Histological Characteristics and Early-Stage Diagnosis Are Associated With Better Survival in Young Patients With Epithelial Ovarian Cancer: A Retrospective Analysis Based on Surveillance Epidemiology and End Results Database

Abstract

PurposeTo analyze the potential prognostic factors of epithelial ovarian cancer (EOC) in women aged under 35 compared to those aged 60–79.MethodsCases were retrospectively obtained from SEER database. Clinical characteristics, such as race, histological type, AJCC stage, laterality of tumors, CA125 results, and surgical strategies, were analyzed in < 35 years group and 60–79 years group. Kaplan-Meier survival curves were used to evaluate overall survival (OS) and cause-specific survival (CSS). Cox proportional hazard model was used to identify the predictors for CSS.ResultsSixteen thousand eight hundred forty-seven EOC patients diagnosed in 2004–2015 were identified from SEER database, with 1,015 aged under 35 and 15,833 aged 60–79. In < 35 years group, mucinous (32.2%) was the most common histological type, followed by high-grade serous (26.6%) and endometrioid (18.3%), while in 60–79 years group, high-grade serous (68.3%) represented the leading histological type. Most young women were diagnosed at stage I (57.7%), while most old women were diagnosed at stage (48.1%). Both 5-year OS and 5-year CSS were higher in < 35 years group (5-year OS: 76.00% vs 40.18%, p < 0.001; 5-year CSS: 83.56% vs 55.18%, p < 0.001). The multivariate analysis identified histological type and stage as prognostic factors for CSS in both groups. Endometrioid represented a positive predictor for CSS, while carcinosarcoma and malignant Brenner were related to a worse CSS. (< 35 years group: carcinosarcoma vs endometrioid: HR 5.630, p=0.024; malignant Brenner vs endometrioid: HR 4.005, p < 0.001; 60–79 years group: carcinosarcoma vs endometrioid: HR 3.606, p < 0.001; malignant Brenner vs endometrioid: HR 2.291, p < 0.001). Tumors laterality, CA125 levels, surgery and lymphadenectomy failed to be associated with the CSS in < 35 years group, while found to be independent risk factors in 60–79 years group.ConclusionEOC women aged under 35 had a better survival outcome over EOC women aged 60–79, owing to high proportion of endometrioid and mucinous types in histology, as well as early-stage diagnosis. Identification of histological types and gene profiles should be underscored in young EOC patients.

Survival impact of number of removed para-aortic lymph nodes in stage I epithelial ovarian cancer

“…Age, tumor factors (grade, histologic type, presence of LVSI or molecular factors such as abnormal oncogene expressions or gene mutations) and surgical factors such as execution of lymphadenectomy have been reported to determine the prognosis of stage I EOC [2,4,[8][9][10]. Of those, only the surgical factors can be changed and improved.…”

Nomogram for predicting postoperative cancer-specific early death in patients with epithelial ovarian cancer based on the SEER database: a large cohort study

“…The prognosis of stage III and IV patients is generally poor and mainly depends on the size of intraperitoneal metastases [ 24 ]. As stage progresses, the risk of death increases [ 25 , 26 ]. A large retrospective cohort study based on the SEER database suggested that mortality in patients with stage III–IV ovarian cancer is as high as 10% in 1 year [ 27 ].…”

Evaluation of the Calculated Risk of Malignancy Index as a Predictor of the Nature of Adnexal Masses

“…The survival rate is related to the stage of the disease at the diagnosis. In patients diagnosed with advanced stage III-IV ovarian cancer, the 5-year survival rate is about 30%, whereas in those diagnosed at an early stage the 5-year survival rate is about 90% [15][16][17] . Therefore, it seems worthwhile to diagnose ovarian cancer at an early stage [18] .…”

“…Unnecessary surgical procedures results from inadequate diagnostic tools preoperatively. Different laboratory markers, imagination methods and clinical parameters were presented for identifying malignancy potential of an adnexal mass [16] .…”