Obstet Gynecol Sci.  2021 Nov;64(6):524-531. 10.5468/ogs.21176.

Prognostic significance of tumor laterality in advanced ovarian cancer

• Yamada Y
• Mabuchi S
• Kawahara N
• Kawaguchi R

• KMID: 2522476
• DOI: http://doi.org/10.5468/ogs.21176

Abstract

Objective
This study aimed to investigate the effect of incorporating tumor laterality into the International Federation of Gynecology and Obstetrics (FIGO) staging system for advanced ovarian cancer.
Methods
The clinical data of 131 patients with advanced ovarian cancer treated between 2008 and 2018 were retrospectively reviewed. To investigate the prognostic significance of tumor laterality, we divided the patients into unilateral and bilateral groups. The prognostic significance of tumor laterality (bilateral vs. unilateral) was evaluated using univariate and multivariate analyses. The effect of incorporating tumor laterality into the FIGO staging system to predict survival outcomes was evaluated using the Kaplan-Meier method.
Results
Both overall survival (OS) and progression-free survival (PFS) were longer in the unilateral group than in the bilateral group. Multivariate analysis demonstrated that tumor laterality was an independent predictor of OS (hazard ratio, 1.75; confidence interval, 1.05-2.92; P=0.032). In patients with stage III disease, the bilateral group had a shorter OS than the unilateral group, but it was comparable to the OS in stage IV patients (P=0.354). The incorporation of tumor laterality into the FIGO staging system improved the stratification of survival probabilities.
Conclusion
Tumor laterality can be an independent prognostic factor in patients with advanced ovarian cancer. The incorporation of tumor laterality may improve the predictive performance of the FIGO staging system in patients with advanced ovarian cancer.

Keyword

FIGO staging system; Ovarian cancer; Prognosis; Risk factors; Tumor laterality

Figure

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  Fig. 1 Survival of patients with advanced ovarian cancer (stage III-IV) according to tumor laterality (unilateral vs. bilateral). Kaplan-Meier estimates of (A) progression-free survival (PFS) and (B) overall survival (OS). PFS and OS were significantly longer in the unilateral group than in the bilateral group.

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  Fig. 2 Clinical implications of tumor laterality in patients with ovarian cancer according to the disease stage. (A) Incorporation of tumor laterality into the International Federation of Gynecology and Obstetrics (FIGO) staging system. Survival curves according to the stage grouping in the two systems. Figure (A, B) reflect the difference in distribution of stage III patients; the revised FIGO staging system widens the distance between the curves, thus better stratifying the survival probabilities. (C) Kaplan-Meier estimates of overall survival (OS) according to tumor laterality. The OS of the stage III bilateral group was significantly shorter than that of the stage III unilateral group (P =0.004) and comparable to that of stage IV ovarian cancer patients (P =0.354).

Reference

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