Predictors of survival trajectories among women with epithelial ovarian cancer

Peres, Lauren C.; Sinha, Sweta; Townsend, Mary K.; Fridley, Brooke L.; Karlan, Beth Y.; Lutgendorf, Susan K.; Shinn, Eileen H.; Sood, Anil K.; Tworoger, Shelley S.

doi:10.1016/j.ygyno.2019.12.011

Cited by 33 publications

(32 citation statements)

References 47 publications

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“…By 10 years after diagnosis, the number of all-cause death had decreased to 1.2%. Similar findings were observed also in the US SEER data ( 22 , 30 ). Providing updated survival information to survivors could reduce their feelings of uncertainty and mitigate their fear of cancer recurrence ( 31 ).…”

Section: Discussionsupporting

confidence: 89%

Conditional Relative Survival of Ovarian Cancer: A Korean National Cancer Registry Study

Shin

Bae

et al. 2021

Front. Oncol.

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ObjectiveConditional relative survival (CRS) rates, which take into account changes in prognosis over time, are useful estimates for survivors and their clinicians as they make medical and personal decisions. We aimed to present the 5-year relative conditional survival probabilities of patients diagnosed with ovarian cancer from 1997–2016.MethodsThis nationwide retrospective cohort study used data from the Korean Central Cancer Registry. Patients diagnosed with ovarian cancer between 1997 and 2016 were included. CRS rates were calculated stratified by age at diagnosis, cancer stage, histology, treatment received, year of diagnosis, and social deprivation index.ResultsThe 5-year relative survival rate at the time of diagnosis was 61.1% for all cases. The probability of surviving an additional 5 years, conditioned on having already survived 1, 2, 3, 4, and 5 years after diagnosis was 65.0, 69.5, 74.6, 79.3, and 83.9%, respectively. Patients with poorer initial survival estimates (older, distant stage, serous histology) generally showed the largest increases in CRS over time. The probability of death was highest in the first year after diagnosis (11.8%), and the conditional probability of death in the 2nd, 3rd, 4th, and 5th years declined to 9.4%, 7.9%, 6.1%, and 5.2%, respectively.ConclusionCRS rates for patients with ovarian cancer increased with each year they survived, but this did not reach the level of ‘no excess mortality’ even 5 years after diagnosis. The largest improvements in CRS were observed in patients with poorer initial prognoses. Our findings provide updated prognosis to ovarian cancer survivors and clinicians.

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Section: Discussionsupporting

confidence: 89%

Conditional Relative Survival of Ovarian Cancer: A Korean National Cancer Registry Study

Shin

Bae

et al. 2021

Front. Oncol.

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“…We found that unmarried status was associated with worse overall survival in SCSTs patients. Although no previous study on SCSTs has investigated it, many studies on ovarian cancer have shown that unmarried women have an higher risk than married women, especially for those who are widowed or separated/divorced [ 29 , 30 ]. Although this predictive factor could be confounded by emotional and economic support, it should still be considered in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Prognostic Prediction Model for Postoperative Ovarian Sex Cord-Stromal Tumor Patients

2020

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Background We developed a nomogram for prognostic prediction of overall survival (OS) in postoperative ovarian sex cord-stromal tumor (SCST) patients and discuss the effect of chemotherapy at various FIGO stages. Material/Methods SCST patients after surgery from 2004 to 2015 were enrolled from the Surveillance, Epidemiology and End-Results (SEER) database, matched into pairs by propensity score matching (PSM), and divided into a training set and a validation set. Univariate and multivariate Cox analyses were conducted to identify significant variables for the development of the nomogram. The nomogram model was validated by concordance index (C-index), receiver operating characteristics (ROCs) curve, calibration plot, and decision curve analysis (DCA). Survival curves showed the integrative ability of prognostic prediction and the efficacy of chemotherapy. Results A total of 913 SCST patients were initially enrolled, and after PSM, 506 patients were included. Age, marital status, CA125 levels, tumor size, FIGO stage, grade, and chemotherapy were indicators for building the OS nomogram. The C-index was 0.850 in the training set and 0.786 in the validation set. Calibration plots were satisfactory and the nomogram had relatively better clinical utility than FIGO stage. The survival analysis showed that the low-risk group had generally longer survival than the high-risk group based on the prognostic score, and chemotherapy had an overall reverse effect on OS. Conclusions The nomogram model displays the potential to provide individualized prognosis probability of SCSTs and to aid in clinical decision-making. The unfavorable results of chemotherapy in all stages shows the need for further exploration.

