Nomogram for Predicting Individual Survival After Recurrence of Advanced-Stage, High-Grade Ovarian Carcinoma

Obstet Gynecol. 2019 Feb;133(2):245-254. doi: 10.1097/AOG.0000000000003086.

Abstract

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.

Publication types

  • Meta-Analysis
  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Antineoplastic Agents, Phytogenic / therapeutic use
  • Carcinoma / drug therapy
  • Carcinoma / mortality*
  • Female
  • Humans
  • Middle Aged
  • Neoplasm Recurrence, Local / mortality*
  • Nomograms
  • Ovarian Neoplasms / drug therapy
  • Ovarian Neoplasms / mortality*
  • Paclitaxel / therapeutic use
  • Platinum Compounds / therapeutic use
  • Retrospective Studies
  • United States / epidemiology

Substances

  • Antineoplastic Agents, Phytogenic
  • Platinum Compounds
  • Paclitaxel

Associated data

  • ClinicalTrials.gov/NCT00002717
  • ClinicalTrials.gov/NCT00011986
  • ClinicalTrials.gov/NCT00837993
  • ClinicalTrials.gov/NCT00002568
  • ClinicalTrials.gov/NCT01074398