Risk Factors for the Morbidity and Prognosis of Lung Metastases in Newly Diagnosed Ovarian Carcinoma: A Large Population-based Study
Abstract Background: To evaluate the risk factors for the morbidity and prognosis of lung metastases (LM) in patients with newly diagnosed ovarian carcinoma (OC). Methods: Based on the Surveillance, Epidemiology, and End Results (SEER) dataset, OC patients from 2010 and 2016 were retrospectively analyzed. Risk factors for the morbidity of LM in OC patients and their survival were assessed by logistic regression analysis and Kaplan-Meier and Gray method, respectively. Cox regression analysis was performed to identify risk factors for the prognosis of OC patients with LM, and their prognostic potentials were further validated by two established nomograms.Results: There are 27,123 eligible OC patients were enrolled in the study, with the morbidity of LM at 5.61% (1,521/27,123). Logistic regression models illustrated that T3 stage [odds ratio (OR)=2.74, 95%CI=2.09-3.66, P<0.01], advanced N stage (OR=1.86, 95%CI=1.62-2.14, P<0.01), and the prevalence of bone metastasis (OR=3.78, 95%CI=2.79-5.11, P<0.01), brain metastasis (OR=4.67, 95%CI=2.50-8.63, P<0.01) and liver metastasis (OR=3.60, 95%CI=3.14-4.12, P<0.01) were all significantly correlated with the morbidity of LM in OC patients. Median survival for OC patients with LM was 11 months (interquartile range, 3 to 25 months). Cox regression analyses illustrated over 80 years of age [hazard ratio (HR)=2.52, 95%CI=2.33-2.72, P<0.01] and positive expression of cancer antigen 125 (CA-125, HR=1.63, 95%CI=1.47-1.82, P<0.01) were significantly correlated with the high mortality of LM, while chemotherapy (HR=0.62, 95%CI=0.59-0.65, P<0.01) was significantly correlated with the low mortality. Two nomograms were established to examine the concordance index (C-index), calibration curves, the area under the curve (AUC), decision curve analyses (DCAs) and clinical impact curves (CICs), which validated the prognostic potentials of identified risk factors in OC patients with LM. Conclusion: The population-based cohort study provides references for guiding clinical screening and individualized treatment of OC patients with LM.