SUROVA study: global real-world treatment strategies and mortality risk prediction in advanced ovarian cancer.
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Chiva Luis, Ordas Pilar, Mishra Jagannath, Ayhan Ali, Lee Yoo-Young, Bogani Giorgio, Sp Somashekhar, Lomnytska Marta, Stukan Maciej, Fruscio Robert, Chura Bernabe Fora, Salcedo-Hernandez Rosa A, De Iaco Pierandrea, Haidopoulos Dimitrios, Svintsitskiy Valentyn, Jain Vandana, Stanciu Paul, Rawert Friederike Luise, Akdemir Celal, Abdallah Reem, Chacon Enrique, Minguez Jose Angel, Gil-Moreno Antonio, Kharchenko Kateryna, Mofrad Malihe Hasanzadeh, Gebauer Gerhard, Díaz-Feijoo Berta, Scibilia Giuseppe, Klaric Marko, Škof Erik, Saadeh Feras Abu, Mueller Michael D, Saarelainen Sami, Tejerizo García Álvaro, Fotopoulou Christina, Coronado Pluvio, Dermikiran Fuat, Goffin Frederic, Tsolakidis Dimitrios, Gonzalez-Martin Antonio, SUROVA Study Group
Аннотация
METHODS: SUROVA is a retrospective, international cohort study involving patients treated between 2018 and 2019 across 174 centers in 55 countries. Patients underwent primary surgery or received neoadjuvant chemotherapy followed by interval surgery, per institutional protocols. Propensity score matching was based on 7 baseline variables: age, race, Eastern Cooperative Oncology Group performance status at diagnosis, CA125 level at diagnosis, FIGO (International Federation of Gynecology and Obstetrics) stage IV disease, presence of ascites, and final tumor grade. Cox regression models with time-dependent effects and interaction terms were applied. A clinical risk calculator was developed and internally validated.
RESULTS: A total of 3286 patients had a mean age of 60.0 years (SD 12); 2978 (90.6%) had high-grade serous carcinoma, and 795 (24.7%) presented with FIGO stage IV disease. A total of 1666 patients (50.7%) underwent primary cytoreductive surgery, and 1620 (49.3%) received neoadjuvant chemotherapy. The median follow-up duration was 43.8 months (interquartile range; 22.6-59.3). After propensity score matching (n=1524), overall survival was similar between groups (67.2 vs 65.0 months; HR 1.002, 95% CI 0.85 to 1.18, p=.98). Outcomes differed by ethnicity, residual disease, and post-operative complications. Post-operative complications (28%) significantly worsened survival (66 vs 46 months; HR 1.5, 95% CI 1.2 to 1.9, p<.001), especially among patients undergoing primary surgery (73 vs 46 months; HR 1.85, 95% CI 1.43 to 2.37, p<.001). The most favorable outcomes were observed among patients with primary surgery, complete resection, and no complications, with median overall survival not reached (HR 1.25, 95% CI 1.12 to 1.40, p<.001).
CONCLUSIONS: Although overall survival was similar between groups, treatment effects differed by ethnicity, residual disease, and complications. Post-operative complications were associated with significantly worse survival, particularly among patients undergoing primary surgery, while the best outcomes were achieved in those who had primary surgery with complete resection and no complications.