Stage-specific associations between clinical, demographic, and treatment factors and long-term survival in ovarian cancer.

Abstract

e17610 Background: Ovarian cancer remains the deadliest gynecologic malignancy, largely due to advanced-stage presentation and variation in access to care. While surgery and chemotherapy are central to management, the relative importance of clinical and system-level factors may differ by disease stage. We examined stage-specific associations between demographic, clinical, and treatment factors and long-term survival among surgically treated patients. Methods: Adults with surgically treated ovarian cancer were identified from the National Cancer Database (2004–2020). Pathologic stage was defined using AJCC criteria and grouped to correspond with FIGO 2014 I–IV categories. Survival was categorized as 0–2, 2–5, or >5 years from diagnosis. Ordinal logistic regression assessed associations between demographic, socioeconomic, tumor, and treatment factors and the odds of belonging to a higher survival category, reported as adjusted odds ratios (aORs). Results: Among 23,560 patients, 39.5%, 11.8%, 35.6%, 13.1% had stage I, II, III, and IV disease, respectively. In stage I, Medicaid insurance (aOR 0.72, p < 0.05), higher comorbidity (aOR 0.86, p < 0.001), low income (aOR 0.75, p < 0.05), and 30-day readmission after surgery (aOR 0.69, p < 0.05) were associated with lower survival. In stage II, Non-Mexican Hispanic ethnicity (aOR 0.57, p < 0.05), uninsured status (aOR 0.46, p < 0.05), and mesenchymal histology (aOR 0.49, p < 0.001) were associated with lower survival, while chemotherapy was associated with higher survival (aOR 1.51, p < 0.001). In stage III, older age (aOR 0.98, p < 0.001) and higher comorbidity (aOR 0.89, p < 0.05) were associated with lower survival. Asian/Pacific Islander (aOR 0.63, p < 0.05) and American Indian/Other patients (aOR 0.55, p < 0.05) had reduced survival odds. Care in Medicaid expansion states (aOR 1.22, p < 0.05) and absence of postoperative readmission (aOR 1.50, p < 0.001) were associated with higher survival. In stage IV, Black race (aOR 0.68, p < 0.05) and non-private insurance (aOR 0.23–0.65, p < 0.05) were associated with lower survival. Mesenchymal or non-epithelial histology remained adverse (aOR 0.50, p < 0.001). Chemotherapy showed the strongest association with higher survival across all stages (aOR 1.51–2.86, p < 0.001). Conclusions: Associations between survival and clinical or system-level factors vary substantially by ovarian cancer stage. Early-stage outcomes were most strongly associated with patient health status and perioperative recovery, whereas in advanced disease, chemotherapy access and insurance status showed the strongest associations with long-term survival. These findings highlight stage-specific vulnerabilities in care delivery that may contribute to observed survival differences.