Clinical significance of ascites in epithelial ovarian cancer

Abstract

The prognostic significance of ascites in the dissemination of metastases in epithelial ovarian cancer (EOC) is unclear. Our study aimed to investigate the association between clinicopathological factors and the development of ascites, as well as its prognostic significance. Three hundred and thirty three patients with primary EOC were suitable for inclusion. We analyzed the correlation between clinicopathological factors, including the extent of metastases, and ascitic volume. The prognostic significance of ascites was assessed using the Kaplan-Meier method and multivariate Cox's regression analysis. The average ascitic volume was 1,800 ml. Significantly, more patients with advanced FIGO stage disease presented with ascites. The volume of ascites increased significantly when metastatic disease was present in more than three regions (p<0.05), and this was the sole factor identified as associated with ascitic volume by multiple linear regression analysis. Median survival was significantly different between those with an ascitic volume less than 1,800 ml (median survival = 58 months), and those with a volume greater than 1,800 ml (median survival = 28.6 months) (p<0.05). Subgroup analysis of stage III and IV patients also revealed a poor prognosis in the presence of massive ascites (p = 0.03). Multivariate analyses found that massive ascites and poor differentiation were independent poor prognostic factors for stage III and IV EOC patients by Cox regression, using a backward elimination procedure. The volume of ascites increased significantly with the extent of metastastic disease. Massive ascites and poor tumor differentiation were associated with a worse prognosis in patients with advanced stage ovarian cancer.

Impact of ascites volume on clinical outcomes in ovarian cancer: A cohort study

“…Age, stage, response to surgery (optimal vs. sub-optimal), and initial platinum-free interval are the strongest predictors of overall clinical outcome [2]. Some clinical factors associated with surgical outcome include pre-operative CA 125, spread of disease on pre-operative imaging, hematologic parameters, extent of disease identified at the time of surgery, and presence or absence of ascites [2–4]. …”

“…A number of studies have identified the presence of ascites and volume of ascites as negative prognostic factors in patients with ovarian cancer [4, 8–10]. It is unclear from these studies whether ascites is simply a manifestation versus a driver of disease progression.…”

Natural Killer Cells Response to IL-2 Stimulation Is Distinct between Ascites with the Presence or Absence of Malignant Cells in Ovarian Cancer Patients

“…However, 61% of patients present at an advanced stage, and despite therapeutic advances, only 27% survive for 5 years after diagnosis [1]. One of the reasons for late diagnosis is that ovarian cancer is asymptomatic until the occurrence of abdominal bloating or swelling, symptoms commonly associated with ascites and metastases beyond the ovary [2]. Peritoneal ascites are a distinguishable feature of patients with advanced ovarian cancer, and is a result of the inflammatory response triggered by the malignancy.…”

Flow-induced Shear Stress Confers Resistance to Carboplatin in an Adherent Three-Dimensional Model for Ovarian Cancer: A Role for EGFR-Targeted Photoimmunotherapy Informed by Physical Stress

“…The presence and progression of ascites are associated with grim survival statistics, a decreased quality of life, and may have predictive value for malignant ovarian tumors [3,5,11,[14][15][16][17]26,31,[99][100][101][102]. The predictive value of ascites remains a source of debate, as is the case with most clinical and biological markers for this challenging disease [98,[103][104][105]. Ascites in ovarian cancer patients is treated by managing the underlying disease, typically via surgical resection and adjuvant platinum-based chemotherapy.…”

“…Unfortunately, an estimated 85% of ovarian cancer patients who achieve remission following first-line therapy will develop recurrent disease, which is associated with a median survival of 12 to 24 months [2,12,14,105]. Intractable ascites often develop in these patients, a major co-morbidity that is managed by draining the fluid to temporarily alleviate the associated pain and discomfort [3,5,14,103,104]. Treatment approaches to reduce ascites and improve chemotherapy efficacy include the use of anti-vascular endothelial growth factor agents as well as targeting the renin-angiotensin system [3,5,14].…”