Introduction The 5-year survival rate for patients with advanced epithelial ovarian cancer remains poor. Given the high mortality associated with this disease, it is important to analyze the factors associated with long-term survival beyond 5 years.

Methods We retrospectively analyzed data from patients with stage III or IV epithelial ovarian cancer diagnosed from 2013 to 2019. Characteristics of women who survived ≥5 years after diagnosis were compared to those who survived fewer than 5 years of diagnosis using chi-square tests and multivariable logistic regression.

Results Of the 345 patients who survived more than 5 years, 214 (62%) experienced recurrence, and 43 (12.5%) died with disease during a median f/u time of 78 (60–144) months. The long-term survivors were more likely to receive the primary cytoreductive surgery (85.0% in ≥5 year group, 68.9% in <5 year group, p<0.001) and had higher ratio of no gross residual disease (78.3% in ≥5 year group, 60.4% in <5 year group, p<0.001). They had a higher rate of BRCA mutation (p=0.001), longer progression-free survival (median 44.5 vs. 18.0 months in ≥5 year group vs. <5 year group, p<0.001). In addition, when the disease recurred, they received more aggressive surgical treatments after disease recurrence (24.6% in ≥5 year group, 8.3% in <5 year group, p<0.001).

Conclusion/Implications Long-term survival is not common in patients with epithelial ovarian cancer, even in advanced cases. Although several prognostic factors are well known, there is a need to follow up on the current state of knowledge of relevant factors in long-term survivors. These findings are important for patient counselling.