Survival after recurrence in early-stage high-risk epithelial ovarian cancer: A Gynecologic Oncology Group study

Objective: This study aimed to evaluate the clinical outcome of recurrent early-stage high-risk epithelial ovarian cancer patients. Methods: Demographic and clinicopathological data were collected from women enrolled in GOG 157 who underwent surgical staging and had recurrent disease. Survival probability was estimated using Kaplan-Meier method, and hazard ratio of death was analyzed using Cox regression model. Results: Of 74 women with recurrent early-stage high-risk ovarian cancer, the median age at recurrence was 63 years; 93% were White, 2.7% were Black, 2.7% were Asian, and 1.4% were Others. Fifty-eight percent had stage I, and the remainder had stage II disease. Clear cell, serous, endometrioid, mucinous, and other tumors consisted of 28.4%, 25.7%, 24.3%, 16.2%, and 5.4% of patients, respectively; in addition, 36.5% had ascites, 33.8% had positive cytology, and 43.2% had ruptured tumors. Fifty-eight percent underwent three cycles, and 42% had six cycles of adjuvant chemotherapy with paclitaxel and carboplatin. Recurrence was diagnosed clinically in 46% and radiographically in 54% of women. The median time from completion of primary chemotherapy to recurrence (treatment-free interval, TFI) was 21 months. Overall, median survival after recurrence was 24 months. Patients with longer (> 24 months) TFI had a higher median survival after subsequent treatment at 35 months compared to only 10 months in those who recurred ≤ 24 months (p = 0.003). Conclusions: Although patients with primary early-stage high-risk ovarian cancer have an overall favorable prognosis, survival after recurrence is poor and comparable to those with recurrent advanced-stage disease. Novel therapeutic modalities are warranted in these high-risk patients.