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. 2023 Aug 31;12(8):1937-1950.
doi: 10.21037/tcr-23-58. Epub 2023 Aug 9.

Prognostic factors and clinic-pathologic characteristics of ovarian tumor with different histologic subtypes-a SEER database population study of 41,376 cases

Chang Shao #  1 , Hualei Guo #  2 , Linfeng Chen  3 , Jing Chen  4 , Li Wang  5 , Haibin Wang  6
Affiliations

Prognostic factors and clinic-pathologic characteristics of ovarian tumor with different histologic subtypes-a SEER database population study of 41,376 cases

Chang Shao et al. Transl Cancer Res. .

Abstract

Background: Ovarian cancer is considered the leading cause of cancer-related deaths among all gynecological malignancies and a significant reason for mortality in women. This cohort study aimed to explore the survival trends of malignant ovarian tumors (MOT), cancer antigen 125 (CA125) level, and clinicopathological prognostic factors of MOT by histological subtype.

Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, a total of 41,411 MOT cases diagnosed between January 2005 and December 2014 were extracted. According to the histological classification of MOT, four categories were included: epithelial ovarian carcinoma (EOC), malignant ovarian germ cell tumors (MOGCTs), malignant ovarian sex cord-stromal tumors (MOSCSTs) and ovarian neuroendocrine tumors (ONTs). We analyzed disease-specific survival (DS) and overall survival (OS) among the four categories, and their histological subtypes. Kaplan-Meier method was used to estimate survival curves, and log-rank test was used to evaluate differences between curves. Univariate and multivariate Cox proportional hazards models were applied to evaluate the prognostic impact of MOT.

Results: Significant predictors related to improved OS were younger age, low grade, early FIGO stage and localized SEER stage, while positive/elevated CA125 level was a risk factor. For MOGCT and MOSCST, 3-, 5- and 10-year DS rate estimates were all >80%, followed by ONT around 70%. Malignant epithelial cancer showed low DS rate at 3-year (70.7%), 5-year (58.7%), and 10-year (47.3%).

Conclusions: EOC patients had the worst outcome, whereas MOGCT cases had the most favorable survival. Positive/elevated CA125 level led to poor prognosis. Furthermore, younger age, low grade, early FIGO stage and localized SEER stage were significant predictors for improved OS.

Keywords: Cancer antigen 125 protein (CA125 protein); SEER program; fertility preservation; ovarian tumor; prognostic factor.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tcr.amegroups.com/article/view/10.21037/tcr-23-58/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow-chart for patient selection. EOC, epithelial ovarian carcinoma; MOGCT, malignant ovarian germ cell tumor; MOSCST, malignant ovarian sex cord-stromal tumor; ONT, ovarian neuroendocrine tumor; LCNEC, large cell neuroendocrine carcinoma; SCNEC, small cell neuroendocrine carcinoma.
Figure 2
Figure 2
CA125 level of malignant ovarian tumor by histological subtypes. CA125, cancer antigen 125; PDSLCT, poorly-differentiated Sertoli-Leydig cell tumor; LCNEC, large cell neuroendocrine carcinoma; SCNEC, small cell neuroendocrine carcinoma.
Figure 3
Figure 3
DS (A) and OS (B) according to histological classifications. DS, disease-specific survival; OS, overall survival; EOC, epithelial ovarian carcinoma; MOGCT, malignant ovarian germ cell tumor; MOSCST, malignant ovarian sex cord-stromal tumor; ONT, ovarian neuroendocrine tumor.
Figure 4
Figure 4
DS curves according to histological subtypes in EOC (A), MOGCT (B), MOSCST (C), and ONT (D). DS, disease-specific survival; EOC, epithelial ovarian carcinoma; MOGCT, malignant ovarian germ cell tumor; MOSCST, malignant ovarian sex cord-stromal tumor; ONT, ovarian neuroendocrine tumor; PDSLCT, poorly-differentiated Sertoli-Leydig cell tumor; LCNEC, large cell neuroendocrine carcinoma; SCNEC, small cell neuroendocrine carcinoma.
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