983P - Hospital follow up in ovarian cancer: physical examination does not improve relapse detection or survival

Date 29 September 2012
Event ESMO Congress 2012
Session Poster presentation I
Topics Ovarian Cancer
Presenter Shien Chow
Authors S. Chow1, S.J. Ayers2, A. Clamp1, G.C. Jayson1, J. Hasan1
  • 1Medical Oncology, The Christie NHS Foundation Trust, M20 4BX - Manchester/UK
  • 2Oncology, The Christie NHS Foundation Trust, M20 4BX - Manchester/UK

Abstract

Rationale

There are no trial data that define the optimum follow up strategy for patients with epithelial ovarian cancer (EOC). Relapse is suspected on the basis of symptoms, signs or elevated CA125. The relative merit of each of these is unclear because of a lack of data on cost-effectiveness and survival benefit. The aim of this study was to assess the utility of follow up procedures in relapse detection and survival.

Study design

A cohort of 429 patients with FIGO stage I-III EOC in remission after first-line treatment was identified from the Christie Hospital ovarian cancer database. 138 patients with recurrent disease were identified in this cohort. Patients were categorised as having symptomatic relapse, relapse with clinical signs, CA125 elevation or combinations of the three. The clinical value of each of the three indicators of relapse and their effect on survival were analysed.

Results

41% of relapses were detected by single detection method. In 82% of patients, relapse was detected from a rising CA125 irrespective of symptoms or clinical signs. 18% of cases had disease that did not secrete CA125 at relapse. 66% of patients had symptoms at relapse, and 21% had at least one physical examination finding suspicious of relapse. A combination of rising CA125 and symptoms detected majority of relapses (98%) regardless of physical examination findings. Symptoms only were predictive of relapse in 13% of cases. Physical examination alone had the lowest detection rate of 2% (3/138). None of these patients were suitable for salvage surgery. CA125 and symptoms detected relapse in all 18 patients who had salvage surgery. 10/18 had single site relapse. There were no statistically significant differences in survival between detection methods at 1, 3 and 5 year (p = 0.81).

Conclusion

Physical examination is of limited benefit in the follow-up of EOC. It did not contribute to detection of disease suitable for salvage surgery. CA125 and symptom history can safely detect relapse in 98% of cases without compromising survival. This study questions the utility of routine hospital follow up in EOC patients.

♦ Decimals rounded to nearest whole number.

Disclosure

All authors have declared no conflicts of interest.