Ovarian Cancer Subpopulations Seeing Long-Term Survival

Rosemary Cress, MPH, PhD

Rosemary Cress, MPH, PhD

The majority of survival studies in patients with ovarian cancer have been short term, not extending beyond a 5-year analysis post diagnosis. Rosemary Cress, MPH, PhD, an epidemiologist and associate adjunct professor in the UC Davis Department of Public Health Science, and colleagues sought to identify long-term survival of patients with epithelial ovarian cancer, as well as the epidemiological characteristics associated with such survival. The study was published August 5 2015, in theJournal of Obstetrics and Gynecology.¹

The retrospective study was conducted on patient data recorded in California Cancer Registry, the largest population-based cancer registry in the United States and part of both the Centers for Disease Control and Prevention National Program of Cancer Registries and the National Cancer Institute Surveillance Epidemiology and End Results program.²

Patients residing in California and diagnosed with ovarian cancer between 1994 and 2001 were identified for the study and were followed-up through 2011, providing 10-year data on all surviving patients. The patient population was divided into four cohorts based on length of survival: more than 10 years, between 5 to 10 years, between 2 to 5 years, and less than 2 years. Other factors included in the analysis were race, neighborhood, insurance coverage, patient demographics, tumor characteristics, and hospitals.

Of the 11,541 patients included in the study, most survived less than 5 years. Unprecedentedly, 3582 patients (31%, CI, 30.2—31.8%) survived more than 10 years. Close to 57% of the long-term survivors were older than 50 years. While 51% of the long-term survivors had early, stage I cancer, 32% had stage III and IV cancer. Low-grade tumors were predominant in 58% of long-term survivors.

“The perception that almost all women will die of this disease is not correct,” Cress said. “The new information obtained from this study will be helpful to physicians who first diagnose these patients, as well as the obstetricians/gynecologists who take care of them after they receive treatment from specialists.”

While the study showed that tumor biology (cancer stage, grade, and histology) had the strongest associations with survival and low-grade cancers had improved survival over high-grade cancers, nearly one third of all long-term survivors had stages III and IV epithelial cancer.

The authors propose that the improved outcomes could be attributed to overall improved interventions for the patients. They also speculate a link to the underlying genetic alterations where somatic alterations might provide a long-term survival advantage over germline mutations. Other studies have shown thatBRCA1orBRCA2mutation carriers with ovarian cancer have an improved survival compared to those without these mutations.^3-5

“This information is important for patient counseling,” said study coauthor Gary Leiserowitz, MD, MS, professor of gynecologic oncology and interim chair of the UC Davis Department of Obstetrics and Gynecology. “Many patients and physicians know that ovarian cancer is a dangerous cancer, but they don’t realize that there is significant biological variability among patients. It’s not a uniformly fatal prognosis.”

The authors conclude that the availability of patient-specific interventions has increased the long-term survival of patients with ovarian cancer. This brings new challenges where physicians must be prepared to address cancer survivorship needs in long-term survivors who are challenged with anxiety, fatigue, sexual, social, and financial problems.⁶The study results can be a useful resource for healthcare providers and patient counseling.

References:

1.     Cress RD, Chen YS, Morris CR, et al. Characteristics of Long-Term Survivors of Epithelial Ovarian Cancer.Obstet Gynecol. 2015. doi: 10.1097/AOG.0000000000000981.

2.     California Cancer Registry.http://www.ccrcal.org/. Accessed August 10, 2015.

3.     Zhong Q, Peng HL, Zhao X, et al. Effects of BRCA1- and BRCA2-related mutations on ovarian and breast cancer survival: a meta-analysis.Clin Cancer Res. 2015;21: 211-220.

4.     Sun C, Li N, Ding D, et al. The role of BRCA status on the prognosis of patients with epithelial ovarian cancer: a systematic review of the literature with a meta-analysis. PLoS One 2014;9:e95285.

5.     Barlin JN, Jelinic P, Olvera N, et al. Validated gene targets associated with curatively treated advanced serous ovarian carcinoma.Gynecol Oncol. 2013;128:512-517.

Wenzel LB, Donnelly JP, Fowler JM, et al. Resilience, reflection, and residual stress in ovarian cancer survivorship: a gynecologic oncology group study.Psychooncology.