Clinicopathologic characteristics associated with long-term survival in advanced epithelial ovarian cancer: an NRG Oncology/Gynecologic Oncology Group ancillary data study

Abstract

Objective To identify clinicopathologic factors associated with 10-year overall survival in epithelial ovarian cancer (EOC) and primary peritoneal cancer (PPC), and to develop a predictive model identifying long-term survivors. Methods Demographic, surgical, and clinicopathologic data were abstracted from GOG 182 records. The association between clinical variables and long-term survival (LTS) (>10 years) was assessed using multivariable regression analysis. Bootstrap methods were used to develop predictive models from known prognostic clinical factors and predictive accuracy was quantified using optimism-adjusted area under the receiver operating characteristic curve (AUC). Results The analysis dataset included 3,010 evaluable patients, of whom 195 survived greater than ten years. These patients were more likely to have better performance status, endometrioid histology, stage III (rather than stage IV) disease, absence of ascites, less extensive preoperative disease distribution, microscopic disease residual following cyoreduction (R0), and decreased complexity of surgery (p<0.01). Multivariable regression analysis revealed that lower CA-125 levels, absence of ascites, stage, and R0 were significant independent predictors of LTS. A predictive model created using these variables had an AUC=0.729, which outperformed any of the individual predictors. Conclusions The absence of ascites, a low CA-125, stage, and R0 at the time of cytoreduction are factors associated with LTS when controlling for other confounders. An extensively annotated clinicopathologic prediction model for LTS fell short of clinical utility suggesting that prognostic molecular profiles are needed to better predict which patients are likely to be long-term survivors.

Predictors of Long-Term Survival among High-Grade Serous Ovarian Cancer Patients

“…We used forwardselection to build the model and retained all variables with a P < 0.3. We decided a priori that age, stage, and CA-125 level at diagnosis would be in the final model as these factors have been previously reported to be associated with survival among ovarian cancer cases (5,6). We computed the Elixhauser comorbidity score (7) for each case and included individual components of the score in the model-building process if at least 20 patients had the condition.…”

Morphology and tumour‐infiltrating lymphocytes in high‐stage, high‐grade serous ovarian carcinoma correlated with long‐term survival

“…A study of the California Cancer Registry on 11 541 ovarian cancer patients among all histological subtypes and stages identified a total of 3583 patients (31%) who survived more than 10 years and, of these, 32.4% had stage III/IV disease. Similarly, a retrospective analysis of the Gynecologic Cancer Intergroup GOG182‐ICON5 trial on advanced‐stage EOC identified 195 of 3010 patients who survived more than 10 years; 76% of these had serous histology . These studies illustrate that long‐term survival occurs in high‐risk ovarian cancer.…”

“…Similarly, a retrospective analysis of the Gynecologic Cancer Intergroup GOG182-ICON5 trial on advanced-stage EOC identified 195 of 3010 patients who survived more than 10 years; 76% of these had serous histology. 13 These studies illustrate that long-term survival occurs in high-risk ovarian cancer. To date, detailed analysis of clinical data or histopathological and molecular characterisations are only sparse (for review see Hoppenot et al 10 ), but offer great potential to deepen our understanding of tumour progression and chemosensitivity of HGSC.…”

Can we predict who lives long with ovarian cancer?

“…9 Factors associated with long-term survival included the following: endometrioid histology, stage III (vs stage IV), absence of ascites, preoperative disease distribution score, optimal microscopic cytoreduction, and lower surgical complexity score. Among a subset of 3010 patients enrolled in GOG 0182, a total of 195 patients (6.5%) survived longer than 10 years.…”

“…Among a subset of 3010 patients enrolled in GOG 0182, a total of 195 patients (6.5%) survived longer than 10 years. 9 Factors associated with long-term survival included the following: endometrioid histology, stage III (vs stage IV), absence of ascites, preoperative disease distribution score, optimal microscopic cytoreduction, and lower surgical complexity score. However, the combined model fell short of predefined clinical utility boundaries, and the authors concluded that the addition of tumor molecular profiles should be considered.…”