Is the watch and wait approach adequate after comprehensive surgical staging in invasive stage I epithelial ovarian cancer? The Norwegian Radium Hospital experience.

OBJECTIVES

The aim of this study on stage I epithelial ovarian cancer (EOC) was to see if our different treatment policies after 1995, when lymph node staging and paclitaxel were introduced, have affected the survival, try to define risk groups for relapse and who should get adjuvant chemotherapy (AC).

METHODS

A retrospective study based on record information from all patients with invasive EOC stage I operated at the Norwegian Radium Hospital (NRH) 1984-2001, in total 252 patients.

RESULTS

Total 5-year survival was 83 and 82%, respectively, in both time periods. We found age and histology to be significant prognostic factors for overall survival (OS) (p < 0.01). From 1995 survival was significantly better for those who had been properly staged than for the others (p = 0.02), with a 5-year survival rate of 87 vs 64%. Those who did not get chemotherapy but were staged, had a significantly better overall survival than those who were not (p = 0.02), with a 5-year survival of 93 vs 77%. In the period 1995-2001 the patients who received no adjuvant treatment lived longer than those who underwent chemotherapy and/or radiotherapy (p = 0.03). In the first period 17% had no adjuvant treatment vs 58% in the last. Patients in a high-risk group getting AC had a tendency toward better survival than those who did not (p = 0.08).

CONCLUSIONS

Patients with Stage I low and medium risk EOC do not need AC if properly staged. For the high-risk group the optimal AC has not yet been established.