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Symptomatic or asymptomatic recurrence of ovarian cancer: does it influence survival?
  1. Karen Madland1,
  2. Line Bjorge1,2,
  3. Milada Cvancarova Småstuen3,
  4. Anne Dørum4 and
  5. Ingvild Vistad5,6
  1. 1 Haukeland University Hospital, Bergen, Norway
  2. 2 Department of Obstetrics and Gynecology, University of Bergen Center for Cancer Biomarkers, Bergen, Norway
  3. 3 Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Akershus, Norway
  4. 4 Department of Gynecologic Oncology, Oslo University Hospital, Oslo, Norway
  5. 5 Gynecologic, Sorlandet Hospital Kristiansand, Kristiansand, Norway
  6. 6 Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
  1. Correspondence to Dr Karen Madland, Haukeland University Hospital, 5021 Bergen, Norway; madland92{at}


Objective The survival benefit of monitoring CA125 in ovarian cancer patients after primary treatment is debated due to findings varying from insignificant survival differences to prolonged median overall survival in favor of asymptomatic patients. Hence we aimed to compare ovarian cancer patients with and without symptoms at the time of the first diagnosed recurrence in terms of post-recurrence survival and overall survival, and to explore time to recurrence and common symptoms at recurrence.

Methods We included 421 women with ovarian cancer from a prospective multi-institutional Norwegian study of first recurrence of gynecological cancer over the period from March 2012 to April 2016. Patients were interviewed by clinicians at participating hospitals, and patient reported and clinical variables were recorded in a standardized questionnaire. The Kaplan–Meier method and the multivariate Cox model were used to evaluate post-recurrence survival and overall survival.

Results Of the 406 patients included, 183 (45%) patients were diagnosed with asymptomatic recurrence, and 223 (55%) patients had symptoms at recurrence. Asymptomatic patients had their recurrence detected 2 months later than symptomatic patients (14 vs 12 months, respectively, p=0.17). Median post-recurrence survival was significantly longer in asymptomatic patients compared with patients with symptoms at recurrence (33.9 vs 26.2 months, respectively, p=0.002). The post-recurrence survival rate remained higher for symptomatic patients in the adjusted analysis (hazard ratio (HR)=1.42, p=0.001). Median overall survival was 47.8 months for asymptomatic patients versus 44.0 months for symptomatic patients in the unadjusted analyses (p=0.056). Asymptomatic patients had a significantly longer survival in the adjusted analysis (HR=1.24, p=0.046). Pain was the most common symptom at recurrence (54%).

Conclusion Patients with asymptomatic recurrence had a better prognosis based on post-recurrence data and the multivariate Cox regression analysis of overall survival. However, a closer exploration of differences in development of recurrence is needed as these results may give rise to more individualized follow-up for ovarian cancer patients.

  • Ovarian Cancer
  • Neoplasm, Residual
  • Medical Oncology
  • Ascites
  • Cytoreduction surgical procedures

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors IV and AD designed the study and obtained the data. IV, LB, and KM had the idea for the present study and interpreted the data. MCS was responsible for the statistical analysis. KM drafted the manuscript. All authors supplemented and revised the editing of the manuscript. IV acted as the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.