Patterns of Relapse and Survival Analysis of Advanced Epithelial Ovarian Cancers Operated in a Tertiary Cancer Centre

  • M. P. Viswanathan
  • D. Suresh KumarEmail author
  • P. Muniasamy
  • S. Navin Noushad
  • D. Pradeep
Original Article



Advanced epithelial ovarian cancers have a dismal prognosis with a 5-year survival rate of 29.2%. A relapse rate in excess of 75% is noted in patients who achieve remission following neoadjuvant chemotherapy and cytoreductive surgery. Our study aims to find out the progression-free survival and overall survival of advanced epithelial ovarian cancers in South Indian population.

Materials and Methods

Demographic data, neoadjuvant treatment and surgery details, recurrence, and survival status of patients operated for advanced ovarian cancer in our department from year 2015 till 2018 were retrospectively collected through medical records. Statistical analyses were performed using SPSS version 25.


Our study included 111 patients with the majority staged as IIIC (82%). 107 patients received neoadjuvant chemotherapy. Six patients were lost to follow-up. The median pre- and post-chemotherapy CA 125 level was 694 IU/L and 33.5 IU/L, respectively. Optimal cytoreduction was achieved in 87.6% of patients. At a median follow-up of 24 months, median progression-free survival was 30 months (95% CI: 26.5–34.5) in the optimally cytoreduced versus 13 months (95% CI: 10.3–15.4) in the suboptimally cytoreduced patients (P0.005). The median overall survival was 36 months (95% CI: 32–39) in optimally cytoreduced versus 19 months (95% CI: 17.6–20.3) in suboptimally cytoreduced patients (P0.001).


Patients achieving optimal cytoreduction after neoadjuvant chemotherapy have significantly lower recurrence rates, higher progression-free survival, and overall survival rates than those suboptimally cytoreduced. Results from our centre are equivalent to apex centres in India.


Advanced ovarian cancers Progression-free survival Overall survival 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest to declare.


  1. 1.
    ‘Ovarian Cancer—Cancer Stat Facts’, SEER. [Online]. Available: Accessed 19 Mar 2019.
  2. 2.
    Zapardiel I, Morrow CP. New terminology for cytoreduction in advanced ovarian cancer. Lancet Oncol. 2011;12(3):214.CrossRefGoogle Scholar
  3. 3.
    Kang S, Nam B-H. Does neoadjuvant chemotherapy increase optimal cytoreduction rate in advanced ovarian cancer? Meta-analysis of 21 studies. Ann Surg Oncol. 2009;16(8):2315–20.CrossRefGoogle Scholar
  4. 4.
    Vergote I, Amant F, Ehlen T. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med. 2010;363:943.CrossRefGoogle Scholar
  5. 5.
    Sobiczewski P, Kupryjanczyk J, Michalski W, Śpiewankiewicz B. The evaluation of risk factors associated with relapse and recurrence of borderline ovarian tumors with long-term follow-up. Int J Gynecol Cancer. 2016;26(6):1053–61.CrossRefGoogle Scholar
  6. 6.
    van Driel WJ, et al. Hyperthermic intraperitoneal chemotherapy in ovarian cancer. N Engl J Med. 2018;378(3):230–40.CrossRefGoogle Scholar
  7. 7.
    Stuart GCE, et al. 2010 Gynecologic Cancer InterGroup (GCIG) consensus statement on clinical trials in ovarian cancer: report from the fourth ovarian cancer consensus conference. Int J Gynecol Cancer. 2011;21(4):750–5.CrossRefGoogle Scholar
  8. 8.
    Basu P, De P, Mandal S, Ray K, Biswas J. Study of “patterns of care” of ovarian cancer patients in a specialized cancer institute in Kolkata, eastern India. Indian J Cancer. 2009;46(1):28–33.CrossRefGoogle Scholar
  9. 9.
    Murthy NS, Shalini S, Suman G, Pruthvish S, Mathew A. Changing trends in incidence of ovarian cancer—the Indian scenario. Asian Pac J Cancer Prev. 2009;10(6):1025–30.PubMedGoogle Scholar
  10. 10.
    (PDF) Epidemiology of epithelial ovarian cancer: a tertiary hospital based study in Goa, India. [Online]. Accessed 01 May 2019.
  11. 11.
    Harter P, et al. A randomized trial of lymphadenectomy in patients with advanced ovarian neoplasms. N Engl J Med. 2019;380(9):822–32.CrossRefGoogle Scholar
  12. 12.
    Kumar DS, Noushad SN, Viswanathan MP. Pelvic lymphadenectomy as a component of interval cytoreduction for ovarian cancer: is there a benefit? A pilot study. Int J Res Med Sci. 2017;5(3):821.CrossRefGoogle Scholar
  13. 13.
    Ozols RF, et al. Phase III trial of carboplatin and paclitaxel compared with cisplatin and paclitaxel in patients with optimally resected stage III ovarian cancer: a gynecologic oncology group study. J Clin Oncol. 2003;21(17):3194–200.CrossRefGoogle Scholar
  14. 14.
    Maheshwari A, et al. Outcomes of advanced epithelial ovarian cancer treated with neoadjuvant chemotherapy. Indian J Cancer. 2018;55(1):50.CrossRefGoogle Scholar
  15. 15.
    Harter P, et al. Surgery in recurrent ovarian cancer: the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR trial. Ann Surg Oncol. 2006;13:1702.CrossRefGoogle Scholar

Copyright information

© Association of Gynecologic Oncologists of India 2019

Authors and Affiliations

  • M. P. Viswanathan
    • 1
  • D. Suresh Kumar
    • 1
    Email author
  • P. Muniasamy
    • 1
  • S. Navin Noushad
    • 1
  • D. Pradeep
    • 1
  1. 1.Department of Surgical OncologyTamil Nadu Government Multi Super Specialty HospitalChennaiIndia

Personalised recommendations