Long-Term Survival Among Histological Subtypes in Advanced Epithelial Ovarian Cancer: Population-Based Study Using the Surveillance, Epidemiology, and End Results Database

Abstract

Background Actual long-term survival rates for advanced epithelial ovarian cancer (EOC) are rarely reported. Objective This study aimed to assess the role of histological subtypes in predicting the prognosis among long-term survivors (≥5 years) of advanced EOC. Methods We performed a retrospective analysis of data among patients with stage III-IV EOC diagnosed from 2000 to 2014 using the Surveillance, Epidemiology, and End Results cancer data of the United States. We used the chi-square test, Kaplan–Meier analysis, and multivariate Cox proportional hazards model for the analyses. Results We included 8050 patients in this study, including 6929 (86.1%), 743 (9.2%), 237 (2.9%), and 141 (1.8%) patients with serous, endometrioid, clear cell, and mucinous tumors, respectively. With a median follow-up of 91 months, the most common cause of death was primary ovarian cancer (80.3%), followed by other cancers (8.1%), other causes of death (7.3%), cardiac-related death (3.2%), and nonmalignant pulmonary disease (3.2%). Patients with the serous subtype were more likely to die from primary ovarian cancer, and patients with the mucinous subtype were more likely to die from other cancers and cardiac-related disease. Multivariate Cox analysis showed that patients with endometrioid (hazard ratio [HR] 0.534, P<.001), mucinous (HR 0.454, P<.001), and clear cell (HR 0.563, P<.001) subtypes showed better ovarian cancer-specific survival than those with the serous subtype. Similar results were found regarding overall survival. However, ovarian cancer–specific survival and overall survival were comparable among those with endometrioid, clear cell, and mucinous tumors. Conclusions Ovarian cancer remains the primary cause of death in long-term ovarian cancer survivors. Moreover, the probability of death was significantly different among those with different histological subtypes. It is important for clinicians to individualize the surveillance program for long-term ovarian cancer survivors.

What proportion of patients with stage 3 ovarian cancer are potentially cured following intraperitoneal chemotherapy? Analysis of the long term (≥10 years) survivors in NRG/GOG randomized clinical trials of intraperitoneal and intravenous chemotherapy in stage III ovarian cancer

“…These figures are similar to our findings but do not distinguish between the proportion alive without recurrence and those living with recurrent EOC. The SEER registry data also shows that although 80% of ovarian cancer deaths occur within 5 years of diagnosis, almost 50% of patients who are alive at 5 years will die after this with the majority of deaths due to ovarian cancer [2,14]. Even among patients who are progression free at 5 years, late relapse may occur, and we observed disease recurrence between 5 and 10 years in 53 patients in our study, thus supporting the need for follow up beyond 5 years [14].…”

Neoadjuvant chemotherapy induces an elevation of tumour apparent diffusion coefficient values in patients with ovarian cancer

“…Most (90%) OCs are of the epithelial subtype. Rapidly evolving, heterogeneous high-grade serous ovarian cancer (HGSOC) is the most common epithelial OC and one of the aggressive histological subtypes [ 2 – 6 ]. At the time of diagnosis, approximately two-thirds of epithelial OCs are Federation of Gynaecology and Obstetrics (FIGO) stage III or IV and present with signs of extra-ovarian dissemination, such as peritoneal and omental nodules, and high-volume ascites [ 4 , 7 ].…”

IRAK1 is a critical mediator of low molecular weight hyaluronic acid-induced stemness in high-grade serous ovarian cancer

“…Recent advances in chemotherapy and surgical procedures have resulted in improvements in the overall survival of patients with epithelial ovarian cancer (EOC), yet it remains the deadliest gynecological malignancy with <25% surviving beyond 5-years 1 . PARP inhibitors have demonstrated durable and highly effective antitumor responses in BRCA -mutated advanced EOC, which represents about 20% of the patients, though their effectiveness in BRCA wildtype and platinum-resistant EOC remain poor 2 .…”