Ovary

--Parham G, Phillips JL, Hicks ML, Andrews N, Jones WB, Shingleton HM, Menck HR. The National Cancer Data Base report on malignant epithelial ovarian carcinoma in African-American women. Cancer 1997; 80:816-826. (!)

Epithelial ovarian carcinoma is the fifth most common cause of cancer death among African-American women. Although the incidence rate of ovarian carcinoma for whites is higher than that for African-Americans, the relative survival rate for African-Americans is poorer. The data used for this analysis were cases submitted to NCDB for invasive epithelial tumors of the ovary diagnosed between 1985 through 1988 and 1990 through 1993. African-American women with epithelial ovarian carcinoma were compared with non-Hispanic white women with the same disease. The groups of white women with which African-American women were compared were classified as "White-same facility" and "White-other facility". "White-same facility" were white patients from hospitals that contributed a substantial proportion of African-American patients. "White-other facility" were white patients from hospitals that contributed few or no African-American patients. No patients had a prior history of cancer. African-American women with advanced invasive epithelial ovarian carcinoma were less often treated with combined surgery and chemotherapy and more often treated with chemotherapy only. African-American women were twice as likely as white women not to receive appropriate treatment. African-American women had poorer survival rates than white women from the same or different hospitals, regardless of income. Among staged cases, African-American women were more often diagnosed with stage IV disease than either group of white women. The current study findings show that African-American women with advanced epithelial ovarian carcinoma received less aggressive treatment than white women and had a poorer prognosis.

--Partridge EE, Phillips JL, Menck HR. The National Cancer Data Base report on ovarian cancer treatment in United States hospitals. Cancer 1996; 78:2236-2246. (!)

The data from the NCDB represent ovarian cancer cases from of 940 hospitals. The 15,254 patients diagnosed in 1988 or 1993, had no prior cancer diagnosis. Data quality had improved by 1993; 89.4% of the records included American Joint Committee on Cancer (AJCC) staging information in 1993, compared with 67.9% in 1988. Borderline epithelial tumors and germ cell tumors were most commonly found in younger women and were more likely to be diagnosed at stage I. The percentage of women with carcinoma treated only with surgery increased substantially by 1993. Relative survival decreased with increasing tumor stage or grade. Five-year survival was considerably lower for women with carcinoma (38%) than for women with either borderline carcinoma (95%) or germ cell tumors (86%). The addition of chemotherapy to the treatment of stage I carcinoma did not improve outcome, nor was dramatic improvement in survival brought about by the addition of chemotherapy to the treatment of stage II and III low-grade disease. Chemotherapy was beneficial to patients with stage II or III disease, grade 3 or 4, and stage IV disease.

--Averette HE, Menck HR. The National Cancer Data Base report on ovarian cancer. Cancer 1995; 76:1096-1103.

Three Calls for Data from hospital registries across the United States yielded 17,114 ovarian cancer cases for 1985, 1986, 1991 combined. These data represent approximately 23%, 23%, and 43%, respectively, of the annual number of cases of ovarian cancer in the United States for those years. One-fourth of the reported cases of ovarian cancer were diagnosed in women less than 50 years of age. Younger patients (<40 years) were more likely to have received conservative therapy (unilateral oophorectomy), consistent with their high prevalence (59%) of sage I disease. The number of patients reported with an unknown AJCC stage decreased from 49% in 1985-1986 to 17% in 1991, although the distribution within stages was unchanged. Increases in important staging procedures were reported in 1991, with threefold increase in the proportion of debulking procedures and a 50% increase in omentectomies accompanying hysterectomy compared with 1985-1986. More advanced disease was reported for those of older age, lower income, African Americans, and patients in smaller hospitals. Relative 5-year survival rates were 74% for patients with stage I disease, 58% for stage II, 30% for stage III, and 19% for stage IV. Asians and Hispanics presented with a relatively high rate of stage I-II disease (45%) compared with non-Hispanic whites and African-Americans (38% and 33%, respectively). Hispanics presented with the most favorable stage I/IV ratio (1.5) and had an overall 5- year survival of 50% compared with 41% and 37% for non-Hispanic whites and African- Americans (stage I/IN ratios of 1.0 and 0.7, respectively). There was little difference reported in the use of multimodality treatment between 1985-1986 and 1991.

--Averette HE, Menck HR. Ovarian cancer. In: Steele GD, Winchester DP, Osteen RT, Menck HR, Murphy GP: eds. National Cancer Data Base: Annual review of patient care, 1994. Atlanta, GA: American Cancer Society, 1994.

Data were received on 4,217 ovarian cancer cases from 464 hospitals in 1985, 4,386 cases from 474 hospitals in 1986, and 8,511 cases from 937 hospitals in 1991. These data represent approximately 23%, 23%, and 43% of all ovarian cancers in the United States in 1985, 1986, and 1991, respectively. The most recent NCDB data from 1991 on ovarian cancer indicate that a trend toward more appropriate management and better prognosis has begun. However, ovarian cancer remains a major cause for morbidity and morality among women, and further improvement in this management must occur. Currently there are no adequate ways to consistently detect ovarian cancer in its earlier stages, but studies utilizing tumor markers and pelvic sonography in high-risk groups are being evaluated. Recent studies also suggest that pelvic and abdominal CT scans and sonography, as well as Ca-125 determinations, may be of diagnostic value in high-risk groups. For example, in familial ovarian cancer up to 50% of offspring may develop the disease. To achieve the best results, therapy should include appropriate preoperative diagnostic studies, preparation for complete surgery, adequate surgical staging, and appropriate follow up with adjunctive therapy. In addition to efforts to detect ovarian cancer in its early stage and treat it appropriately with surgery and chemotherapy, newer methods of management must be investigated. These include intraperitoneal chemotherapy, use of biologic response modifiers, combinations of multi-agent chemotherapy with whole abdominal radiotherapy, photodynamic therapy, and chemotherapy based on newer methods of chemosensitivity testing.

--Rodriguez M, Nguyen HN, Averette HE. National survey of ovarian carcinoma XII: Epithelial ovarian malignancies in women less than or equal to 25 years of age. Cancer 1994; 73:1245-1250. (*)

--Averette HE, Hoskins W, Nguyen HN, Boike G, Flessa HC, Chmiel JS, Zuber-Ocwieja KE, Karnell LH, Winchester DP. National survey of ovarian carcinoma: A patient care evaluation study of the American College of Surgeons. Cancer (Supplement) 1993; 71:1629-1638. (*)

Data were collected from 904 hospitals with cancer programs in 1983 and 1988. The first 25 consecutive patients at each facility were eligible for inclusion. There was a total of 12,316 patients, of whom 80% were 45-85 years old. Contrary to popular belief, only 8.2% of patients were nulliparous; 85% of patients had one to five children. Of significance, 18.2% of patients with ovarian cancer had undergone a previous hysterectomy with ovarian preservation. Primary surgical treatment was used in 94.9% of patients and consisted of: oophorectomy, 81.9%; hysterectomy, 55.1%; and omentectomy, 59.0%. However, only 12-25% of patients had biopsies of the diaphragm, paracolic gutters, colon, small bowel, pelvic and paraaortic lymph nodes, and cul-de-sac to permit adequate surgical staging. The primary surgeons were: gynecologic oncologists, 21%; obstetrician- gynecologists, 45%; general surgeons, 21%; and others, 13%.

--Winchester DP, Averette HE, Hoskins W. National survey of ovarian carcinoma. Cancer 1993; 71(suppl):1629-1637.

Clinical Infomation Bibliography