Cisplatin-based combination chemo-therapy regimens have clearly produced higher response rates, complete remission rates, and an improvement in the median survival of patients with advanced ovarian cancer. The impact on long term survival has been modest, and the majority of patients with advanced ovarian cancer still die of their disease. Five-year survival rates for patients treated with cisplatin-based regimens are approximately 20% to 25%. While this is a substantial improvement over the 5% to 10% survival rate reported for patients with advanced disease in the pre-platinum era, it is obvious that ovarian cancer still remains a formidable challenge and that new treatment approaches are needed.

The prognosis for patients with epithelial ovarian cancer is related to several clinical variables. Survival analyses based on the most commonly used prognostic variables are presented below. Including patients at all stages, patients less than 50 years of age have a 5-year survival rate of about 40%, compared with about 15% for patients older than 50 years.

The 5-year survival rate for carefully and properly staged patients with stage I disease is 76% to 93%, depending on the tumor grade. The 5-year survival for stage II is 60% to 74%. The 5-year survival rate for stage IIIa is 41%, for stage IIIb about 25%, for stage IIIc 23% and for stage IV disease 11%. An analysis of the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database reveals a trend toward improved survival for ovarian cancer in the U.S. during the last period of analysis (1988-1994). In this cohort, the survival for stage I was 93%, for stage II 70%, for stage III 37% and for stage IV 25%. Compared with the interval 1983-1987, there was a statistically significant improvement in survival for stages I, III and IV disease.

Survival of patients with borderline tumors is excellent, with stage I lesions having a 98% 15-year survival. When all stages of borderline tumors are included, the 5-year survival rate is about 86% to 90%.

For invasive cancers grade affects the prognosis. For invasive stage I disease, the 5-year survival rate for grade 1 epithelial ovarian cancers is about 91%, compared with about 74% for grade 2 and 75% for grade 3. For stage II disease, the survivals are 69%, 60% and 51%, respectively, for grades 1, 2 and 3. Examining stage III-IV patients, the 5-year survivals for grades 1, 2 and 3, respectively, are 38%, 25%, and 19%. Patients with stage III disease with microscopic residual disease at the start of treatment have a 5-year survival rate of about 40% to 75%, compared with about 30% to 40% for those with optimal disease and only 5% for those with non-optimal disease. Patients whose Karnofsky index (KI) is low (<less than> 70) have a significantly shorter survival than those with a KI <more than> 70.