At the time of first relapse, all patients underwent thorough staging with radiology, biochemistry, and clinical examination.
Thus, it is likely that the survival improvement associated with lymphadenectomy over time is due to an increase in proportion of true early-stage patients after a thorough staging procedure, and subsequent removal of inaccurately staged patients with true stage IIIC disease.
The stage migration phenomenon occurs when comparisons are made between groups of patients who have undergone less or more thorough staging techniques and as such is likely to occur when the comparisons are made over a time period which spans the introduction of new technology.
The identification of a higher proportion of palliative patients in the re-audit may reflect the introduction of the directive that all patients should be discussed at MDT with more thorough staging and assessment of irresectable metastatic disease and medical infirmity.
Only ovarian cancer patients who have undergone a thorough surgical staging procedure, with early-stage and well or moderately differentiated tumours, may be considered as cured by surgery alone, and therefore do not require adjuvant therapy (Trimbos et al, 1991).
The proposed architecture has a thorough four-stage detection process that analyses billing records in IP detail record (IPDR) format – an emerging IP-based billing standard – for signs of fraud.
Therefore, once IMLN recurrence was detected, a thorough re-staging workup was necessary to evaluate the extent of the disease status.
Future implications for patient management will be a thorough baseline staging and assessment of disease activity, therapy response monitoring and prognosis prediction.
According to the authors, these patients would benefit from more thorough preoperative staging and alternative neoadjuvant chemotherapy regimens, including induction chemotherapy.
