Abstract
BackgroundActual long-term survival rates for advanced epithelial ovarian cancer (EOC) are rarely reported.ObjectiveThis study aimed to assess the role of histological subtypes in predicting the prognosis among long-term survivors (≥5 years) of advanced EOC.MethodsWe 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.ResultsWe 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.ConclusionsOvarian 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.
Highlights
BackgroundAdvanced stage epithelial ovarian cancer (EOC) is usually incurable
Ovarian cancer remains the primary cause of death in long-term ovarian cancer survivors
Patients with the serous subtype had a higher risk of regional lymph node metastasis than those with the endometrioid and mucinous subtypes (35.7% vs 26.2%-31.5%), while those with the clear cell subtype had a higher risk of regional lymph node metastasis than those with the other 3 histological subtypes (42.6% vs 26.2%-35.7%) (P
Summary
BackgroundAdvanced stage (stage III-IV) epithelial ovarian cancer (EOC) is usually incurable. Approximately 25% and 15% of patients with EOC survive for >5 years and >10 years, respectively [1,2,3,4] It largely remains unknown why long-term survivors have a better outcome, investigating the underlying mechanisms or factors is key for developing individualized follow-up strategies for patients with EOC. A previous study using the California Cancer Registry reported that the nonserous subtype is an independent predictor of long-term survival in EOC; favorable prognoses were observed among patients with the endometrioid, mucinous, and clear cell subtypes than in those with the serous subtype [3]. Actual long-term survival rates for advanced epithelial ovarian cancer (EOC) are rarely reported
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