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Modifiable risk factors associated with long-term survival in women with serous ovarian cancer: a National Cancer Database study
  1. Anja Sophia Frost1,
  2. Anna Jo Bodurtha Smith2,
  3. Amanda N Fader1 and
  4. Stephanie L Wethington1
  1. 1Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  2. 2Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Stephanie L Wethington, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; swethington{at}jhmi.edu

Abstract

Objective To identify patient, clinical and hospital factors associated with long-term survival (≥10 years) in women with serous ovarian cancer.

Methods This National Cancer Database cohort study included women with stage II–IV serous ovarian cancer. Multivariate logistic regression models were used to examine the association of long-term survival with patient (race, insurance, location, household income, education, distance traveled), clinical (age, comorbidities, stage, grade, primary treatment) and hospital factors (region, institution, hospital volume ≥20).

Results Of the 4640 women identified, 12% (n=561) experienced long-term survival. Median overall survival was 41 months (95% CI 39 to 42). The odds of long-term survival were lower for women with public or no insurance (adjusted OR 0.71, 95% CI 0.55 to 0.92), age ≥75 years (0.33, 0.22 to 0.50), any comorbidities (0.70, 0.54 to 0.92), higher stage (stage III: 0.31, 0.25 to 0.41; stage IV: 0.16, 0.12 to 0.22), and moderately/poorly differentiated, undifferentiated, or tumors of unknown grade (moderately/poorly differentiated: 0.30, 0.20 to 0.47; undifferentiated: 0.28, 0.17 to 0.47; unknown: 0.30, 0.18 to 0.50). The odds of long-term survival among women who were publicly insured were lower with neoadjuvant chemotherapy (0.13, 0.04 to 0.044) and higher with optimal cytoreduction (2.24, 1.49 to 3.36). Among women who were privately insured, the odds of long-term survival were higher with optimal cytoreduction (1.99, 1.46 to 2.70) and unaffected by neoadjuvant chemotherapy.

Conclusions While immutable clinical factors such as age, stage, and grade are associated with long-term survival in women with serous ovarian cancer, modifiable factors, such as insurance type, optimal cytoreductive status, and neoadjuvant chemotherapy provide an opportunity for targeted improvement in care with potential to affect long-term patient outcomes.

  • ovarian cancer
  • ovarian neoplasms
  • cytoreduction surgical procedures

Data availability statement

Data may be obtained from a third party and are not publicly available. Data were obtained from the National Cancer Database.

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Data availability statement

Data may be obtained from a third party and are not publicly available. Data were obtained from the National Cancer Database.

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Footnotes

  • Twitter @amandanfader

  • Presented at Preliminary data from this study were presented at the 2019 Western Association of Gynecologic Oncologists Annual Meeting in Huntington Beach, California.

  • Contributors ASF conceived and presented the idea. SLW supervised the findings of the work and serves as guarantor. AJS performed the computations and statistics analysis. All authors discussed the work. ASF wrote the primary draft of the manuscript, and all authors contributed to critical analysis and editing of the final manuscript.

  • 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.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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