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Impact of clinical factors and surgical outcome on long-term survival in high-grade serous ovarian cancer: a multicenter analysis
  1. Joanna Baum1,2,
  2. Elena Ioana Braicu1,2,
  3. Oliver Hunsicker3,
  4. Ignace Vergote2,4,
  5. Nicole Concin2,5,
  6. Els Van Nieuwenhuysen2,4,
  7. Aarne Feldheiser3,
  8. Patriciu Achimas-Cadariu2,6,
  9. Silvia Darb-Esfahani2,7,
  10. Astrid Berger2,5,
  11. Bogdan Fetica2,8,
  12. Sven Mahner2,9,10,
  13. Andrea Papadia11,12,
  14. Linn Wölber2,10,
  15. Maria Luisa Gasparri11,12,
  16. Adriaan Vanderstichele2,4,
  17. Pierluigi Benedetti Panici13,
  18. Michael D Mueller12,
  19. Ilary Ruscito1,14,
  20. Hannah Woopen1,2 and
  21. Jalid Sehouli1,2
  1. 1Department of Gynecology, European Competence Center for Ovarian Cancer, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
  2. 2Tumorbank Ovarian Cancer Network, Berlin, Germany
  3. 3Department of Anaesthesiology and Intensive Care Medicine, CCM / CVK Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
  4. 4Department of Gynecology and Obstetrics, Leuven Cancer Institute, University Hospital Leuven, Catholic University of Leuven, Leuven, Belgium
  5. 5Department of Gynecology and Obstetrics, Innsbruck Medical University, Innsbruck, Austria
  6. 6Department of Surgical and Gynecological Oncology, The Oncology Institute Cluj-Napoca, University of Medicine and Pharmacy Iuliu Hatieganu Cluj-Napoca, Cluj-Napoca, Romania
  7. 7Institute of Pathology, Charite Universitatsmedizin Berlin, Berlin, Germany
  8. 8Department of Pathology, Oncology Institute Prof Dr Ion Chiricuta, Cluj-Napoca, Romania
  9. 9Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
  10. 10Department of Gynecology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
  11. 11Department of Obstetrics and Gynecology, University of the Italian Switzerland (USI), Ente Ospedaliero Cantonale of Lugano, Lugano, Switzerland
  12. 12Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
  13. 13Department of Gynecology, Obstetrics and Urology, University Sapienza of Roma, Rome, Italy
  14. 14Gynecology Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, Rome, Italy
  1. Correspondence to Professor Jalid Sehouli, Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charite Universitatsmedizin Berlin, Berlin 13353, Germany; jalid.sehouli{at}


Introduction Long-term survivors of ovarian cancer are a unique group of patients in whom prognostic factors for long-term survival have been poorly described. Such factors may provide information for a more personalized therapeutic approach. The objective of this study is to determine further characteristics of long-term survivors with high-grade serous ovarian cancer.

Methods Long-term survivors were defined as patients living longer than 8 years after first diagnosis and were recruited within seven high volume centers across Europe from November 1988 to November 2008. The control group included patients with high-grade serous ovarian cancer with less than 5 years' survival identified from the systematic ‘Tumorbank ovarian cancer’ database. A subanalysis of Charité patients only was performed separately for in-depth analysis of tumor dissemination. Propensity score matching with nearest-neighbor caliper width was used to match long-term survivors and the control group regarding age, FIGO stage, and residual tumor.

Results A total of 276 patients with high-grade serous ovarian cancer were included, divided into 131 long-term survivors and 145 control group patients. After propensity score matching and multivariable adjustment, platinum sensitivity (p=0.002) was an independent favorable prognostic factor whereas recurrence (p<0.001) and ascites (p=0.021) were independent detrimental predictors for long-term survival. Significantly more long-term survivors tested positive for mutation in the BRCA1 gene than the BRCA2 gene (p=0.016). Intraoperatively, these patients had less tumor involvement of the upper abdomen at initial surgery (p=0.024). Complexity of surgery and surgical techniques were similar in both cohorts.

Conclusion Platinum sensitivity constitutes a favorable factor for long-term survival whereas tumor involvement of the upper abdomen, ascites, and recurrence have a negative impact. Based on clinical estimation, long-term survival is associated with combinations of clinical, surgical, and molecular factors.

  • ovary
  • gynecologic surgical procedures
  • BRCA1 protein
  • intestines
  • surgical procedures
  • operative

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  • JB and EIB contributed equally.

  • HW and JS contributed equally.

  • Contributors Concept development: JB, EIB, HW, JS. Patient enrolment/data collection: all authors. Statistical analyses: OH and AF. Writing of manuscript: JB, EIB, JS, IR, HW, OH, AF. Revising and approving of manuscript: all authors.

  • 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.

  • Patient consent for publication Not required.

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

  • Data availability statement Data are available upon reasonable request. The raw data supporting the conclusions of this manuscript will be made available by the authors, without undue reservation, to any qualified reader.