Ovarian Cancer Survival Significantly Improved: SEER Data

NEW ORLEANS—The survival rate for patients with primary invasive epithelial ovarian cancer has steadily increased over the past 3 decades, despite rising diagnoses among African-American women and women over age 60, according to an analysis presented at the Society of Gynecologic Oncologists’ 34th annual meeting (abstract 3).

Researchers from Wayne State University, Detroit, presented their findings regarding the patterns of diagnosis and relative survival in women diagnosed with the cancer from 1973 to 1997, with follow-up through 1999. In 2002, an estimated 23,100 new cases are expected. While the incidence of the disease remains unchanged, mortality has decreased, the study found.

Lead investigator Adnan R. Munkarah, MD, associate professor and director, Division of Gynecologic Oncology, Wayne State University, attributed the improvements to better medical care in general, improved access to care for minorities and the underprivileged, and improved survival among acutely ill patients. The concept of surgical staging and more appropriate treatments, including the addition of taxanes to chemotherapy regimens, have also had an impact, he said.

The population was drawn from the Surveillance, Epidemiology and End Results Program (SEER) database covering the 3 decades and involving 32,845 women diagnosed with invasive epithelial ovarian cancer during that time.

The study found that overall relative survival has continuously improved. The 2-year survival rate improved significantly, from 49% in 1973-1979 to 62% for the period 1990-1997. The 5-year survival rate increased slightly over the 3 decades, from 37% for the period 1973-1979, to 39% for 1980-1989, to 43% for 1990-1997, Dr. Munkarah reported.

However, patients age 70 and older and those of African-American ethnicity continue to have the worst relative survival, with 5-year survival rates of 26% and 37%, respectively, for the most recent period, and no improvements over the 3 decades. This is an important issue, he noted, since the population of women aged 70 and older represents 36% of ovarian cancer diagnoses.

Increases have been observed in the proportions of diagnoses among ethnic minorities and among women over 60 years of age at the time of diagnosis. There has not been a clinically significant change in the distribution of tumors by histology, he added.

Multivariate analyses revealed several factors that have an independent effect on prognosis: disease stage; use of primary surgery; and patient age, ethnicity, and marital status.

"The strength of this study is that the data are population-based, uniform, and closely monitored, and the sample size is very large," Dr. Munkarah said. "The weaknesses are the lack of treatment details, the lack of information about socioeconomic and insurance status, and the unreliability of the cause of death."

Edward L. Trimble, MD, PhD, of Johns Hopkins University and the National Cancer Institute, noted that the results reflect improvements in treatment patterns. He agreed that the strength of the study is diminished by the lack of information on several topics: prior gynecologic surgery, amount of residual disease, chemotherapy regimen, comor-bidity, and socioeconomic status, along with the lack of a centralized pathology review.