Survival in women with grade 1 serous ovarian carcinoma

Abstract

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.

Fig. 1

A. Progression-free survival of grade 1 patients stratified by extent of residual disease (log-rank test, P<.001). Median progression-free survival for the microscopic group was 33.2 months (95% confidence interval [CI] 23.1–72.6), 14.7 months (95% CI 12.1–18.2) for the optimal (0.1–1.0 cm) group, and 14.1 months (95% CI 11.6–16.1) for the suboptimal (more than 1 cm) group. B. Overall survival of patients with low-grade serous carcinoma stratified by extent of residual disease (log-rank test, P<.001). Median overall survival for the microscopic group was 96.9 months (95% CI 76.2–not applicable), 44.5 months (95% CI 37.1–60.9) for the optimal group, and 42.0 months (95% CI 27.0–66.5) for the suboptimal group. The crosses in each panel represent censored data. Fader. Low-Grade Serous Carcinoma and Survival. Obstet Gynecol 2013.

Fig. 2

A. Progression-free survival of Gynecologic Oncology Group (GOG) 182 protocol patients stratified by tumor grade and residual disease (log-rank test, P<.001). Progression-free survival for the low-grade serous carcinoma nonmeasurable disease group was 33.2 months (95% CI 23.1–72.6), 26.8 months (95% CI 22.8–31.3) for the high-grade serous carcinoma nonmeasurable disease group, 14.1 months (95% CI 12.5–16.1) for the low-grade serous carcinoma measurable disease group, and 14.4 months (95% CI 13.9–14.9) for the high-grade serous carcinoma measurable disease group. B. Overall survival of GOG-182 patients stratified by tumor grade and residual disease (log-rank test, P<.001). Median overall survival for the low-grade serous carcinoma nonmeasurable disease group was 96.9 months (95% CI 76.2–not applicable), 77.1 months (95% CI 67.5–88.8) for the high-grade serous carcinoma nonmeasurable disease group, 42.0 months (95% CI 36.8–53.2) for the low-grade serous carcinoma measurable disease group, and 37.7 months (95% CI 35.9–39.4) for the high-grade serous carcinoma measurable disease group. The crosses in each panel represent censored data. Fader. Low-Grade Serous Carcinoma and Survival. Obstet Gynecol 2013.