Patients (pts) with advanced CCOC have a significantly poorer prognosis than other Epithelial ovarian cancer (EOC) subtypes. Being able to predict which pts are more likely to relapse could assist with treatment and monitoring decisions. The system inflammatory score (SIS) aims to predict postsurgical prognosis for CCOC by stratifying pts into 3 groups (gps). The Risk of OVarian cAncer Relpase (ROVAR) score aims to predict ROR for EOC following first line treatment and stratifies pts into low/intermediate (int)/high gps. We attempted to validate both scores in a non-trial population.
We reviewed the medical records for pts with CCOC treated at two UK gynaecological cancer centres between 2002 and 2017. Data comprising pt and tumor characteristics, treatment and outcome. Analysis was performed using Mantel Cox and Fisher Exact Tests.
119 pts; stage I (65), II (19), III (22), IV (10) and unknown (3). ROVAR was calculated for 90 (75%) pts; 24 (20%) had incomplete data, 6 (5%) excluded for other. Pts classified into low (20%), int (44%) and high (36%) gps. ROR for low or int gps vs high p = 0.0001; ROR for low vs int gps p = 1. Compared to low/int, pts in high-risk gp were younger 53.87yrs (34-72) vs 57.81yrs (35-74), had smaller tumours 106mm (45-240) vs 136mm (50-230), with increase in both hypercalcaemia (21% vs 5%; p = 0.306) and thromboembolic events (37.5% vs 10%; p = 0.0047). SIS was calculated for 67 pts (56%); 39 (33%) had insufficient data, 13 (11%) excluded for other. Pts classified into gp 0 (34.3%), 1 (37.3%) and 2 (28.3%) with no statistical difference in PFS (p = 0.9118) or OS (p = 0.849) between gps.
ROVAR significantly predicts ROR in CCOC in pts with high vs low/int risk disease. Our data suggests that the features that promote treatment-resistance are linked to paraneoplastic phenomenon and emerge early in tumour development, resulting in diagnosis at a smaller size in younger women. Another possibility is that these are two pathologically similar, but ultimately distinct, disease entities from the outset. Patients with high risk disease may benefit from more intensive follow-up and, given the chemo-resistant phenotype of the disease, early enrolment in clinical trials.
Clinical trial identification
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All authors have declared no conflicts of interest.