TY - JOUR
T1 - Nomogram for Predicting Individual Survival after Recurrence of Advanced-Stage, High-Grade Ovarian Carcinoma
AU - Rose, Peter G.
AU - Java, James J.
AU - Salani, Ritu
AU - Geller, Melissa A.
AU - Secord, Angeles Alvarez
AU - Tewari, Krishnansu S.
AU - Bender, David P.
AU - Mutch, David G.
AU - Friedlander, Michael L.
AU - Van Le, Linda
AU - Method, Michael W.
AU - Hamilton, Chad A.
AU - Lee, Roger B.
AU - Wenham, Robert M.
AU - Guntupalli, Saketh R.
AU - Markman, Maurie
AU - Muggia, Franco M.
AU - Armstrong, Deborah K.
AU - Bookman, Michael A.
AU - Burger, Robert A.
AU - Copeland, Larry J.
N1 - Publisher Copyright:
© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
PY - 2019/2/1
Y1 - 2019/2/1
N2 - 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.
AB - 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.
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U2 - 10.1097/AOG.0000000000003086
DO - 10.1097/AOG.0000000000003086
M3 - Article
C2 - 30633128
AN - SCOPUS:85060554570
SN - 0029-7844
VL - 133
SP - 245
EP - 254
JO - Obstetrics and gynecology
JF - Obstetrics and gynecology
IS - 2
ER -