Prognostic factors in young ovarian cancer patients: An analysis of four prospective phase III intergroup trials of the AGO Study Group, GINECO and NSGO

Eur J Cancer. 2016 Oct;66:114-24. doi: 10.1016/j.ejca.2016.07.014. Epub 2016 Aug 23.

Abstract

Objectives: We evaluated in a large study meta-database of prospectively randomised phase III trials the prognostic factors for progression-free survival (PFS) and overall survival (OS) in patients < and >40 years of age with advanced epithelial ovarian cancer.

Methods: A total of 5055 patients of the AGO, GINECO, NSGO intergroup studies AGO-OVAR 3, 5, 7 and 9 were merged to identify 294 patients <40 years and 4761 patients ≥40 years. We conducted survival analyses and Cox proportional hazard regression models and additionally analysed a very homogeneous subcohort of 405 patients with serous epithelial ovarian cancer, excellent performance status, who had received complete macroscopic upfront cytoreduction and ≥5 chemotherapy cycles.

Results: For patients <40 years, the median PFS was 28.9 months and the median OS was 75.3 months, while the median PFS for patients ≥40 years was 18.1 months and the median OS was 45.7 months. Independent prognostic factors were similar in both age groups. In a multivariate analysis including prognostic factors potentially leading to confounding, young age appeared to improve PFS (hazard ratio [HR], 0.86; 95% confidence interval [CI]: 0.72-1.03) and OS (HR, 0.73; 95% CI: 0.59-0.91). The observed effect was even stronger in the subcohort of optimally treated patients with SEOC: PFS (HR, 0.34; 95% CI: 0.19-0.59) and OS (HR, 0.23; 95% CI: 0.09-0.56).

Discussion: Prognostic factors were similar in both age groups. Young age appeared a strong independent protective prognostic factor for PFS and OS in the subcohort.

Keywords: Ovarian cancer; Prognostic factors; Younger patients.

Publication types

  • Meta-Analysis

MeSH terms

  • Adult
  • Age Factors
  • Age of Onset
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Carcinoma, Ovarian Epithelial
  • Clinical Trials, Phase III as Topic
  • Endometrial Neoplasms / drug therapy
  • Endometrial Neoplasms / mortality
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Middle Aged
  • Neoplasms, Glandular and Epithelial / drug therapy
  • Neoplasms, Glandular and Epithelial / mortality*
  • Ovarian Neoplasms / drug therapy
  • Ovarian Neoplasms / mortality*
  • Prognosis
  • Prospective Studies
  • Retrospective Studies