Prognostic factors for survival in advanced epithelial ovarian cancer: A retrospective analysis.

Abstract

e17604 Background: Approximately 60% of Epithelial Ovarian cancer (EOC) cases are diagnosed at an advanced staged, and 75% of patients experience disease relapse within five years. In this study, we determined the prognostic factors for overall survival (OS) of patients with advanced EOC treated at a public institution. Methods: 251 patients with advanced EOC treated at the Instituto Nacional de Enfermedades Neoplásicas in Lima, Peru, between 2015 and 2020 were evaluated. Clinical data were extracted from electronic medical records. OS and progression-free survival (PFS) were evaluated using Kaplan-Meier curves, and prognostic factors were identified through multivariate Cox regression analysis. Results: Median age was 58 years (39.4% > 60yo). Obesity was noted in 10.9% of patients, while 20.5% scored 2-3 on the ECOG scale. At diagnosis, 69.7% of patients presented with stage III, while 30.4% had stage IV disease. Liver and lung metastases were the most common, each affecting 35.5% of patients. High grade serous ovarian carcinoma was the most frequent histology (69.7%), followed by clear cell carcinoma (9.2%) and endometroid (5.2%). 84.6% had grade 3 histology, and CA-125 levels was elevated in 88.9% of cases. Only 6% of patients had access to BRCA testing. Regarding treatment, 55% of patients underwent primary surgery, with optimal cytoreduction achieved in 73.9% and suboptimal cytoreduction in 26.1%; 86.2% received adjuvant chemotherapy (CT). Neoadjuvant platinum-based CT was given to 45% of patients as primary treatment, with interval debulking surgeries achieving optimal outcomes in 50.4%, suboptimal in 8.8%, and 25.7% having unresectable disease. Recurrence was reported in 65.9% (147/221) of patients, most commonly as platinum-sensitive disease (59.3%) and peritoneal carcinomatosis (47.7%). After a median follow-up of 6.2 years (95% CI: 6.0–6.4), the median PFS was 16.8 months (18.7% 5-year PFS rate) and median OS was 33.6 months (29.5% 5-year OS rate). Platinum-sensitive recurrence was associated with a median OS of 48 compared to 20.4 months for platinum-resistant recurrence. Univariate analysis showed better OS was significantly associated with ECOG 0–1, stage III disease, primary surgery, optimal cytoreduction, adjuvant CT, receiving more than five cycles of adjuvant CT, and platinum-sensitive recurrence (p < 0.05). However, multivariate analysis identified ECOG 0–1 (HR: 1.8, p = 0.033), optimal cytoreduction (HR: 2.2, p < 0.001), and more than five cycles of adjuvant CT (HR: 1.7, p = 0.010) as independent predictors of improved OS. Conclusions: These findings underscore the importance of optimal cytoreduction and adequate adjuvant chemotherapy in enhancing survival outcomes for advanced EOC patients. Limited access to BRCA testing highlights the need for expanded genetic testing to enable personalized treatments, including PARP inhibitors, in first line and platinum recurrent setting.