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Examining Survival Outcomes of 852 Women With Advanced Ovarian Cancer: A Multi-institutional Cohort Study
  1. Taymaa May, MD, MSc*,,
  2. Alon Altman, MD,
  3. Jacob McGee, MD§,
  4. Lin Lu, MSc,
  5. Wei Xu, PhD,
  6. Kelly Lane, BSc,
  7. Prafull Ghatage, MD# and
  8. Barry Rosen, MD**
  1. * Division of Gynecologic Oncology, Princess Margaret Cancer Center;
  2. Department of Obstetrics and Gynecologic, University of Toronto, Toronto, ON;
  3. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cancer Care Manitoba, Winnipeg, MB;
  4. § Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, London Health Sciences Centre, London, ON;
  5. Department of Biostatistics, Princess Margaret Cancer Center, University of Toronto;
  6. Techna Institute for the Advancement of Technology for Health, University Health Network, Toronto, ON;
  7. # Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Tom Baker Cancer Center, Calgary, AB; and
  8. ** Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Beaumont Medical Center, MI.
  1. Address correspondence and reprint requests to Taymaa May, MD, MSc, FRCSC, Princess Margaret Cancer Center, 610 University Ave, M700 Toronto, ON, M5S 1Z6. E-mail: Taymaa.may{at}


Introduction This study examines patterns of clinical practice in the management of women with advanced high-grade serous ovarian carcinoma (HGSC).

Methods A total of 852 patients with advanced HGSC were included in this retrospective cohort analysis. Patients underwent primary cytoreductive surgery (PCS) or neoadjuvant chemotherapy (NACT). Wilcoxon rank-sum test and χ2 test were applied. Univariate- and multivariate-analyses were performed, and survival outcomes were measured using Kaplan–Meier curves.

Results A total of 449 (53%) of 852 patients underwent PCS, and 403(47%) of 852 patients underwent NACT. The median 5-year overall survival (OS) was 3.89 in PCS and 2.48 in NACT. Patients with 0 mm residual had OS of 4.66, compared with 1- to 9-mm residual (OS = 2.80) and 10-mm residual or longer (OS = 2.50). The survival advantage harbored by the extent of surgical cytoreduction was more pronounced in PCS compared with NACT (P < 0.001). Patients who had PCS with 1- to 9-mm residual had similar OS to NACT patients with 0-mm residual (P = 0.17) and superior OS to NACT with 1- to 9-mm residual (P < 0.001).

Conclusions In this multicenter study, 53% of women with advanced HGSC seen by a gynecologic oncologist were selected for PCS. Survival was longer in patients who underwent PCS than patients who underwent NACT. Within each group, survival was highest in those who had complete cytoreduction to 0-mm residual disease. We believe all patients with advanced HGSC should be assessed by a gynecologic oncologist for the feasibility of surgical resection. Primary cytoreductive surgery should be the favorable treatment modality with the goal of complete resection to 0 mm residual disease. Importantly, if 0 mm residual is not feasible, PCS to a residual of 1 to 9 mm should be attempted given the survival advantage in this group over patients who were treated with NACT.

  • Ovarian cancer
  • High-grade serous
  • Advanced stage
  • Primary cytoreduction
  • Neoadjuvant chemotherapy
  • Overall survival

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  • The authors declare no conflicts of interest.