Abstract
Objective: Despite optimal treatment with debulking surgery and chemotherapy, the majority of patients with advanced stage epithelial ovarian cancer (EOC) die within five years. Survival beyond eight years is rare and the mechanisms that lead to such favorable outcomes are incompletely understood. We aimed to identify characteristics associated with long-term survival (LTS) in a population-based cohort of patients with advanced stage EOC. Methods: Patients with advanced stage (FIGO IIB-IV) EOC diagnosed between 2008 and 2012 were identified from the Netherlands Cancer Registry. LTS was defined as survival for more than eight years after diagnosis, based on 20% survival within this cohort. Patient, tumor, and treatment characteristics were analyzed using multivariable logistic regression to find predictors for LTS. Results: We identified 2744 eligible patients of whom 571 were long-term survivors (survival longer than eight years). Younger age, lower tumor stage, low-grade histology, FIGO IV based on extra-abdominal lymph node compared to pleural metastasis, primary debulking surgery vs neo-adjuvant chemotherapy followed by interval debulking surgery, residual disease less than one cm or no macroscopic disease, and ascites less than 100 mL were associated with LTS. Furthermore, less than six chemotherapy cycles compared to six, and carboplatin plus paclitaxel combined with other chemotherapy agents compared to carboplatin plus paclitaxel, were associated with a lower odds of LTS. Conclusion: Characteristics of the tumor, patient and treatment play a substantial role in respect to the prognosis of advanced stage EOC, and can assist in the prediction of LTS.
Highlights
Epithelial ovarian cancer (EOC) is the most common type of ovarian cancer and accounts for approximately three percent of all cancer types in women in the Netherlands
Descriptive analysis of treatment (Table 2) showed that long-term survivors more frequently received primary debulking surgery (PDS) (71.1% vs 45.4%), a complete debulking (56.9% vs 37.9%), regular carboplatin-paclitaxel combination chemotherapy (91.6% vs 85.0%), six chemotherapy cycles (83.7% vs 67.4%), optimal dose intensity (74.3% vs 66.2%) and less frequently less than six cycles (5.3% vs 13.2%) or more than six cycles (8.6% vs 17.3%) than patients who died within eight years
The analyses suggested that 20% of the women survived for more than eight years and that there were significant associations between long-term survival (LTS) and younger age, favorable tumor characteristics, treatment characteristics, less than 100 mL ascites, and chemotherapy characteristics
Summary
Epithelial ovarian cancer (EOC) is the most common type of ovarian cancer and accounts for approximately three percent of all cancer types in women in the Netherlands. EOC is the leading cause of cancer related death in Western countries [1,2]. Most women present with advanced stage disease and have a high risk of disease recurrence and death [3]. Despite the knowledge gained about prognostic factors and treatment enhancements, patients continue to show poor survival [4,5]. 15% of women with advanced stage EOC survive for more than 10 years [6,7,8]. Several studies have attempted to evaluate these so-called ‘longterm survivors’, yet the underlying mechanism responsible for this extraordinary survival remains poorly understood [6,7,8,9,10,11,12]
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