Materials and Methods
Information of women diagnosed with high-grade serous cancers was obtained from the Surveillance, Epidemiology, and End Results (SEER) (accessed Aug. 21, 2012) of the National Cancer Institute. Because SEER is a nationwide, deidentified database, our study was not covered by an institutional review board application. Patient demographic data, cancer data (such as histology, stage, and grade), diagnosis date, surgical treatment and radiation therapy, follow-up of vital status, and cause of death (if applicable) were recorded. Serous cancer was defined using International Classification of Disease , third revision, codes (8441, 8442, 8460, 8461, and 9014) between the years 2004 and 2009.
The SEER program encompasses approximately 26% of the US population in varied demographic areas. A Kaplan-Meier and Cox proportional hazards model were used to investigate survival statistics. The outcome of interest was survival rate with regard to the original site of origin of cancer. Two-tailed tests at values of P < .05 were considered significant. All data were analyzed using R 3.0.2 using the package survival for survival analyses (R Foundation for Statistical Computing, Vienna, Austria).
Results
Patient characteristics
Of 12,336 patients with high-grade, serous carcinoma, the median age was 64 years (range, 24–97 years) ( Table 1 ). Of these women, 563 had TC, 8560 had ovarian carcinoma (OC), 1037 had primary peritoneal carcinoma (PPC), and 2176 had uterine serous carcinoma (USC). Subjects with USC and PPC were older than patients with TC and OC (68 and 67 vs 63 and 62 years, P < .01), whereas a greater proportion of PPC and TC patients reported being white than OC and USC patients (91% and 89% vs 88 and 74%, P < .01).
| Factor | Total (n = 12,336) | TC (n = 563) | OC (n = 8560) | USC (n = 2176) | PPC (n = 1037) | P value |
|---|---|---|---|---|---|---|
| Median age, y (range) | 64 (24–97) | 63 (32–91) | 62 (24–97) | 68 (27–96) | 67 (30–91) | < .01 |
| Race | ||||||
| White | 10,511 (86%) | 497 (89%) | 7466 (88%) | 1607 (74%) | 941 (91%) | < .01 |
| Black | 970 (8%) | 24 (4%) | 506 (6%) | 400 (18%) | 40 (4%) | |
| Asian | 804 (7%) | 38 (7%) | 551 (6%) | 160 (7%) | 55 (5%) | |
| Surgery | ||||||
| Yes | 11,859 (96%) | 563 (100%) | 8302 (97%) | 2029 (93%) | 965 (93%) | < .01 |
| No | 469 (4%) | 0 (0%) | 253 (3%) | 144 (7%) | 72 (7%) | |
| Stage | ||||||
| I | 1313 (12%) | 101 (19%) | 558 (7%) | 654 (32%) | — | < .01 |
| II | 912 (8%) | 86 (16%) | 615 (7%) | 211 (10%) | — | |
| III | 5652 (52%) | 250 (46%) | 4720 (57%) | 682 (33%) | — | |
| IV | 3014 (28%) | 103 (19%) | 2382 (29%) | 529 (25%) | — | |
In the overall study group, 96% of patients (n = 11,859) underwent primary surgery, which comprised 563 with TC, 8302 with OC, 965 with PPC, and 2029 with USC. Of all patients, 12% had stage I, 8% had stage II, 52% had stage III, and 28% had stage IV disease. Based on stage at presentation ( Figure 1 ), those with TC and USC had more than a 2-fold higher proportion of early-stage cancers as compared with ovarian cancer ( P < .01). More specifically, 35% of TC and 42% of USC patients presented with stage I and II disease, compared with 14% of ovarian cancer patients. Those with OC presented with advanced cancers at 86%, whereas TC and USC patients had 65% and 58% advanced cancers, respectively. There was no staging diagnosis available for PPC cancers.
