Survival of Patients with Epithelial Ovarian Cancer and the Effect of Lymphadenectomy in Those with Stage 3 Disease
Authors: D.G. Allen MMed, MRACMA, FCOG(SA), FRANZCOG, CGO  , J. Coulter FRCSI, MRCOG  
Published: February 2008

EDITORIAL COMMENT: This paper on ovarian cancer from a single institution should interest readers because it presents a relatively big experience for any series of patients treated in Australia. The authors have shown that there appears to be a significant improvement in overall survival in all grades of ovarian cancer with the more recent management with modern chemotherapy regimens in additional to hysterectomy and oophorectomy with debulking, with or without lymphadenectomy. The authors' results on patients who have had lymphadenectomy would seem to support the performance of this procedure although, as they point out, a randomized trial would be necessary to provide incontrovertible evidence on this point. Such a trial is not easy to perform which is one reason why the information in this paper should be published and heeded. The authors have made the point that where randomization has not been performed it is difficult to say why one group of patients with Stage 3 disease had lymphadenectomy performed and others did not. This paper does not include an analysis of the possible effect of different regimens of chemotherapy because the detailed information was not available although most of the patients both pre‐1987 and subsequently had received some form of chemotherapy. The main takeaway message for readers from this paper is that this experience with ovarian cancer in one of Melbourne's teaching hospitals shows that over a long period of time the survival rate of women with advanced ovarian cancer with modem treatment is worthwhile. Most noteworthy is the fact that in the series as a whole the 5‐year survival rate for patients with Stage 3 disease was approximately 1 in 4, and 1 in 5 for those with Stage 4 disease, which taken alone, in the editor's opinion, justifies the considerable team effort made by oncologists and nursing staff and other health professionals to manage these patients. N.B.

Summary: This study looks at the 10‐year survival data in patients with epithelial ovarian carcinoma at the Mercy Hospital for Women, Melbourne. An ovarian cancer database was established at the hospital in 1980, since then 253 patients have been diagnosed with epithelial ovarian cancer. The 5‐year survival rates for Stages 1 to 4 are 75%, 55%, 24% and 21% respectively. The 10‐year survival rates are 65%, 55%, 16% and 15% respectively. One hundred and thirty patients have been diagnosed with Stage 3 disease. The Gynaecologic Oncology Department at the Mercy Hospital for Women was formalized in 1987. Patients treated for ovarian cancer by the unit since 1987 had a significantly better survival (median 47 months) than patients treated prior to 1987 (median 17 months), p = 0.03. There is much debate as to whether lymphadenectomy in patients with ovarian cancer is of therapeutic value. In this study the patients with Stage 3 disease and who had a lymphadenectomy performed had a better 5‐year survival rate of 38% compared to 22% in the group who did not have a lymphadenectomy (p < 0.05). The Stage 3 patients who had negative retroperitoneal nodes had a 10‐year survival rate of 51%. There was no difference in survival rate between patients with endometrioid and serous papillary carcinomas.