Introduction/Background Ovarian cancer is the most lethal of all gynaecological neoplasms in young women, affecting up to 10–15% of premenopausal women, however, there is very limited data on which are the most important prognostic factors
Methodology A multicentre and retrospective study was performed including women treated for epithelial ovarian cancer who were younger than 45 years old collected between January-2010 and December-2019. Borderline and non-epithelial ovarian cancers were excluded from the study
Results A total of 998 young patients with epithelial ovarian cancer from 55 different institutions in Spain were collected. The mean (standard deviation) age in the study population was 38.9 (5.8) years, and 853 (85.5%) presented an ECOG performance status grade 0 at diagnosis. The grouped FIGO stage distribution was 508 (50.9%) patients in initial stages (stages I and II) and 490 (49.1%) in advanced ones (stages III and IV). Three hundred thirty-four (33.4%) patients presented with recurrent disease after a mean follow up of 43.94 (SD 34.4) months. The type of staging surgery (incomplete vs. complete), the type of initial treatment modality (primary cytoreduction vs. interval surgery), and the amount of residual disease were all significantly associated with the overall survival. In the multivariate analysis, the response based on radiological findings (HR=3.91 95% CI 2.60–5.90 for partial response, HR=13.13; 95% CI 9.17–18.81 for progression), neoadjuvant chemotherapy (HR=1.81; 95%CI 1.32–2.46), and FIGO Stage (HR=1.68 95%CI 1.40–2.02) were identified as independent prognostic factors associated with the worst oncological outcomes (p<0.001)
Conclusion The radiology-based response, neoadjuvant chemotherapy and FIGO stage were independent prognostic factors associated with the worst oncological outcomes in women younger than 45 years old with epithelial ovarian cancer. It highlights the importance of primary complete cytoreduction, performing maximal-effort surgery in these patients due to the tumor´s characteristics and the better tolerance to maximal-effort cytoreduction in comparison to older women
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