Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr 11:12:860046.
doi: 10.3389/fonc.2022.860046. eCollection 2022.

Women With Ovarian Cancer and With Fertility Preservation: A Survival Analysis Using the Surveillance, Epidemiology, and End Results Database and Construction of Nomograms to Predict Cancer-Specific Survival

Yue-Min Hou  1 , Hui Yu  1 , Jia-Tao Hao  1 , Fang Feng  1 , Rui-Fang An  1
Affiliations

Women With Ovarian Cancer and With Fertility Preservation: A Survival Analysis Using the Surveillance, Epidemiology, and End Results Database and Construction of Nomograms to Predict Cancer-Specific Survival

Yue-Min Hou et al. Front Oncol. .

Abstract

Objective: This study aimed to determine the risk and prognostic factors of ovarian cancer (OC) in women having fertility-sparing surgery, as well as survival outcomes of those with stage I epithelial ovarian cancer (EOC). We also determined the effect of chemotherapy in OC treatment and used multiple independent risk factors to establish a prognostic nomogram model for patients with stage I EOC.

Patients and methods: Individuals with OC and with fertility-sparing surgery (FSS) between 1998 and 2016 were identified in the SEER database. Univariate and multivariate logistic regression was performed to identify the distributions of patient characteristics according to chemotherapy. Cancer-specific survival (CSS) was assessed using Kaplan-Meier curves and log-rank tests. Univariate and multivariate Cox regression was conducted to determine the independent prognostic factors for CSS. Cox analysis was used to construct a nomogram model. The C-index and calibration plots showed the performance evaluation results.

Results: A total of 1,839 women with OC with FSS were identified in the SEER database. Factors associated with significantly higher odds of undergoing chemotherapy included younger age, being unmarried, having grades 2-4, stages II-III, or clear cell and non-epithelial histologic type following a multivariate logistic regression analysis. Multivariate Cox regression analysis confirmed that age, marital status, chemotherapy, histologic type, grade, and the International Federation of Gynecology and Obstetrics (FIGO) stage were independent prognostic factors for CSS. In stage I EOC, the prognosis in patients with stage IA/IB-grade 3 (5-year CSS 85.3%) or stage IC (5-year CSS 80.6%) was worse than that in those with stage IA/IB-grade 1 (5-year CSS 95.2%), or stage IA/IB-grade 2 (5-year CSS 94.7%). However, chemotherapy improved the survival of patients with stage IA/IB-grade 3 (5-year CSS 78.1% vs. 94.6%, p = 0.024) or stage IC (5-year CSS 75.1% vs. 86.7%, p = 0.170).

Discussion: The study provided population-based estimates of risk factors and prognoses in patients with OC and with FSS as well as the survival outcomes of patients with stage I EOC and the effect of chemotherapy. The constructed nomograms exhibited superior prognostic discrimination and survival prediction for patients with stage I EOC.

Keywords: SEER; chemotherapy; fertility preservation; ovarian cancer; prognosis.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of patient selection from the SEER database.
Figure 2
Figure 2
Kaplan–Meier curves for CSS in stage I EOC. (A) Stage IA/IB vs. stage IC, (B) stage IA/IB-grade 1 vs. stage IA/IB-grade 2, (C) stage IA/IB-grade 2 vs. stage IA/IB-grade 3, (D) stage IA/IB-grade 2 vs. stage IC, and (E) stage IA/IB-grade 3 vs. stage IC.
Figure 3
Figure 3
CSS curves stratified in stage I EOC by chemotherapy. (A) Stage IA/IB-grade 1, (B) stage IA/IB-grade 2, (C) stage IA/IB-grade 3, and (D) stage IC [0 = non-chemotherapy; 1 = chemotherapy].
Figure 4
Figure 4
Nomograms to predict 3-, 5-, and 10-year CSS for stage I EOC.
Figure 5
Figure 5
The calibration plot established for the nomogram among patients of stage I EOC. The x-axis describes nomogram-predicted survival; the y-axis indicates observation survival. The graph along the 45° line shows the ideal calibration model, where the predicted probability is consistent with the actual result. (A) 3- year, (B) 5- year.
See this image and copyright information in PMC

References

    1. National Cancer Institute . Cancer Stat Facts: Ovarian Cancer. Available at: https://seer.cancer.gov/statf acts/html/ovary.html (Accessed February 20, 2019).
    1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA Cancer J Clin (2021) 71(1):7–33. doi: 10.3322/caac.21654 - DOI - PubMed
    1. Kehoe S, Hook J, Nankivell M, Jayson GC, Kitchener H, Lopes T, et al. . Primary Chemotherapy Versus Primary Surgery for Newly Diagnosed Advanced Ovarian Cancer (CHORUS): An Open-Label, Randomised, Controlled, Non-Inferiority Trial. Lancet (2015) 386(9990):249–57. doi: 10.1016/S0140-6736(14)62223-6 - DOI - PubMed
    1. du Bois A, Reuss A, Pujade-Lauraine E, Harter P, Ray-Coquard I, Pfisterer J. Role of Surgical Outcome as Prognostic Factor in Advanced Epithelial Ovarian Cancer: A Combined Exploratory Analysis of 3 Prospectively Randomized Phase 3 Multicenter Trials. Cancer (2009) 115(6):1234–44. doi: 10.1002/cncr.24149 - DOI - PubMed
    1. Carter J, Rowland K, Chi D, Brown C, Abu-Rustum N, Castiel M, et al. . Gynecologic Cancer Treatment and the Impact of Cancer-Related Infertility. Gynecol Oncol (2005) 97(1):90–5. doi: 10.1016/j.ygyno.2004.12.019 - DOI - PubMed

LinkOut - more resources