Predictive factors for long-term survivors in advanced-stage epithelial ovarian cancer.

BACKGROUND: Most women with epithelial ovarian cancer present with advanced-stage disease and have poor survival outcomes. However, the factor associated with long-term survival and the prognostic impact of histologic subtype in this population remain incompletely characterized. OBJECTIVE: To identify factors associated with long-term survival and to compare survival outcomes across histologic subtypes in advanced-stage epithelial ovarian cancer. STUDY DESIGN: We conducted a retrospective cohort study of 359 women with stage III to IV epithelial ovarian cancer. Multivariable logistic regression analysis was used to identify independent predictors of long-term survival, defined as overall survival of 5 years or longer. Cox proportional hazards models were applied to evaluate survival outcomes. RESULTS: Among patients with advanced-stage epithelial ovarian cancer, 109 patients (30.4%) achieved long-term survival. Median follow-up was 111.8 months. BRCA mutation status was independently associated with improved long-term survival (adjusted OR 8.11, 95% CI 2.46-26.67; P<.001). Optimal surgical cytoreduction and good performance status were also independently associated with long-term survival. In contrast, clear cell carcinoma was a negative predictor of long-term survival and associated with inferior oncologic outcomes, including a 5-year overall survival of 13.1% and an approximately twofold increased risk of mortality compared with high-grade serous carcinoma (adjusted HR 2.01, 95% CI 1.37-2.95; P<.001). A landmark analysis among 5-year survivors showed that the BRCA survival advantage did not persist beyond 5 years (P=.661). CONCLUSION: Long-term survival in advanced-stage epithelial ovarian cancer is independently associated with BRCA mutation status, optimal surgical cytoreduction, favorable performance status, and histologic subtype. Clear cell carcinoma is linked to significantly worse outcomes. These findings highlight the importance of universal genetic testing and maximal surgical cytoreduction.