Discussion
ovarian cancer, tumor, tumors, AJCC
OVARIAN CANCER, TUMOR, RESIDUAL TUMOR, LUNG METASTASIS, DISEASES, DISEASE, BONE METASTASIS, SURGICAL COMPLICATION, SURGICAL COMPLICATIONS, EFFECTS OF CHEMOTHERAPY, REGRESSION, LIVER METASTASIS, TUMORS, EPITHELIAL OVARIAN CANCER
Epithelial ovarian cancer is one of the most common and fatal gynecologic tumors, which is often diagnosed in postmenopausal women. Recently, researchers mainly focused their studies on patients with EOC at childbearing age [Previously, various factors had been found to be related to the prognosis of patients with EOC, such as race, grade, histology, tumor size, lymph nodes examined, T stage, N stage, FIGO stage, AJCC stage, surgery, chemotherapy, serum CA125 level, surgery, age, residual lesion size, liver metastasis, bone metastasis, and lung metastasis. Therefore, we included as many of these factors as possible in our study. By univariate and multivariate Cox regression analysis, we found that a total of 12 variables were significantly related to OS, and 13 variables were meaningfully related to CSS, which were included in the two nomograms, respectively. According to the results of our study, advanced age was positively associated with a worse prognosis in EOC patients. There were several factors that might contribute to the poorer prognosis of EOC patients with age, including worse nutritional status, performance status, more complex underlying diseases as well as poor tolerance to treatment. Taylor Jolyn S et al. found that Non-white elderly women are less likely to receive the standard of care treatment for ovarian cancer and more likely to die from their disease than white elderly women [At present, the efficacy of surgery, chemotherapy, and radiotherapy were still unclear for elderly patients with EOC. Whether or not to choose surgery, chemotherapy, and radiotherapy for these patients had aroused many disputes in gynecologists as no consistent guidance [Based on the SEER database and the independent prognostic factors in our study, we established and validated two nomograms for predicting the prognosis of elderly patients with EOC in this study. Results of the validation of these nomograms indicated that they had an excellent predictive and discriminative performance. We established two new risk stratification systems for elderly patients with EOC by calculating the total score for each patient based on the two nomograms, which also showed a good ability to differentiate risk groups compared with the AJCC stage system.This study also had some defects indisputably. Firstly, variables’ information like specific chemotherapy regimens, residual tumor size, concomitant underlying disease conditions, surgical complications, and side effects of chemotherapy were unavailable from the SEER database. Secondly, some correlated prognostic variables like residual tumor size and surgical complication were not contained in our nomograms which resulted in some limitations in our studies. Finally, there is inevitable selection bias as this study is based on a retrospective database, external validation should be performed to provide more reliable evidence.