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Is There a High-Risk Subgroup of Stage I Epithelial Ovarian Cancer that Is Most Likely to Benefit From 6 Versus 3 Cycles of Adjuvant Chemotherapy?
  1. Jamie N. Bakkum-Gamez, MD*,
  2. Debra L. Richardson, MD,
  3. Leigh G. Seamon, DO,
  4. Giovanni D. Aletti, MD§,
  5. Cecelia A. Powless, MD,
  6. Gary L. Keeney, MD,
  7. David M. O'Malley, MD# and
  8. William A. Cliby, MD*
  1. *Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN;
  2. Division of Gynecologic Oncology, UT Southwestern Medical Center, Dallas, TX;
  3. Division of Gynecologic Oncology, University of Kentucky College of Medicine, Lexington, KY;
  4. §Division of Gynecologic Oncology, European Institute of Oncology, Milan, Italy;
  5. Department of Obstetrics and Gynecology, Howard Regional Health System, Kokomo, IN;
  6. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN; and
  7. #Division of Gynecologic Oncology, The Ohio State University College of Medicine, Columbus, OH.
  1. Address correspondence and reprint requests to Jamie N. Bakkum-Gamez, MD, Division of Gynecologic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905. E-mail: bakkum.jamie{at}


Objective: Despite results from Gynecologic Oncology Group (GOG) 157 showing no statistically significant survival differences in patients treated with 3 versus 6 cycles of carboplatin and paclitaxel, further analysis of GOG 157 data suggested that certain early-stage epithelial ovarian cancers (EOCs) might benefit from extended chemotherapy. We sought to determine those stage I EOC cases at highest risk of failing 3 cycles of therapy.

Methods: All patients with surgical International Federation of Gynecology and Obstetrics stage I EOC operated on at the Mayo Clinic and The Ohio State University between January 1991 and December 2007 were identified through retrospective chart review. A cohort of patients who received 6 cycles of adjuvant carboplatin and paclitaxel chemotherapy was compared with a cohort of patients who received 3 cycles. Disease-free survival and disease-specific survival were primary outcomes analyzed.

Results: There were 107 patients who received either 3 or 6 cycles of adjuvant carboplatin and paclitaxel. Among all stage I EOCs, the number of cycles did not influence disease-free survival or disease-specific survival. The highest recurrence rate (7 [46.7%] of 15 cases) was among stage IC cases with fixed tumors and positive cytology and/or surface involvement. Among this cohort, 6 (66.7%) of the 9 patients who received 3 cycles recurred, whereas only 1 (16.7%) of the 6 patients who received 6 cycles recurred (hazard ratio, 5.97; 95% confidence interval [CI], 0.98-114.46; P = 0.05, Cox proportional hazards regression model) for an odds ratio of 3.94. The absolute risk reduction for 6 cycles in this highest risk cohort was 50%.

Conclusions: Patients with stage IC cancer and with fixed tumors and positive cytology and/or tumor surface involvement appear to have a higher risk of recurrence after 3 cycles (compared with 6) of platinum-based chemotherapy. The clinical behavior of this highest risk cohort implies a more aggressive tumor biology, and further understanding of such stage I EOCs is warranted.

Abbreviations: EOC - Epithelial ovarian cancer, GOG - Gynecologic Oncology Group, FIGO - International Federation of Gynecology and Obstetrics, DFS - Disease-free survival, DSS - Disease-specific survival, HR - Hazard ratio

  • Ovarian cancer
  • Chemotherapy
  • Carboplatin
  • Paclitaxel
  • Disease recurrence
  • Death from disease

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  • Presented at the Society of Gynecologic Oncologists, Annual Meeting, San Antonio, Texas, February 7, 2009, as an oral presentation.

  • There are no conflicts of interest for this manuscript.

  • Copyright © 2010 by Mayo Foundation.