Department 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.
Tumorbank Ovarian Cancer Network, Berlin, Germany.
Int J Gynecol Cancer. 2021 May;31(5):713-720. doi: 10.1136/ijgc-2020-002023. Epub 2021 Feb 9.
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.
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.
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.
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.
卵巢癌的长期幸存者是一组独特的患者，他们的长期生存预后因素描述不佳。这些因素可能为更个性化的治疗方法提供信息。本研究的目的是确定高级别浆液性卵巢癌长期幸存者的进一步特征。
长期幸存者被定义为首次诊断后生存时间超过 8 年的患者，并于 1988 年 11 月至 2008 年 11 月在欧洲的七个大容量中心招募。对照组包括从系统的“肿瘤银行卵巢癌”数据库中确定的生存时间少于 5 年的高级别浆液性卵巢癌患者。仅对 Charité 患者进行了亚分析，以深入分析肿瘤播散情况。使用最近邻卡尺宽度的倾向评分匹配来匹配长期幸存者和对照组的年龄、FIGO 分期和残余肿瘤。
共纳入 276 例高级别浆液性卵巢癌患者，分为 131 例长期幸存者和 145 例对照组患者。经过倾向评分匹配和多变量调整后，铂类药物敏感性（p=0.002）是独立的有利预后因素，而复发（p<0.001）和腹水（p=0.021）是长期生存的独立不利预测因素。BRCA1 基因突变的长期幸存者明显多于 BRCA2 基因突变（p=0.016）。这些患者在初次手术时上腹部肿瘤受累的比例较低（p=0.024）。两组手术的复杂性和手术技术相似。
铂类药物敏感性是长期生存的有利因素，而上腹部肿瘤受累、腹水和复发则有负面影响。根据临床评估，长期生存与临床、手术和分子因素的组合有关。
