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Localization of distant metastases defines prognosis and treatment efficacy in patients with FIGO stage IV ovarian cancer
  1. Maite Timmermans1,2,3,
  2. G S Sonke4,
  3. K K Van de Vijver5,
  4. P B Ottevanger6,
  5. H W Nijman7,
  6. M A van der Aa1 and
  7. R F P M Kruitwagen2,3
  1. 1 Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
  2. 2 Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, The Netherlands
  3. 3 GROW, School for Oncology and Developmental Biology, Maastricht, The Netherlands
  4. 4 Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
  5. 5 Department of Pathology, Ghent University Hospital, Cancer Research Institute Ghent (CRIG), Ghent, Belgium
  6. 6 Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
  7. 7 Department of Obstetrics and Gynecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
  1. Correspondence to Maite Timmermans, Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht 3511, The Netherlands; m.timmermans{at}


Background Patients with ovarian cancer who are diagnosed with Federation of Gynecology and Obstetrics (FIGO) stage IV disease are a highly heterogeneous group with possible survival differences. The FIGO staging system was therefore updated in 2014.

Objective To evaluate the 2014 changes to FIGO stage IV ovarian cancer on overall survival.

Methods We identified all patients diagnosed with FIGO stage IV disease between January 2008 and December 2015 from the Netherlands Cancer Registry. We analyzed the prognostic effect of FIGO IVa versus IVb. In addition, patients with extra-abdominal lymph node involvement as the only site of distant disease were analyzed separately. Overall survival was analyzed by Kaplan-Meier curves and multivariable Cox regression models.

Results We identified 2436 FIGO IV patients, of whom 35% were diagnosed with FIGO IVa disease. Five-year overall survival of FIGO IVa and IVb patients (including those with no or limited therapy) was 8.9% and 13.0%, respectively (p=0.51). Patients with only extra-abdominal lymph node involvement had a significant better overall survival than all other FIGO IV patients (5-year overall survival 25.9%, hazard ratio 0.77 [95% CI 0.62 to 0.95]).

Conclusion Our study shows that the FIGO IV sub-classification into FIGO IVa and IVB does not provide additional prognostic information. Patients with extra-abdominal lymph node metastases as the only site of FIGO IV disease, however, have a better prognosis than all other FIGO IV patients. These results warrant a critical appraisal of the current FIGO IV sub-classification.

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  • Contributors Study design/concepts: MT, GS, HN, MA, RK. Data acquisition: MT. Quality control of data and algorithms: MT, MvdA. Data analysis and interpretation: MT, GS, KVdV, PO, HN, MA, RK. Manuscript preparation: MT. Manuscript editing and review: MT, GS, KVdV, PO, HN, MA, RK.

  • Funding This work was supported by Dutch Cancer Society (IKNL2014-6838).

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