Real-World Management of Mucinous Ovarian Cancer

Construction of a nomogram designed to predict overall survival in patients with mucinous ovarian cancer (MOC) had valuable significant guidance for the clinical diagnosis and management of patients with MOC for clinical evaluation, according to a recent study (International Journal of Women’s Health 2022; 14:931-943. doi:10.2147/IJWH.S372328).

Ke Zhang, MD, Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China, and colleagues constructed and verified a nomogram for the estimation of overall survival in patients with MOC.

In the study, researchers compiled data from 494 patients with MOC diagnosed from 2010 to 2015 in the SEER database to evaluate the independent prognostic factors for patients with MOC and to construct a nomogram, which can provide a basis for clinical decision-making of patients with MOC.

The following primary inclusion criteria were utilized: (1) patients whose MOC was confirmed by pathology; (2) patients without a history of primary other cancer. Subsequently, researchers performed randomized grouping (6:4) and Cox hazard regression analysis in the training group. Subsequently, the nomogram was created and a variety of indicators were employed to confirm the prognosis value of the nomogram, including the C-index, area under the receiver operating characteristic curve, calibration curve, and decision curve analysis (DCA). Moreover, Kaplan–Meier analysis was utilized to compare the survival results among different risk subgroups.

The Cox hazard regression analysis showed that age, grade, FIGO stage and log odds of positive lymph nodes stage were independent risk factors for patients with MOC.

In the training group, the C-index of the nomogram was 0.827 (95% CI: 0.791–0.863) and the areas under the curve (AUC) predicting the 1-, 3- and 5-year survival rate were 0.853 (95% CI: 0.791–0.915), 0.886 (95% CI: 0.852–0.920) and 0.815 (95% CI: 0.766–0.864), respectively.

The calibration curve showed that the nomogram of the 1-, 3- and 5-year survival rate was consistent with the actual fact. Patients with high risk had a poorer prognosis than those with low risk (P < 0.001). DCA showed that the nomogram had the best clinical value than other classical prognostic markers. Likewise, the nomogram had excellent prognostic ability in the testing group.

They also discussed some of the limitations of the study including a small sample study due to the rarity of MOC, study was a retrospective study from SEER database, and some clinical information about patients was unaccounted for, which led to some inevitable bias in the results. For chemotherapy information, only whether the patient had received chemotherapy was available, but the specific chemotherapy regimens were not clear. Lastly, some clinical information could not be obtained from the SEER database, such as family history, BRCA1/2 mutation status and targeted therapy.

The authors concluded, “The nomogram was constructed to predict overall survival in patients with MOC, which had the significance for clinical evaluation,” adding, “further research is needed to determine the effectiveness of chemotherapy in patients with MOC."