Patient Characteristics

In a population-based analysis of patients with ovarian cancer between 1988 and 2001, age was identified as an independent prognostic factor with a survival advantage in younger women compared with older patients. Of 28,165 patients, 400 were under 30 years of age (very young), 11,601 were 30 to 60 (young), and 16,164 were over 60 (older). Of the very young, young, and older patients, 261 (65.3%), 4664 (40.2%), and 3643 (22.5%) had stage I-II disease, respectively (p < .001). Across all stages, very young women had a significant survival advantage over the young and

Box 1-1. Carcinoma of the Ovary (FIGO Staging)

Stage I Growth limited to the ovaries

IA Growth limited to one ovary; no ascites present containing malignant cells. No tumor on the external surface; capsule intact. IB Growth limited to both ovaries; no ascites present containing malignant cells. No tumor on the external surface; capsule intact. IC Tumor classified as either Stage IA or IB but with tumor on the surface of one or both ovaries; or with ruptured capsule(s); or with ascites containing malignant cells or with positive peritoneal washings.

Stage II Growth involving one or both ovaries, with pelvic extension

IIA Extension and/or metastases to the uterus and/or tubes. IIB Extension to other pelvic tissue.

IIC Tumor classified as either Stage IIA or IIB but with tumor on the surface of one or both ovaries; or with capsule(s) ruptured; or with ascites containing malignant cells or with positive peritoneal washings.

Stage III Tumor involving one or both ovaries with peritoneal implants outside the pelvis and/or positive retroperitoneal or inguinal nodes. Superficial liver metastasis equals Stage III. Tumor is limited to the true pelvis but with histologically proven malignant extension to small bowel or omentum.

IIIA Tumor grossly limited to the true pelvis with negative nodes but with histologically confirmed microscopic seeding of abdominal peritoneal surfaces. IIIB Tumor of one or both ovaries with histologically confirmed implants of abdominal peritoneal surfaces, none exceeding 2 cm in diameter; nodes are negative. IIIC Abdominal implants greater than 2 cm in diameter and/or positive retroperitoneal or inguinal nodes.

Stage IV Growth involving one or both ovaries, with distant metastases. If pleural effusion is present, there must be positive cytological findings to allot a case to Stage IV. Parenchymal liver metastasis equals Stage IV.

older groups, with 5-year disease-specific survival rate estimates at 78.8% versus 58.8% and 35.3%, respectively (P < .001). This survival difference among age groups persists even after adjusting for race, stage, grade, and surgical treatment. Reproductive-age (16 to 40 years) women with stage I-II epithelial ovarian cancer who received uterine-sparing procedures had similar survival rates compared with those who underwent standard surgery (93.3% versus 91.5%; P = .26).48 In another national survey of ovarian carcinoma in patients less than 25 years of age, younger patients appeared to have favorable stage and histologic grade. These factors, combined with good performance status and optimal cytoreduction, resulted in improved survival from cancer.49 Thigpen and associates50 reviewed 2123 patients enrolled in six GOG trials and identified age, volume of residual disease, and performance status as the three major prognostic factors affecting outcome in patients with ovarian cancer. Age over 69 years exhibited poorer survival even after correcting for stage, residual disease, and performance status.

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