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Abstract
Introduction/Background Clarity and precision about the anatomical extent of disease in cancer is essential for prognostication, research, and cancer-control activities. To select effective therapeutic approaches for advanced high-grade serous ovarian cancer (HGSOC), yet the most prevalent and lethal form, it is important to identify stratification factors that could accurately predict prognosis before initial intervention. We hypothesized that women with different tumor dissemination patterns at pre-treatment imaging would have different prognosis.
Methodology This was a retrospective analysis of 209 FIGO stage III-IV HGSOC women, who were scheduled for cytoreductive surgery in SJUH Leeds between Jan 2015 to Dec 2018 with curative or life-prolonging intent. CT scans were reported by an MDT radiologist. Three pre-treatment imaging dissemination patterns were identified and verified by final histology. A Cox proportional hazard analysis was used to test the effect of imaging dissemination patterns, age, performance status (PS), timing of surgery (upfront vs delayed cytoreduction), surgical complexity score (SCS), residual disease (RD), disease score, and type of chemotherapy on survival. Kaplan-Meier survival curves were produced using SPSS® 26.
Results There were no statistical differences in the cytoreduction rates amongst the three groups (figure 1). The mean progression free survival (PFS) for patients grouped as intraperitoneal (n=137), intraperitoneal and lymphatic (n=56), and intraperitoneal and haematogenous (n = 16) was 26.5 (95% CI 23.4–29.6), 21.3 (95% CI 18.3–24.4) and 19.1 months (95% CI 15.1–22.9), respectively. The mean overall survival (OS) was 45.8 (95% CI 41.5–50.2), 34.8 (95% CI 29.2–40.3) and 30.7 months (95% CI 24.5–36.9), respectively (p=0.05) (figure 2). The mean PFS and OS for the entire cohort was 25 months (95% CI 22.6–27.3) and 41.8 (95% CI 38.3–45.2), respectively. For PFS, Cox regression analysis identified PS (HR 1.23, 95% CI 1.1–1.5, p=0.04), RD (HR 0.69, 95% CI 0.46–0.98, p=0.05) as statistically significant. For OS, Cox regression analysis identified PS (HR 1.47, 95% CI 1.14–1.89, p=0.03), dissemination pattern (HR 1.36, 95% CI 1.02–1.86, p=0.05) as statistically significant.
Conclusion For HGSOC prognosis, one should consider not only the patient’s disease burden but also their overall medical status and ability to undergo extensive surgery. Prolonged survival rates were found predominantly in those patients with intraperitoneal only pre-treatment imaging dissemination pattern. Baseline tumor dissemination pattern can be a prognostic factor for overall survival. Classification of such patterns can help counsel patients initially on their prognosis and identify those who might benefit from intraperitoneal chemotherapy.
Disclosures No disclosures.