Survival outcomes based on patient characteristics
In the overall study group, the 5 year survival rate was 37%. Those with stages I, II, III, and IV disease had survival rates of 73%, 62%, 44%, and 22% ( P < .01) ( Table 2 ).
| Variable | TC | OC | USC | PPC a | P value |
|---|---|---|---|---|---|
| Overall | 50% | 37% | 40% | 26% | < .01 |
| Stage I | 73% | 83% | 88% | — | |
| Stage II | 62% | 64% | 72% | — | |
| Stage III | 44% | 34% | 55% | — | |
| Stage IV | 22% | 15% | 17% | — | |
| P value | < .01 | < .01 | < .01 | — |
Outcomes based on site of origin
Based on the tumor site of origin, the survivals of those with TC, OC, PPC, and USC were 50%, 37%, 40%, and 26%, respectively ( P < .01) ( Figure 2 , A–C). Adjusted for stage of disease, the 5 year disease-specific survival rates of stages I, II, III, and IV TC were 73%, 61%, 44%, and 22% ( P < .01), OC were 83%, 64%, 34%, and 15% ( P < .01), and USC were 88%, 72%, 55%, and 17% ( P < .01). Adjusted for stage of disease, the survival rates of those with stages I-II were 68%, 71%, and 64%, and those with stages III-IV were 39%, 32%, and 23%.
After adjusting using a multivariate model, older age (hazard risk [HR],1.03; 95% conofidence interval [CI], 1.03–1.03; P < .01), black race (HR, 1.36; 95% CI, 1.22–1.51; P < .01), advanced stage (HR, 3.88; 95% CI, 3.47–4.34; P < .01), and ovarian (HR, 1.45; 95% CI, 1.20–1.75; P < .01) or uterine serous cancer (HR, 1.82; 95% CI, 1.49–2.21; P < .01) were independent predictors for poorer survival ( Table 3 ).
| Factor | HR | 95% CI | P value |
|---|---|---|---|
| Age a | 1.03 | 1.03–1.03 | < .01 |
| Race b | |||
| Black | 1.36 | 1.22–1.51 | < .01 |
| Asian | 0.99 | 0.87–1.13 | .86 |
| Stage c | |||
| High stage | 3.88 | 3.47–4.34 | < .01 |
| Site of origin d | |||
| Ovary | 1.45 | 1.20–1.75 | < .01 |
| Uterus | 1.82 | 1.49–2.21 | < .01 |
a Age as a continuous variable
b White vs black; white vs Asian
c Stage I vs stage II, stage I vs stage III, and stage I vs stage IV
Results
Patient characteristics
Of 12,336 patients with high-grade, serous carcinoma, the median age was 64 years (range, 24–97 years) ( Table 1 ). Of these women, 563 had TC, 8560 had ovarian carcinoma (OC), 1037 had primary peritoneal carcinoma (PPC), and 2176 had uterine serous carcinoma (USC). Subjects with USC and PPC were older than patients with TC and OC (68 and 67 vs 63 and 62 years, P < .01), whereas a greater proportion of PPC and TC patients reported being white than OC and USC patients (91% and 89% vs 88 and 74%, P < .01).
| Factor | Total (n = 12,336) | TC (n = 563) | OC (n = 8560) | USC (n = 2176) | PPC (n = 1037) | P value |
|---|---|---|---|---|---|---|
| Median age, y (range) | 64 (24–97) | 63 (32–91) | 62 (24–97) | 68 (27–96) | 67 (30–91) | < .01 |
| Race | ||||||
| White | 10,511 (86%) | 497 (89%) | 7466 (88%) | 1607 (74%) | 941 (91%) | < .01 |
| Black | 970 (8%) | 24 (4%) | 506 (6%) | 400 (18%) | 40 (4%) | |
| Asian | 804 (7%) | 38 (7%) | 551 (6%) | 160 (7%) | 55 (5%) | |
| Surgery | ||||||
| Yes | 11,859 (96%) | 563 (100%) | 8302 (97%) | 2029 (93%) | 965 (93%) | < .01 |
| No | 469 (4%) | 0 (0%) | 253 (3%) | 144 (7%) | 72 (7%) | |
| Stage | ||||||
| I | 1313 (12%) | 101 (19%) | 558 (7%) | 654 (32%) | — | < .01 |
| II | 912 (8%) | 86 (16%) | 615 (7%) | 211 (10%) | — | |
| III | 5652 (52%) | 250 (46%) | 4720 (57%) | 682 (33%) | — | |
| IV | 3014 (28%) | 103 (19%) | 2382 (29%) | 529 (25%) | — | |
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