Conditional Survival of Advanced Epithelial Ovarian Cancer: A Real-World Data Retrospective Cohort Study From the SEER Database

Objective: To analyze conditional survival (CS) in patients with advanced epithelial ovarian cancer (EOC) and investigate prognostic factors that affect the CS rate to provide more accurate survival information.Methods: Patients with advanced EOC between 2004 and 2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. CS analysis was performed to depict exact survival for patients who had already survived a specific number of years. Cox proportional hazards regression was performed to ascertain the individual contribution of factors associated with actuarial overall survival (OS) at diagnosis and CS at 1, 3, and 5 years after diagnosis.Results: Of 11,773 patients, OS decreased from 32.2% at 6 years to 25.1% at 8 years, while the corresponding 5 year CS (CS5) increased from 37.5% at 1 year to 43.9% at 3 years. Subgroup analysis stratified by clinicopathological characteristics showed that CS5 was always higher than the corresponding actuarial survival (all Δ > 0). Based on multivariate analysis at diagnosis, age, race, marital status, histological type, tumor grade, size, T stage, M stage, surgery, radiation therapy, and chemotherapy were independent prognostic factors for OS. Five years after diagnosis, however, only age, histological type, tumor grade, and laterality were persistently significant independent prognostic factors (all P <0.05). Furthermore, patients with poor pathological prognostic factors achieved greater improvements in CS5 rates, and the survival gaps between OS and CS were more obvious.Conclusion: CS of advanced EOC was dynamic and increased over time. Age, histology, tumor grade, and laterality were significant prognostic factors even 5 years after diagnosis. Thus, the availability of updated prognoses at various time points will allow clinicians to better guide their patients.

Long-Term Survival Among Histological Subtypes in Advanced Epithelial Ovarian Cancer: Population-Based Study Using the Surveillance, Epidemiology, and End Results Database

Background Actual long-term survival rates for advanced epithelial ovarian cancer (EOC) are rarely reported. Objective This study aimed to assess the role of histological subtypes in predicting the prognosis among long-term survivors (≥5 years) of advanced EOC. Methods We 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. Results We 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. Conclusions Ovarian 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.

Results of a 2021 French National Survey on Management of Patients with Advanced Stage Epithelial Ovarian Cancer

Background: The aim of this study was to assess current French practices in the management of patients with advanced epithelial ovarian cancer. Method: a 58-question electronic survey was distributed anonymously to the members of the SFOG (French Society of Gynaecological Oncology), GINECO-ARCAGY (National Investigators Group for Ovarian and Breast Cancer Studies in France) and FRANCOGYN (French research group in oncological and gynaecological surgery). Initial diagnostic workup and staging, pathological data, surgical data, treatments and follow-up strategies were assessed. Results: a total of 107 participants responded to emailed surveys. Most of the respondents were obstetrician-gynaecologists (37.4%), surgical oncologists (34.6%) and medical oncologists (17.8%). According to most (76.8%) participants, less than 50% of patients were eligible for primary debulking surgery (PDS). The LION study criteria were applied in 69.5% of cases during PDS and 39% after chemotherapy. The timing of BRCA testing was very heterogeneous and ranged from 1 to 6 months. The use of bevacizumab as an adjuvant schedule was lower in cases of no residual disease (for 54.5% of respondents) compared to cases of residual disease (for 63.6% of respondents). In cases of BRCA1-2 mutations, olaparib was given by 75.8–84.8% of respondents, whereas niraparib was given in cases of BRCA wild-type diseases. Conclusion: this survey provides an extensive and a unique review of current French practices in the management of patients with advanced epithelial ovarian cancer in 2021.