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Patterns and Progress in Ovarian Cancer Over 14 Years

From the ¹Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford Cancer Center, Stanford, California; ²Division of Epidemiology, Department of Health Research and Policy, Stanford University, Stanford, California; and ³Division of Hematology/Oncology, Department of Medicine, Chao Family Comprehensive Cancer Center, University of California, Irvine – Medical Center, Orange, California.

OBJECTIVE: To estimate the change in survival rates of women with ovarian cancer during the past 14 years.

METHODS: Women diagnosed with epithelial, germ cell, sarcomas, and sex-cord stromal ovarian tumors were identified from the Surveillance Epidemiology and End Results Database. Demographic and clinicopathologic factors, and survival information were extracted and tested using ² and Kaplan-Meier and Cox regression analyses.

RESULTS: A total of 30,246 women were diagnosed with ovarian cancer, including 26,753 non–clear cell epithelial, 1,411 clear cell, 818 sarcoma, 778 germ cell, and 486 sex-cord stromal tumors. The 5-year disease-specific survival rate across 1988–1992 and 1993–1997 improved from 45.4% to 48.6% (P<.001). The corresponding estimates show increases for non–clear cell epithelial carcinoma from 42.5% to 45.8% (P<.001), and for sarcomas from 33.5% to 38.8% (P=.07). However, improvements were not observed in those with clear cell, 64.3% to 63.9% (P=.82), and sex-cord stromal, 89.7% to 85.7% (P=.18), tumors of the ovary. In multivariable analyses, younger age, early stage, favorable histologic cell types, low-grade tumors, standard surgery, and recent time interval from 1993–1997 were independent prognostic factors for improved survival.

CONCLUSION: In this large population-based study, there has been some improvement in the overall survival of women with ovarian cancers during a 14-year period. However, new treatment strategies are warranted for those with epithelial cancer and sarcomas of the ovary, given their overall poor prognosis. These results from our updated analyses might help to counsel women diagnosed with ovarian cancers.

LEVEL OF EVIDENCE: II-2

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