Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Institute for Advanced Research, Nagoya University, Furo-cho, Chikusa-ku, Nagoya, 464-8601, Japan.
BMC Cancer. 2024 Nov 29;24(1):1479. doi: 10.1186/s12885-024-13218-1.
The accumulation of ascites is a major symptom of ovarian cancer. The volume of ascites is a pathophysiological indicator of the peritoneal environment, such as inflammation and fibrosis; however, the relationship between the volume of ascites and oncological outcomes remains unclear. We herein retrospectively examined the effects of the volume of ascites on the prognosis of epithelial ovarian cancer in a multi-institutional large cohort using the stratification of clinical characteristics and statistical adjustment methods.
Of 5,268 patients with ovarian tumors in the Tokai Ovarian Tumor Study Group between 1986 and 2020, we included 1,966 cases of epithelial ovarian cancer and examined the relationship between the volume of ascites at the initial surgery and the prognosis of patients. We performed a multivariate analysis and propensity score weighting for covariate adjustments to precisely estimate the prognostic impact of ascites accumulation. A subgroup analysis was also performed to examine differences in the prognostic implications of ascites accumulation among histotypes.
A reservoir of 100 mL of ascites was confirmed as the cut-off value in our cohort. A Kaplan-Meyer analysis with propensity score adjustments indicated that the accumulation of more than 100 mL of ascites shortened overall survival. The multivariate analysis revealed that the increased accumulation of 100 mL of ascites was an independent prognostic factor for overall survival (HR 1.242; 95% CI 1.050-1.470; P = 0.012). The subgroup analysis showed the prognostic significance of ascites accumulation in mucinous and endometrioid histologies.
The accumulation of even a low to intermediate volume of ascites (≥ 100 mL) was confirmed to be an independent poor prognostic factor in epithelial ovarian cancer. Furthermore, its prognostic impact differed among histotypes.
腹水的积聚是卵巢癌的主要症状。腹水的量是腹膜环境的病理生理指标，如炎症和纤维化；然而，腹水的量与肿瘤学结果之间的关系尚不清楚。我们在此回顾性地使用临床特征的分层和统计调整方法，在多机构的大型队列中检查了腹水的量对上皮性卵巢癌预后的影响。
在 1986 年至 2020 年期间，Tokai 卵巢肿瘤研究组的 5268 名卵巢肿瘤患者中，我们纳入了 1966 例上皮性卵巢癌患者，并检查了初始手术时腹水的量与患者预后的关系。我们进行了多变量分析和倾向评分加权，以对协变量进行精确调整，从而准确估计腹水积聚的预后影响。还进行了亚组分析，以检查腹水积聚对不同组织学类型预后的影响差异。
在我们的队列中，我们确定了 100 毫升腹水的储库值为截止值。经过倾向评分调整的 Kaplan-Meier 分析表明，超过 100 毫升的腹水积聚缩短了总生存期。多变量分析显示，腹水积聚增加 100 毫升是总生存期的独立预后因素（HR 1.242；95%CI 1.050-1.470；P=0.012）。亚组分析显示，在黏液性和子宫内膜样组织学中，腹水积聚具有预后意义。
即使是低到中等量的腹水（≥100 毫升）的积聚也被证实是上皮性卵巢癌的独立不良预后因素。此外，其预后影响在不同的组织学类型中有所不同。
