Early death and early relapse in advanced ovarian cancer: distinct clinical phenotypes in the International SUROVA cohort
International Journal of Gynecological Cancer, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Basım Tarihi: 2026
- Doi Numarası: 10.1016/j.ijgc.2026.104897
- Dergi Adı: International Journal of Gynecological Cancer
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, MEDLINE, Health Research Premium Collection (ProQuest)
- Anahtar Kelimeler: Early Death, Early Relapse, Ovarian Cancer, Risk Stratification, Surgical Morbidity
- İstanbul Üniversitesi-Cerrahpaşa Adresli: Hayır
Özet
Objective: Early adverse outcomes after treatment for advanced ovarian cancer are often grouped as early relapse or death, although these events may reflect distinct mechanisms. We aimed to characterize early failure phenotypes and develop pragmatic clinical tools to stratify the risk of early death and early relapse. Methods: This international multi-center real-world study included 3286 patients with advanced ovarian cancer treated within the SUROVA network. Early death was defined as death within 12 months and early relapse as recurrence within 12 months. Baseline, surgical, and post-operative variables were analyzed. Two clinical scores were developed: the Early Lethality Risk Score and the Early Relapse Risk Score. Discrimination was assessed using areas under the curve and compared descriptively with corresponding multi-variable logistic regression models. Results: Within 12 months, 193 patients (5.9%) died; among patients alive at 12 months, 441 (15.8%) experienced early relapse and 2357 (84.2%) had no early adverse event. Early death and documented early relapse showed partial overlap: 45.6% of early deaths occurred without documented progression. Early death was associated with older age, impaired performance status, advanced stage, incomplete cytoreduction, and major post-operative complications. Early relapse among patients who survived 12 months was mainly associated with tumor burden and residual disease. The Early Lethality Risk Score showed acceptable discrimination (area under the curve 0.709, 95% confidence interval 0.666 to 0.752), with modest discrimination for the Early Relapse Risk Score (area under the curve 0.636, 95% confidence interval 0.609 to 0.662). Conclusions: Early failure in advanced ovarian cancer comprises clinically distinguishable early outcome patterns, with early death more strongly associated with vulnerability and post-operative morbidity, and early relapse among patients who survived 12 months more closely associated with disease burden and residual disease.