Impact of bowel obstruction at the time of initial presentation in women with ovarian cancer

Objective To determine whether the presence of bowel obstruction at the time of initial presentation has any prognostic significance in these women. Design Retrospective cohort study. Setting Dedicated gynaecological oncology service of a large tertiary institution. Population Women who had a bowel obstruction as part of their initial presentation of ovarian cancer were identified between 1995 and 2007. Each woman was matched with four control women (with disease but no obstruction). Methods Women with disease were compared with controls to determine the impact, if any, of bowel obstruction at presentation. Several prognostic variables including bowel obstruction were also evaluated in a Cox proportional hazard model. Main outcome measures Progression-free survival (PFS) and overall survival (OS). Results Forty-eight women with disease and 192 controls were identified during the study period. The median follow-up period was 19 months among women with disease versus 20 months in controls. No differences were seen in demographics and clinical characteristics of the women. Optimal cytoreduction rate was similar between the two groups (75% versus 78%, P = 0.7). Patients with bowel obstruction had a shorter PFS and OS compared with controls [19 months versus 21 months (P = 0.01) and 22 versus 35 months (P = 0.008)], respectively. Bowel obstruction at presentation was an independent prognostic variable with a hazard ratio of 1.5 (P = 0.009). Other prognostic variables were age, stage and extent of surgical cytoreduction. Conclusions Bowel obstruction at the time of initial presentation is an adverse prognostic factor in women with ovarian cancer.