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“…13 Chronic social isolation also has been shown to be a risk factor for an increased incidence of ovarian cancer. 7 Paralleling these findings, patients with ovarian cancer who report greater social isolation have demonstrated poorer cellular immunity, 14 higher levels of inflammation 15 and of the stress hormone norepinephrine in tumor and ascites, 16 and elevations in biomarkers of angiogenesis and invasion in the tumor microenvironment. [17][18][19] Similarly, a preclinical model of social isolation in ovarian carcinoma demonstrated greater tumor volume and a greater number of tumor nodules in socially isolated animals.…”

Section: Introductionmentioning

confidence: 89%

“…[1][2][3][4] Social isolation is a host biobehavioral factor that has demonstrated robust associations with clinical outcomes and mortality in both the general population 5,6 and in individuals with cancer. 7,8 For example, social isolation was associated with a greater risk of disease recurrence 9 and poorer survival in several large-scale studies of patients with breast Cancer October 1, 2020 cancer [9][10][11] and in a meta-analysis that examined results from 87 studies of patients with cancer. 12 Among patients with ovarian cancer, we previously have reported that individuals experiencing greater social isolation had significantly shorter survival than those with higher levels of social support, adjusting for clinical covariates.…”

Section: Introductionmentioning

confidence: 99%

Epithelial‐mesenchymal transition polarization in ovarian carcinomas from patients with high social isolation

Lutgendorf

Penedo

Goodheart

et al. 2020

Cancer

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Background Social isolation has shown robust associations with clinical outcomes in the general population and in patients with cancer. In patients with ovarian cancer, social isolation has been found to be related to decreased survival and multiple biomarkers supporting tumor progression. However, to the authors' knowledge, little is known regarding the relationship between social isolation and the molecular characteristics of ovarian tumors. Herein, the authors have used genome‐wide transcriptional profiling to quantify associations between social isolation and epithelial‐mesenchymal transition (EMT) polarization in ovarian tumors and transcriptome‐driven, promoter‐based bioinformatics analyses to identify gene regulatory pathways that may potentially underlie these changes. Methods Tumor was sampled during primary surgical resection and immediately frozen in liquid nitrogen. After RNA extraction, microarray analysis of the transcriptome was performed and samples were analyzed to assess associations between EMT‐related gene transcripts and social isolation (as indicated by a Social Provisions Scale Attachment subscale score <15). Convergent validation was provided by a promoter‐based bioinformatic analysis of transcription factor activity. Results Primary analyses of 99 women demonstrated a lower average expression of gene transcripts previously associated with epithelial differentiation in women with high social isolation (−0.143 ± 0.048 log2 mRNA abundance; P = .004), but no difference in mesenchymal differentiation as a function of social isolation (+0.007 ± 0.0064 log2 mRNA abundance; P = .900). Upregulated activity was shown for 3 of the 4 targeted EMT‐related transcription factors, including GATA4 (P = .014); SMAD2, SMAD3, and/or SMAD4 (P < .001); and TWIST1 (P < .001). Analyses of SNAIL2/SLUG activity indicated a directional trend toward increased activity that did not reach statistical significance (P = .123). Conclusions The findings of the current study demonstrated differential EMT polarization and EMT‐related transcription factor activity according to social isolation, a known socioenvironmental risk factor. Lay Summary Social isolation has shown robust associations with clinical outcomes in the general population and in patients with cancer. Herein, the authors examined the relationship between social isolation and the molecular characteristics of ovarian tumors. The authors investigated the epithelial‐mesenchymal transition (EMT), a process whereby tumor cells lose epithelial characteristics and become more embryonic (mesenchymal), thereby enhancing invasiveness. Primary analyses demonstrated lower expression of genes previously associated with epithelial differentiation and increased activity of specific EMT‐related transcription factors in individuals with high social isolation, indicating increased EMT polarization in these patients. These findings extend the understanding of how socioenvironmental factors may modulate tumor growth.

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Predictors of survival trajectories among women with epithelial ovarian cancer

Cited by 33 publications

References 47 publications

Conditional Relative Survival of Ovarian Cancer: A Korean National Cancer Registry Study

Conditional Relative Survival of Ovarian Cancer: A Korean National Cancer Registry Study

Development and Validation of a Prognostic Prediction Model for Postoperative Ovarian Sex Cord-Stromal Tumor Patients

Epithelial‐mesenchymal transition polarization in ovarian carcinomas from patients with high social isolation

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