2022-RA-423-ESGO Symptomatic or asymptomatic recurrence of ovarian cancer: does it influence survival?

Abstract

Introduction/Background The survival benefit of monitoring CA125 in ovarian cancer patients after primary treatment is debated due to findings varying from insignificant survival differences to prolonged median overall survival in favor of asymptomatic patients. Hence, we aimed to compare ovarian cancer patients with and without symptoms at time of first diagnosed recurrence in terms of post-recurrence survival and overall survival and to explore time to recurrence and common symptoms at recurrence. Methodology We included 421 women with ovarian cancer from a prospective multi-institutional Norwegian study of first recurrence of gynecological cancer over the period March 2012 to April 2016. Patients were interviewed by clinicians at the participating hospitals, and patient-reported and clinical variables were recorded in a standardized questionnaire. The Kaplan-Meier method and the multivariate Cox model were used to evaluate post-recurrence survival and overall survival. Results Of the 406 patients included, 183 were diagnosed with asymptomatic recurrence, and 223 had symptoms at recurrence. Asymptomatic patients had their recurrence detected two months later than symptomatic patients (14 versus 12 months, respectively, p=0.17). Median post-recurrence survival was significantly longer in asymptomatic patients compared to patients with symptoms at recurrence (33.9 versus 26.2 months, respectively, p=0.002). The post-recurrence survival rate remained higher for symptomatic patients in the adjusted analysis (HR=1.42, p=0.001). Median overall survival was 47.8 months for asymptomatic patients versus 44.0 months for symptomatic patients in the unadjusted analyses (p=0.056). Asymptomatic patients had a significantly longer survival in the adjusted analysis (HR=1.24, p=0.046). Pain was the most common symptom at recurrence (54%).