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Survival in Women With Grade 1 Serous Ovarian Carcinoma

Nickles Fader, Amanda MD; Java, James MA; Ueda, Stefanie MD; Bristow, Robert E. MD, MBA; Armstrong, Deborah K. MD; Bookman, Michael A. MD; Gershenson, David M. MD

doi: 10.1097/AOG.0b013e31829ce7ec
Original Research

OBJECTIVE: To examine clinicopathologic variables associated with survival among women with low-grade (grade 1) serous ovarian carcinoma enrolled in a phase III study.

METHODS: This was an ancillary data analysis of Gynecologic Oncology Group protocol 182, a phase III study of women with stage III-IV epithelial ovarian carcinoma treated with carboplatin and paclitaxel compared with triplet or sequential doublet regimens. Women with grade 1 serous carcinoma (a surrogate for low-grade serous disease) were included in the analysis.

RESULTS: Among the 3,686 enrolled participants, 189 had grade 1 disease. The median age was 56.5 years and 87.3% had stage III disease. The median follow-up time was 47.1 months. Stratification according to residual disease after primary surgery was microscopic residual in 24.9%, 0.1–1.0 cm of residual in 51.3%, and more than 1.0 cm of residual in 23.8%. On multivariate analysis, only residual disease status (P=.006) was significantly associated with survival. Patients with microscopic residual had a significantly longer median progression-free (33.2 months) and overall survival (96.9 months) compared with those with residual 0.1–1.0 cm (14.7 months and 44.5 months, respectively) and more than 1.0 cm of residual disease (14.1 months and 42.0 months, respectively; progression-free and overall survival, P<.001). After adjustment for other variables, patients with low-grade serous carcinoma with measurable residual disease had a similar adjusted hazard ratio for death (2.12; P=.002) as their high-grade serous carcinoma counterparts with measurable disease (2.31; P<.001).

CONCLUSIONS: Surgical cytoreduction to microscopic residual was associated with improved progression-free and overall survival in women with advanced-stage low-grade serous ovarian carcinoma.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00011986.

LEVEL OF EVIDENCE: II

Supplemental Digital Content is Available in the Text.Surgical cytoreduction to microscopic residual is associated with improved survival in women with grade 1 serous ovarian carcinoma.

Johns Hopkins Medical Institutions, Baltimore, Maryland; the Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, New York; the University of California San Francisco, Comprehensive Cancer Center, San Francisco, and the University of California, Irvine Medical Center, Orange, California; the University of Arizona, Tucson, Arizona; and the University of Texas, MD Anderson Cancer Center, Houston, Texas.

Corresponding author: Amanda Nickles Fader, MD, 600 N. Wolfe Street, Phipps 287, Baltimore, MD 21287; e-mail: afader1@jhmi.edu.

* For a list of other members of the GOG, see the Appendix online at http://links.lww.com/AOG/A409.

Supported by National Cancer Institute grants to the Gynecologic Oncology Group Administrative Office (CA 27469) and the Gynecologic Oncology Group Statistical Office (CA 37517).

Presented at a plenary session at the Society of Gynecologic Oncology Annual Meeting on Women's Cancer, March 24, 2012 Austin, Texas.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.