Abstract
Objective: To analyze conditional survival (CS) in patients with advanced epithelial ovarian cancer (EOC) and investigate prognostic factors that affect the CS rate to provide more accurate survival information.Methods: Patients with advanced EOC between 2004 and 2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. CS analysis was performed to depict exact survival for patients who had already survived a specific number of years. Cox proportional hazards regression was performed to ascertain the individual contribution of factors associated with actuarial overall survival (OS) at diagnosis and CS at 1, 3, and 5 years after diagnosis.Results: Of 11,773 patients, OS decreased from 32.2% at 6 years to 25.1% at 8 years, while the corresponding 5 year CS (CS5) increased from 37.5% at 1 year to 43.9% at 3 years. Subgroup analysis stratified by clinicopathological characteristics showed that CS5 was always higher than the corresponding actuarial survival (all Δ > 0). Based on multivariate analysis at diagnosis, age, race, marital status, histological type, tumor grade, size, T stage, M stage, surgery, radiation therapy, and chemotherapy were independent prognostic factors for OS. Five years after diagnosis, however, only age, histological type, tumor grade, and laterality were persistently significant independent prognostic factors (all P <0.05). Furthermore, patients with poor pathological prognostic factors achieved greater improvements in CS5 rates, and the survival gaps between OS and CS were more obvious.Conclusion: CS of advanced EOC was dynamic and increased over time. Age, histology, tumor grade, and laterality were significant prognostic factors even 5 years after diagnosis. Thus, the availability of updated prognoses at various time points will allow clinicians to better guide their patients.
Highlights
Ovarian cancer is one of the most common tumors in women, with the highest mortality rate among gynecology malignancies [1, 2]
The inclusion criteria were as follows: [1] patients were pathologically diagnosed with advanced Epithelial ovarian cancer (EOC) between 2004 and 2015 (FIGO stage III and IV); [2] patients were at least 18 years of age; [3] ovarian cancer was the only primary carcinoma; and [4] histological code was in accordance with the International Classification of Tumor Diseases, Third Edition (ICD-O-3) [11]
The improvements in CS5 rates and the survival gaps between overall survival (OS) and conditional survival (CS) were more clear for patients with poor pathological prognostic factors
Summary
Ovarian cancer is one of the most common tumors in women, with the highest mortality rate among gynecology malignancies [1, 2]. Epithelial ovarian cancer (EOC) is the most common histological type of ovarian cancer, accounting for approximately 90% of cases [3]. The 5 year overall survival (OS) rates of patients with Federation International of Gynecology and Obstetrics (FIGO) stage III and IV EOC are 42 and 26%, respectively [3]. The prognosis of patients with cancer mainly depends on stage and the individual’s response to treatment, but prognosis can change for each individual over time. With increased survival, there is increasing interest in quality of life for advanced epithelial ovarian cancer survivors and their survivorship care. Traditional Kaplan–Meier assessment can only be used to determine survival and prognosis at the time of diagnosis and does not change with passage of time [5, 6], which fails to reflect the dynamic prognosis updated to the current status
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