Malignant ascites in ovarian cancer is compatible with long-term (10 year) survival with associations to clinicopathological features.

Abstract

Objectives: Ovarian cancer can present with malignant ascites at initial diagnosis or disease recurrence. Although indicative of advanced disease, the prognosis of malignant ascites is reported to be favorable for ovarian cancers compared to other malignancies. This study aims to detail the survival, in particular long-term (10 year), and predictive clinicopathological factors.

Methods: Cases of malignant ascites confirmed by cytology and radiologic/histologic evidence supportive of ovarian primary, over three-decades, were retrieved. Survival data was obtained, and long-term survivors were identified. Corresponding demographical, clinical, biochemical, hematological, serological, and pathological data at onset of ascites were reviewed for survival analysis.

Results: Totally 277 cases were reviewed, with a mean overall survival of 69.3 months, including 27 (9.7%) long survivors. Old age, high-grade histology, low haemoglobin, serum albumin and total protein, long APTT, ECOG score ≥ 3 and prior chemotherapy associated with mortality and shorter overall survival (p = 0.03-<0.01), whereas administration of chemotherapy after onset of ascites correlated with better outcome (p < 0.01). APTT, ECOG score, total serum protein and prior chemotherapy remained independent predictors on multivariable analysis. Remission was common in long survivors, with only one (3.7%) patient dying of disease. Long survival was more common in patients with younger age, low-grade serous and endometrioid histology, lower platelet count, higher serum albumin and total protein, and patients receiving surgical treatment after ascites (p < 0.05).

Conclusion: Factors predicting long survival in ovarian carcinoma patients with malignant ascites were age, histology, hematological and biochemical markers, and those with favorable clinicopathological features are compatible with long survival.