Surgery Plus Chemotherapy Shows Promise for Stage IV Epithelial Ovarian Cancer

Patients with stage IV epithelial ovarian cancer (OC) treated with surgery and chemotherapy exhibit the best prognosis.

Patients with stage IV epithelial ovarian cancer (OC) treated with surgery plus chemotherapy have the most promising prognosis, according to a study published in BMC Women’s Health.1

Among women, OC is the fourth leading cause of cancer-related deaths, with 19,680 new cases and 12,740 deaths recorded among US women so far in 2024.2 Of the histological types of OC, epithelial OC is the most common, accounting for 65% of cases.1

Current OC treatment methods include surgery, radiotherapy, chemotherapy, and novel targeted molecular therapies; surgery plus postoperative adjuvant chemotherapy is the main treatment option.3 Despite the variety of treatment options available, the researchers noted that there is still uncertainty on which treatment will most benefit the patient’s prognosis.1 Consequently, the researchers analyzed how different treatment options impact the prognosis of patients with stage IV epithelial OC.

"Prognosis" written on blackboard | Image Credit: Yury Zap -

Being Asian or Pacific Islander, married, and testing negative for cancer antigen 125 (CA125) were associated with favorable prognoses. | Image Credit: Yury Zap -

To do so, they analyzed patients with stage IV epithelial OC within the Surveillance, Epidemiology, and End Results (SEER) database from 2011 to 2020; the SEER database collects and stores data on US cancer incidence, survival, and treatment. Cases without data for surgery, marital status, survival time, radiotherapy, cause of death, or cancer antigen 125 (CA125) test results were excluded.

The study population consisted of 5345 patients. Overall, the researchers determined that patients in the surgical group had a longer survival time. Therefore, timely surgery can improve the prognosis of patients with stage IV epithelial OC. They also found surgery plus chemotherapy to be the most effective treatment method in improving the prognosis of patients with stage IV epithelial OC.

More specifically, by using surgery plus chemotherapy as the control group, the researchers determined that receiving surgery plus radiotherapy was a favorable prognostic factor (adjusted HR [aHR], 1.326; 95% CI, 0.910-1.932; P = 0.142). However, being treated with either chemotherapy (aHR, 2.786; 95% CI, 2.553-3.041; P < .001) or radiotherapy (aHR, 3.003; 95% CI, 1.944-4.638; P < .001) alone put patients at significant risk of poor prognosis.

Additionally, by using no metastases in all 4 organs as the control group, the researchers determined that patients with lung metastases (aHR, 1.151; 95% CI, 1.030-1.287; P = .013) or multiple metastases (aHR, 1.417; 95% CI, 1.250-1.606; P < .001) were at significant risk of poor prognosis. Also, patients aged 60 years or older (aHR, 1.214; 95% CI, 1.122-1.313; P < .001) were at significant risk for poor prognosis when the control group consisted of those aged 59 years or younger. Similarly, being unmarried (aHR, 1.154; 95% CI, 1.071-1.242; P < .001) was a significant risk factor for poor prognosis when the researchers considered married patients to be the control group.

As for race, they used Black patients as the control group and discovered favorable prognostic factors among Asian or Pacific Islander patients (aHR, 0.821; 95% CI, 689-0.977; P = .026). Similarly, patients who were CA125 negative (aHR, 0.611; 95% CI,0.464-0.804; P < .001) had favorable prognostic factors when the researchers considered those who were CA125 positive as the control group.

Study limitations were acknowledged, most being related to the SEER database. For example, its sample size and diversity may be constrained, limiting the generalizability of the study's findings. Also, errors or biases encountered in the data collection process may have compromised the credibility and accuracy of the findings. Consequently, the researchers noted that multicenter data validation is necessary to ensure the reliability of their results.

“By validating the findings across different regions, populations, and settings, we can ascertain the robustness of the study outcomes and gain a better understanding of their applicability and impact in real-world settings,” the authors wrote. “This enhances the credibility and reliability of the research, providing a more solid foundation for further applications and decision-making processes.”


  1. Zhang S, Zhang H, Jia N, Suo S, Guo J. Effect of different treatment modalities on the prognosis of stage IV epithelial ovarian cancer: analysis of the SEER database. BMC Womens Health. 2024;24(1):345. Published 2024 Jun 15. doi:10.1186/s12905-024-03199-5
  2. Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin. 2024;74(1):12-49. doi:10.3322/caac.21820
  3. Orr B, Edwards RP. Diagnosis and Treatment of Ovarian Cancer. Hematol Oncol Clin North Am. 2018;32(6):943-964. doi:10.1016/j.hoc.2018.07.010
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