Introduction/Background A subset of patients with advanced epithelial ovarian cancer(EOC) are long term survivors(LTS).The underlying prognostic factors associated with survivorship may provide individualized follow-up strategies.We aimed to characterize the patients with advanced EOC with long and short-term survival.
Methodology We conducted a retrospective analysis of patients diagnosed with advanced EOC(FIGO stage III/IV) treated at a single center, between 2002–2020.Characteristics of short-term survivors (STS), women who survived <2 years, were compared to LTS,patients who lived >10 years from diagnosis.
Results Among 822 patients with advanced EOC,112(14%) women survived <2years, while 139(17%) survived >10 years.Histology,CA125 levels,and debulking approach were not significantly prognostic of survivorship.
LTS were younger at diagnosis,(median age of 56.5 in LTS, vs. 70 in STS,p<0.0001).The majority were diagnosed with stage III,(97%,LTS, vs. 67%,STS).BRCA mutation status was the strongest prognostic factor among LTS(OR=21,p<0.001).Forty-two-percent of LTS were BRCA mutation carriers,whereas most STS were BRCA Wildtype(90%,p<0.001).LTS predominantly had a platinum sensitive disease(98.4%, LTS, vs. 21.6% STS,p<0.0001).Optimal cytoreductive surgery was performed among almost all LTS(41.9%,STS vs. 88.7%,LTS, p<0.0001).A greater proportion of LTS received weekly paclitaxel carboplatin therapy compared to STS(49.2%,LTS vs. 31.6%,STS, p<0.01). Bevacizumab and PARP inhibitors were associated with long term survivorship (p=0.01, and p<0.001 resepctively.The total population with advanced stage(III-IV) had a mOS of 61.77 months, and median progression free survival(mPFS) of 15.2 months.While women with a BRCA mutation had a longer mOS(86 months) and mPFS (19 months) compared to the BRCA WT population(51, and 13 months, respectively,p=0.043),with specifically longer mOS and mPFS among the BRCA2 population in comparison to BRCA1 carriers(112, and 30 months,respectively,p=0.01).
Conclusion The LTS and STS with advanced EOC may be identified early in the clinical assessment, based on distinct patient characteristics associated with survivorship, which are critical in developing a personalized treatment and follow-up approach.
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