Long-Term Survival in High-Grade Serous Ovarian Cancer Compared With the General US Population: A 30-Year Landmark Analysis.
De Vitis Luigi A, Larson Melissa C, Atkinson Hunter J, Block Matthew S, Cliby William A, Couch Fergus J, Dowdy Sean C, Glaser Gretchen E, Goergen Krista M, Goode Ellen L, Gostout Bobbie S, Hartmann Lynn C, Heinzen Ethan P, Huang Yajue, Jatoi Aminah, Jones Monica, Karow Katie J, Keeney Gary L, Kumar Amanika, Langstraat Carrie L, Lee Sun-Hee, Mariani Andrea, Ostby Stuart A, Peethambaram Prema P, Podratz Karl C, Shahi Maryam, Sherman Mark E, Sommerfield Marla Kay, Swisher Elizabeth M, Wall Vonda M, Weroha S John, Wahner Hendrickson Andrea E, Maurer Matthew J, Kaufmann Scott H, Bakkum-Gamez Jamie N, Oberg Ann L
JCO oncology advances · 2026 · PMID 41918500
PURPOSE: To compare mortality risk among long-term survivors of high-grade serous ovarian cancer (HGSOC) with that of the general U.S. population and to examine how mortality and recurrence trends have evolved under changing treatment approaches. MATERIAL AND
METHODS: This is a retrospective cohort study including patients with histologically confirmed HGSOC treated at a single referral cancer center from 1991 to 2022. Mortality risk, expressed as standardized mortality ratios (SMRs, ratio of observed deaths in the study population to expected deaths in an age-matched U.S. population) was assessed at diagnosis and yearly on patients without events (disease persistence, recurrence, or death from any cause).
RESULTS: A total of 2,074 consecutive patients were included. Median follow-up was 12.5 years [interquartile range (IQR) 11.7-13.8]. Most patients were stage III (1396, 69.2%), 1299 (62.8%) underwent primary cytoreductive surgery, and 1688 (87.4%) received platinum-taxane as first-line therapy. At diagnosis, the mortality rate was 7.40 times higher than in the general population [95% confidence interval (CI) 7.04-7.77]. By 7 event-free years, the 95% confidence interval for the SMR included 1 for the first time, and at 10 years, the SMR was 1.05 [95% CI 0.72-1.49]), indicating no statistically significant excess mortality compared to the general population. In those event-free at 10 years, the 5-year cumulative incidence of ovarian cancer-related deaths (8.2% [95% CI 4.2-16.0]) was comparable to that of non-ovarian cancer-related deaths (6.3% [95% CI 2.9-13.8]).
CONCLUSIONS: In this cohort, mortality risk steadily declined for patients who remained event-free, approaching that of the general population by 7 years post-diagnosis. These results emphasize the importance of individualized, long-term follow-up to address both recurrence risk and survivorship needs.