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Patient-Reported Symptoms and Survival in Ovarian Cancer
  1. Koji Matsuo, MD*,
  2. Edward H. Ahn, MD,
  3. Christina P. Prather, MD,
  4. Michele L. Eno, MD§,
  5. Dwight D. Im, MD and
  6. Neil B. Rosenshein, MD
  1. * Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles County Medical Center, Los Angeles, CA;
  2. Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA;
  3. Department of Internal Medicine, University of North Carolina, Chapel Hill, NC;
  4. § Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA; and
  5. The Gynecologic Center, Mercy Medical Center, Baltimore, MD.
  1. Address correspondence and reprint requests to Koji Matsuo, MD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles County Medical Center, 2020 Zonal Ave, IRD522, Los Angeles, CA 90031. E-mail: koji.matsuo{at}gmail.com.

Abstract

Objective While the development of an index of clinical symptoms to use for the detection and diagnosis of ovarian cancer is under active investigation, the role of clinical symptoms in survival after the initial diagnosis is poorly understood. The aim of this study was to correlate the type and extent of clinical symptoms with survival outcomes in ovarian cancer.

Methods Medical records of 276 cases of primary epithelial ovarian, fallopian tube, and peritoneal cancers were evaluated. Thirty-one symptoms in 5 categories were cataloged. The significance of clinical symptoms in progression-free survival (PFS) and overall survival (OS) was evaluated.

Results Overall, 93.5% of ovarian cancer patients expressed at least 1 symptom at the time of initial diagnosis. The 3 most common symptoms were abdominal pain (40.6%), increased abdominal size (33.7%), and bloating (21.7%). In survival analysis, weight loss (16.3%), nausea/vomiting (13.4%), and lower extremity edema (6.5%) were significantly associated with both decreased PFS and OS (all, P < 0.05). In multivariate analysis, lower extremity edema remained the strongest significant symptom, associated with increased surgical mortality rate, decreased response rate to adjuvant chemotherapy after primary cytoreductive surgery, and diminished survival outcomes (median PFS, 4.9 vs 15.3 months, P < 0.0001; and median OS, 5.9 vs 49.1 months, P < 0.001). Multiple symptoms were associated with poor survival outcomes (individual number of symptom ≤1 vs 2 vs ≥3; median PFS, 26.8 vs 17.4 vs 11.7 months [P < 0.001]; and median OS, 70 vs 41.6 vs 37.2 months [P < 0.001]).

Conclusions Lower extremity edema at initial diagnosis is a strong prognostic indicator of ovarian cancer patient.

  • Ovarian cancer
  • Symptom
  • Survival

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Footnotes

  • The authors declare that there is no conflict of interest.

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