Clinical calculator redefines prognosis for high-risk early-stage ovarian cancers and potential to guide treatment in the adjuvant setting

Published:August 31, 2022DOI:


      • Risk calculator redefines prognosis in early stage high risk epithelial ovarian cancer.
      • Cohort of patients identified by the calculator may not benefit from adjuvant treatment.
      • A simplified calculator of age, stage, histology, and grade is also predictive of treatment benefit.



      To determine the utility of a clinical calculator to redefine prognosis and need for chemotherapy among patients with early-stage high-risk epithelial ovarian cancer.


      Data were abstracted for stage I-II, high-risk ovarian cancer from the National Cancer Database from years 2005 to 2015. Based on demographic, pathologic, surgical, and laboratory characteristics, a clinical score was developed using Cox regression. Propensity score weighting was used to adjust for differences between patients who did and did not receive chemotherapy.


      Of 8188 patients with early-stage high-risk ovarian cancer, 6915 (84%) did and 1273 (16%) did not receive chemotherapy. A clinical calculator was created utilizing age, stage, histology, grade, tumor size, number of pelvic and paraaortic lymph nodes examined, the presence of malignant ascites, and CA125. The calculator divided patients into low, moderate, and high-risk groups with 5-year OS (overall survival) of 92%, 82%, and 66%, and 10-year OS of 85%, 67%, and 44%, respectively. Chemotherapy improved 5-year OS and 10-year OS in the high-risk group (56% to 73%; p < 0.001, 34% to 48%; p < 0.001). The moderate risk group had improved 5-year OS (80% to 85%; p = 0.01) but not 10-year OS (66% to 66%; p = 0.13). Chemotherapy did not improve 5-year or 10-year OS in low-risk patients (93% to 92%, p = 1.0, 86% to 84%, p = 0.99).


      The prognosis among high-risk early-stage ovarian cancer patients is heterogeneous. This calculator may aid in patient-centered counseling regarding potential treatment benefits.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Gynecologic Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Siegel R.L.
        • Miller K.D.
        • Jemal A.
        Cancer statistics, 2019.
        CA Cancer J. Clin. 2019; 69: 7-34
        • Torre L.A.
        • et al.
        Ovarian cancer statistics, 2018.
        CA Cancer J. Clin. 2018; 68: 284-296
        • Armstrong D.K.
        • et al.
        Ovarian cancer, version 2.2020, NCCN clinical practice guidelines in oncology.
        J. Natl. Compr. Cancer Netw. 2021; 19: 191-226
        • Chan J.K.
        • et al.
        Prognostic factors for high-risk early-stage epithelial ovarian cancer: a Gynecologic oncology group study.
        Cancer. 2008; 112: 2202-2210
        • Bilimoria K.Y.
        • et al.
        The National Cancer Data Base: a powerful initiative to improve cancer care in the United States.
        Ann. Surg. Oncol. 2008; 15: 683-690
        • Mysona D.P.
        • et al.
        Are there survival differences between women with equivalent residual disease after interval Cytoreductive surgery compared with primary Cytoreductive surgery for advanced ovarian and peritoneal cancer?.
        Ann. Surg. Oncol. 2021; 28: 3605-3615
        • Mysona D.P.
        • et al.
        Clinical calculator predictive of chemotherapy benefit in stage 1A uterine papillary serous cancers.
        Gynecol. Oncol. 2020; 156: 77-84
        • Richardson M.T.
        • et al.
        Long term survival outcomes of stage I mucinous ovarian cancer - a clinical calculator predictive of chemotherapy benefit.
        Gynecol. Oncol. 2020; 159: 118-128
        • Young R.C.
        • et al.
        Adjuvant therapy in stage I and stage II epithelial ovarian cancer: results of two prospective randomized trials.
        N. Engl. J. Med. 1990; 322: 1021-1027
        • Trimbos J.B.
        • et al.
        Impact of adjuvant chemotherapy and surgical staging in early-stage ovarian carcinoma: European Organisation for Research and Treatment of Cancer-adjuvant ChemoTherapy in ovarian neoplasm trial.
        J. Natl. Cancer Inst. 2003; 95: 113-125
        • Bell J.
        • et al.
        Randomized phase III trial of three versus six cycles of adjuvant carboplatin and paclitaxel in early stage epithelial ovarian carcinoma: a Gynecologic oncology group study.
        Gynecol. Oncol. 2006; 102: 432-439
        • Collaborators I.C.O.N.
        International collaborative ovarian neoplasm trial 1: a randomized trial of adjuvant chemotherapy in women with early-stage ovarian cancer.
        JNCI J. Natl. Cancer Inst. 2003; 95: 125-132
        • Chang W.
        • et al.
        Shiny: web application framework for R.
        R Package Vers. 2017; 1: 2017
        • I.C.O.N., E.O.f. Research, and T.o.C.C.A.C.I.O. Neoplasm
        International collaborative ovarian neoplasm trial 1 and adjuvant ChemoTherapy in ovarian neoplasm trial: two parallel randomized phase III trials of adjuvant chemotherapy in patients with early-stage ovarian carcinoma.
        J. Natl. Cancer Inst. 2003; 95: 105-112