The treatment of advanced ovarian carcinoma (I): clinical variables associated with prognosis.

New therapy regimens including cytoreductive surgery and cisplatin-based combination chemotherapy have improved survival for a small group of patients with advanced ovarian carcinoma. However, for the entire group survival remains poor. In this analysis of 65 patients treated at Leiden University Medical Center, the patient group that benefited the most from this approach was characterized by a younger age, good performance status, less extensive disease, low histologic grade and the absence of peritoneal carcinomatosis and ascites, and residual disease less than or equal to 15 mm (successful cytoreduction) after the first operation. Patients who did not have these favorable characteristics but in whom the first operation resulted in residual disease less than or equal to 15 mm, did survive worse than the other patients with individual tumor nodules less than or equal to 15 mm, but still better than those in whom a successful cytoreduction at the first operation could not be achieved. The diameter of the largest residual disease, the diameter of the largest metastasis before cytoreduction, and the presence of ascites and peritoneal carcinomatosis influenced prognosis. Thus the initial tumor burden as well as the burdened tumor volume left behind are of significance with respect to prognosis. However, in the Cox regression analysis the performance status and ascites proved to be the only independent factors influencing survival. A prospective study is needed to establish the proper value of cytoreductive surgery in advanced ovarian carcinoma.