Stage IV ovarian cancer: Disease site-specific rationale for postoperative treatment

Objectives: We aimed to define the site-specific patterns of treatment failure in stage IV ovarian cancer. Methods: Data from all consecutive Mayo Clinic patients with stage IV epithelial ovarian cancer, from 1994 through 2003, were collected and analyzed. Statistical analyses included the χ² test and Kaplan-Meier curves with log-rank tests. Results: Review of our patient database identified 109 patients with stage IV ovarian cancer: mean age, 62 years (range, 36-83 years); 5-year overall survival, 15%. Most patients (74%) had intraperitoneal disease at the time of relapse, 36% had pleural effusion, and 49% had extraperitoneal metastases. At the time of death 75% had intraperitoneal localizations, 51% had pleural effusion, and 46% had extraperitoneal metastases. Patients with pleural effusion were more likely to have pleural disease at relapse and at last follow-up. Extrapleural disease at the time of diagnosis predicted extrapleural disease at relapse and at last follow-up. Most patients classified as having stage IV disease by pleural cytology only, as opposed to all other patients, had intraperitoneal disease at relapse (88% vs 58.7%, P = .001) and last follow-up (88.5% vs 59.6%, P = .001). Patients having stage IV disease by pleural cytology only had survival benefit when disease was optimally debulked in the abdomen and pelvis (median survival, 3.1 years vs 1.3 years; P = .001). Patients with multiple unresectable liver metastases had poor prognosis (median survival, 1.2 years) owing to progression of liver disease. Conclusions: Clinical trials for stage IV ovarian cancer should reflect the site-specific risks for recurrence according to disease location at diagnosis.