Prognostic significance of residual tumor in patients with epithelial ovarian carcinoma stage IV in a 20 year perspective

Objective. We aimed to evaluate prognostic factors impacting on overall survival during a 20 year period with substantial changes in surgical approach and chemotherapy management of patients with epithelial ovarian carcinoma stage IV. Design. A retrospective population-based study. Setting. The Norwegian Radium Hospital during 1985–2005. Population. Three hundred and ninety-four patients with epithelial ovarian carcinoma stage IV treated at the Norwegian Radium Hospital. Methods. The cohort was divided into two groups (1985–1995 and 1996–2005), and clinical and pathological characteristics were compared. Univariate and multivariate analyses were performed to identify prognostic factors during 1985–1995, 1996–2005 and 1985–2005. Main outcome measures. Prognostic factors and overall survival in the three periods. Results. Median overall survival improved from 1985–1995 to 1996–2005 (from 1.3 to 2.1 years). More patients had macroscopic radical surgery (28 vs. 11%), received neoadjuvant chemotherapy and were treated with platinum–taxane combination therapy from 1996–2005 compared to 1985–1995. Patients with primary surgery had improved median overall survival from 1996–2005 compared to 1985–1995. In multivariate analyses, surgical approach was not a prognostic factor for overall survival, but chemotherapy was during 1985–2005. Postoperative residual tumor was a prognostic factor for overall survival in all periods. Conclusions. Macroscopic radical surgery is a strong prognostic factor for overall survival and is achievable in a subset of patients with epithelial ovarian carcinoma stage IV. Improved selection criteria for what treatment algorithm to choose for patients with epithelial ovarian carcinoma stage IV are warranted.