Early demise from high grade serous ovarian cancer is predictable and likely related to tumour biology

Hawarden, AK; Russell, B; Gee, M; Skayali, F; Edmondson, MR; Clamp, A; Jayson, G; Crosbie, E; Edmondson, RJ

Abstract

Introduction: Despite improvements in median survival for patients with advanced ovarian cancer there remains a cohort of patients who suffer early demise; the reasons for which remain poorly understood. A nested case control study was performed to investigate a possible link between early demise and delays in diagnosis.

Methods: A cohort of 28 patients who suffered early demise (died within 100 days of diagnosis) was identified from 321 ovarian cancer patients between 2013 and 2015. This group was matched 1:5 for histology and stage to create a control of 134 patients. A treatment timeline from referral to death, as well as multiple patient demographics and blood parameters were directly compared between the two groups.

Results: Patients with early demise were older (median 73 versus 68 years, P = 0.049), and had poorer performance scores at diagnosis (P = 0.006). Differences were identified between platelet and albumin levels (P < 0.0001), as well as lymphocyte and neutrophil counts (P < 0.0001) at diagnosis. There were no significant differences between co-morbidities or deprivation index. No significant differences were identified regarding patient timelines, including time taken to make a treatment decision. The early demise group was less likely to receive active treatment (30% versus 92%), and more likely to utilise cytology for diagnosis (32% versus 7%). A logistic regression model was built and tested using four simple blood parameters. This was able to identify the early demise group before diagnosis with an area under the curve of 0.94.

Conclusions: In our cohort delays in the patient timeline are not associated with early demise. It is proposed that the differences between blood parameters and patient fitness in the early demise group reflect the identification of unique tumour biology as a contribution to early demise. This group can be accurately and simply predicted, enabling the targeting of these patients for inclusion in novel clinical trials.

Citation

Hawarden, A., Russell, B., Gee, M., Skayali, F., Edmondson, M., Clamp, A., …Edmondson, R. (2019). Early demise from high grade serous ovarian cancer is predictable and likely related to tumour biology.

• Conference Name: Blair Bell Research Society: Annual Academic Meeting
• Conference Location: / RCOG, UK
• Start Date: Feb 27, 2019
• End Date: Feb 28, 2019
• Online Publication Date: Apr 10, 2019
• Publication Date: Apr 10, 2019
• Deposit Date: Jun 23, 2023
• Publisher: Wiley
• Volume: 126
• Pages: E126
• Publisher URL: https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.15677