Clinical predictors of survival in advanced epithelial ovarian cancer: Can we foresee the long-term survivors and develop a personalized treatment approach?
Authors: Shachar Eliya , Raz Yael , Peleg-Hasson Shira , Laskov Ido , Mischan Nadav , Grisaru Dan , Wolf Ido , Safra Tamar 
Published: June 2023

e17605

Background: While women with recurrent disease have a poor prognosis, a subset of women are long term survivors (LTS). We aimed to characterize the demographic and clinical characteristics associated with long and short-term survival of patients with advanced epithelial OC (EOC). Methods: We conducted a retrospective descriptive analysis of 822 patients diagnosed with advanced EOC (FIGO stage III/IV) and treated at a single institution, between 2002-2020. Characteristics of short-term survivors (STS), women who survived less than 2 years, were compared to LTS, patients who lived beyond 7 and 10 years from diagnosis. Descriptive statistics of the clinical, oncologic, and treatment parameters were performed using t-test, chi-square. We assessed the contribution of age and stage, BRCA carrier status, interval or primary debulking, optimal debulking, platinum sensitivity, and treatment scheduling upon oncological outcomes. Results: Among 822 patients with advanced EOC, 112 women (13.6%) died withing 24 months from diagnosis, while 139 (16.9%), and 64 (7.8%) survived beyond 7 and 10 years, respectively. Histology, CA125 level at diagnosis, and interval or primary debulking approach, were not significant among the STS and LTS. LTS were younger at diagnosis, (median age of 57, and 56.5 among women who lived > 7 and 10 years, respectively vs. 70 in STS, p < 0.0001). The majority of LTS were diagnosed with stage III disease, (95%, and 97%, > 7 and > 10 years, respectively vs. 67% of STS), in contrast to a greater proportion of STS diagnosed with stage IV (33.0% of STS vs. 5.0%, 3.1% of LTS > 7 and > 10 years, respectively, p < 0.0001). BRCA mutation status was the strongest prognostic factor for LTS ( > 7 and 10 years, OR = 17.8, 21.2 respectively, p < 0.001). Almost half of LTS who were carriers of a deleterious BRCA mutation, (47.3%, 46.2% of LTS > 7 and 10 years, respectively, p < 0.0001), whereas most STS were not carriers of BRCA mutations (89.8%). LTS were predominantly platinum sensitive (99.3%, 98.4% > 7 and > 10 year, vs. 21.6% of STS, P < 0.0001). Optimal cytoreductive surgery was performed in a smaller number of STS compared to the LTS (41.9% of STS vs. 83.5% and 88.7% of LTS > 7 and 10 years, respectively, p < 0.0001). A greater proportion of LTS received weekly treatment scheduling of paclitaxel and carboplatin compared to STS (50.8% and 49.2% of LTS > 7 and 10 years, respectively vs. 31.6% of STS, p < 0.01). Conclusions: The long and short-term survivors of advanced EOC may be identified early in the clinical assessment, based on distinct patient characteristics associated with survivorship, which are critical in developing a personalized treatment approach. Our work demonstrated that LTS are a distinct group of women diagnosed at a younger age, lower stage, optimally debulked, platinum sensitive disease, and BRCA mutation carriers.