2007 Cancer Committee

Transcription

1 2007 Cancer Committee Ovarian Cancer Study Stage III & IV Albert Bonebrake, MD Rosie Netzer, RHIT, CTR Joanne Schahuber, R.T.(R)(T)(M)(QM)

2 Table of Contents Table of Contents... 1 Ovarian Cancer Facts:... 2 Ovarian Cancer Study Criteria: Ovarian Cancer Study Details:... 3 Item I -- Patients Diagnosed with Ovarian Cancer... 3 Item II Identify Age, Histology, and Grade... 3 Item III - Treatment...4 Item IV - Patient Survival Rates..5 Conclusion:... 7 Works Cited 7

3 Ovarian Cancer Facts: Ovarian cancer is the 7 th most common cancer among women. Ovarian cancer usually arises in the epithelial cells on the surface of the ovary. About 85-90% of ovarian cancers are epithelial in type with nearly 75% diagnosed as stage III or IV disease. In the U.S. an expected 20,500 women will be diagnosed with epithelial ovarian cancer per year with the incidence declining 0.7% per year in the years Ovarian cancer ranks 4 th in cancer deaths among women causing more deaths than any other female reproductive tract cancer, an estimated 15,500 in Ovarian Cancer Study Criteria: CoxHealth Cancer Committee In 2007, the Hulston Cancer Committee elected to conduct an outcome and survival analysis of our Stage III and IV Ovarian Cancer patients. This study focused upon patients with an initial diagnosis between the time periods of 1996 through 2005 (see criteria below). Members voted unanimously to approve the Ovarian Cancer study as outlined. CRITERIA: STAGE III and IV CLASS 0-2 REVIEW: I. Review patients diagnosed with ovarian cancer in II. Identify Age, Histology, Grade and AJCC Stage at Time of Diagnosis. III. Review Treatment IV. Identify patients on protocol V. Review Personal and Family History Breast Cancer 2

4 2007 Ovarian Cancer Study Details: Item I -- Patients Diagnosed with Ovarian Cancer During the years 1996 and 2005, there were 83 patients Stage III and 24 patients Stage IV ovarian cancer. Of those 107 patients, 4 patients were eliminated from study due to review of histology. Item II Identify Age, Histology, and Grade The age distribution is depicted with the decade intervals after age 55 accounting for 75% of the patients. (Fig. 1) % of Cases total Age <35 1 1% % % % % > % Total % The histology as depicted is also expected with the number of women with serous histology also approaching 75%. Four patients were eliminated after review for non-epithelial histology. Two patients with malignant mixed mullerian tumors, one patient with small cell carcinoma stage III, and one patient with lymphoma stage IV. (Fig. 2) Histology Cases % of total Papillary Serous Cystoadenoca 43 42% Serous Cystoadenocarcinoma 24 23% Adenocarcinoma 9 9% Serous Surface Papillary Ca 7 7% Endometroid Adenocarcinoma 7 7% Papillary Adenocarcinoma 5 4% Other 8 8% Total % 3

5 The grade distribution is depicted also relates to a higher grade of malignancy with higher stage. (Fig. 3) Stage III Stage IV % of total Grade % % % % Unknown % Total % Item III Treatment An attempt was made to evaluate the adequacy of the surgical staging and documentation of the amount and location of residual disease. The reviewer then made a best judgment as to suboptimal vs optimal for the individual patient. Of the stage III patients 48 out of 80 had lymphadenectomy of which 34 had positive nodes and only 2 of 80 described as optimally resected did not have pelvic or periarotic lymphadenectomy. Optimal (46 patients) vs suboptimal (34 patients) was determined from detailed operative and path report review. Stage IV patients had several path and surgical finding of interest. These patients were not categorized as optimal vs suboptimal, but the location of disease identifying these women as Stage IV was enlightening. In reviewing stage IV patients 9 out of the 24 had pleural or pleural cytology positive, 5 patients had mesocolonic lymph node involvement, 2 splenic involvement, 5 hepatic involvement and the remaining 3 with multi-site metastasis (bone, liver, lung, abdominal wall). The first line treatment is as follows: 76 patients (74%) received a platinum based drug plus Taxol. Out of the 76 patients 22 (22%) were placed on a platinum based clinical trial. Second and third line of treatment for recurrence was beyond the scope of this review, but is an exciting area for research and Phase II trials. There were 27 patients who did not receive chemotherapy due to post-op death, refused treatment, comorbodities or other unknown reasons. NCCN guidelines for Stage III & IV Epithelial Ovarian Cancer: IV Taxane/carboplatin for 6cycles with interval debulking as indicated by tumor response and potential respectability in selected patients or IP chemotherapy in <1 cm optimally debulked Stage III patients 4

6 Item IV-Patient Survival Rates CoxHealth s five-year overall survival was compared to National Cancer Data Base (NCDB) and IMPAC MRS Cancer Information Reference File (CIRF). (See table and graph below) Ovarian Cancer Survival Stage III-IV 5-Year Observed Survival CoxHealth vs CIRF vs National Percent Surviving Months Surviving (National Survival Years ) Cox III Cirf III National III Cox IV Cirf IV National IV Stage III Stage IV CoxHealth 16% 14% CIRF 32% 15% NCDB ( ) 32% 15% For comparison to CIRF data we looked at the time period of 1996 to For this time period CoxHealth diagnosed 83 patients with stage III and 24 patients with Stage IV disease. Of the 107 patients 4 have been excluded due to histology. The remaining 103 patients have been followed and compared to CIRF data comprised of 17,517 patients. National data comparison depicts the years with a total of 41,040 patients. 5

7 Survival by Age by Stage III & IV: Ovarian Cancer Stage III & IV 5-Year Survival by Age CoxHealth vs CIRF Percent Surviving > Age Range CoxHealth CIRF Median Survival by Age: Ovavian Cancer Median Survival by Age CoxHealth vs CIRF* Months Surviving > AGE CoxHealth CIRF *IMPAC MRS CANCER INFORMATION REFERENCE FILE 6

8 Conclusion: The morbidity associated with ovarian carcinoma is partially attributed to the fact that two-thirds of patients present with advanced-stage disease (stage III or IV) at the time of diagnosis. Although multiple techniques have been developed for screening asymptomatic women to achieve an earlier stage at diagnosis, these techniques have been insufficiently sensitive and specific to meet these goals and therefore, have not resulted in a shift toward earlier diagnosis and improved survival. Our study reflects CoxHealth appears to follow the national trend with 61% of ovarian carcinoma patients presented with advanced stage III or IV disease. Further statistical analysis regarding the correlation of national staging data and Hulston Cancer Center staging data is underway. Works Cited: 1. The American Cancer Society s Clinical Oncology. The American Cancer Society National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Ovarian Cancer V