11,541 women diagnosed from 1994 to 2001 with epithelial ovarian cancer. This is the most common type of ovarian cancer; in fact, nine of 10 cases of ovarian cancer are epithelial.

About one-quarter of the women were younger than 50 year. Most were non-Hispanic white women, but there were Hispanic, Asian/Pacific Islander, and non-Hispanic black women in the study cohort.

Most patients were treated at a high-volume hospital, and 97% lived in an urban area. Only about one-fifth of the women had stage I disease; 67% had stage III or IV disease.

The predominant histologic type was serous, followed by endometrioid, clear cell, and mucinous types.

One-Third Still Alive After a Decade

The data showed that 3582 (31%) patients survived more than 10 years.

Longer survival was associated with younger age, early-stage disease, low-grade disease, and nonserous histology.

Nearly half of the long-term survivors were 18 to 50 years of age. This younger age group made up only 13% of those who survived less than 2 years.

Hispanic and Asian/Pacific Islander women made up a higher proportion of long-term survivors than women of other ethnic groups.

A slightly higher proportion of patients who survived more than 10 years had private insurance, more patients who survived at least 2 years lived in neighborhoods with high socioeconomic status, and more patients who survived at least 2 years were cared for in hospitals that treated more than 40 ovarian cancer patients during the study period.

However, women with high-risk cancer were also long-term survivors.

Although most of the long-term survivors (10 years or more) had stage I disease at diagnosis, 32.4% had stage III or IV disease.

Tumor grade also varied significantly. Most women with low-grade cancers survived more than 10 years, but about 58% of the long-term survivors had grade I or II cancer.

Endometrioid, clear cell, and mucinous cancers were associated with longer-term survival; however, 62.3% of stage I/II patients with grade III/IV tumors survived at least 10 years, and 66.2% of stage I/II patients with serous histology survived at least 10 years.

Younger age was a significant positive prognostic factor, but race, socioeconomic status, insurance, and hospital volume were not significant, the researchers report.

"We were struck by the fact that of the 3582 long-term survivors, 954 of them had been considered to be at high risk of dying from their disease because of their tumor stage, grade, or older age at diagnosis," Dr Cress explained.

"There were some women you would normally expect to be at high risk of dying quickly who actually survived a long time. We don't really know why that is," she said.

"This information is important for patient counseling. Many patients and physicians know that ovarian cancer is a dangerous cancer, but they don't realize that there is significant biological variability among patients. It's not a uniformly fatal prognosis," said study coauthor Gary Leiserowitz, MD, professor of gynecologic oncology and interim chair of the UC Davis Department of Obstetrics and Gynecology in Sacramento.

For example, 74-year-old Jacqueline Price from Fair Oaks, California, was diagnosed at age 60 with stage IIIC ovarian cancer. Her pathology report said she had 2 months to live and she was advised to call hospice.

"I thought, if I only have a couple of months, I want to spend it with my family. I wasn't going to have any treatment. It was doom and gloom," Price said in a statement.

But Dr Leiserowitz, who was her oncologist, urged her to reconsider. She did, and underwent surgery followed by aggressive chemotherapy.

"I cannot even imagine missing these past 15 years," Price said.

As a result of her experience, she now reaches out to other ovarian cancer patients and organizes "healing circles."

Dr Leiserowitz said he wonders, "for a disease that is so dangerous, why so many women are surviving."

"This is an exploratory study to figure out who has survived. We can now go back and look at tumor tissue to do a comparison between long- and short-term survivors to see if there is a genetic basis for that," he said in a statement.

This work was supported by an NCI Comprehensive Cancer Center Support Grant. Dr Cress and Dr Leiserowitz have disclosed no relevant financial relationships.

Obstet Gynecol. Published online July 31, 2015. Abstract

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