Objective To investigate the independent prognostic factors for ovarian cancer patients with lung metastases based on the Surveillance, Epidemiology and End Results Database (SEER) of the United States and to establish a survival prediction model.
Methods Clinical data of 1 804 ovarian cancer patients diagnosed with lung metastases from 2010 to 2015 were collected, and they were divided into modeling set (1 203 cases) and validation set (601 cases) in a 2:1 ratio. Independent prognostic factors of ovarian cancer patients with lung metastasis were evaluated by Cox regression analysis and Nomogram prediction model was established. C index, receiver operating characteristic (ROC) curve and correction curve were used to evaluate the accuracy of the model.
Results Multivariate Cox regression analysis showed that age>80 years old (HR=1.42; 95%CI, 1.15 to 1.76), moderately or poorly differentiated or undifferentiated tumor (HR=3.96, 4.24, 3.03; 95%CI, 1.21 to 12.98, 1.34 to 13.43, 0.95 to 9.70), Nx stage of N stage (HR=1.25; 95%CI, 1.06 to 1.47), ten positive lymph nodes or more (HR=1.44, 95%CI, 1.01 to 2.10), bone metastasis (HR=1.42; 95%CI, 1.10 to 1.83), liver metastasis (HR=1.28; 95%CI, 1.12 to 1.47), elevated CA125 (HR=1.89; 95%CI, 1.18 to 3.05) were independent risk factors for overall survival (P < 0.05). The epithelial type II of histological type (HR=0.70; 95%CI, 0.52 to 0.92), surgical R0 resection or other surgical methods (HR=0.40, 0.54, 95%CI, 0.31 to 0.51, 0.45 to 0.66), chemotherapy (HR=0.31, 95%CI, 0.26 to 0.36) and married status (HR=0.86, 95%CI, 0.75 to 0.99) were independent protective factors for overall survival (P < 0.05). Age>80 years old, no surgery, no chemotherapy, liver metastasis, bone metastasis, and elevated cancer antigen-125 (CA125) were independent risk factors for cancer-specific survival (P < 0.05). Nomogram prediction models were established for the overall survival rate and cancer-specific survival rate, and the C index of internal and external verification were 0.767, 0.761 and 0.750, 0.742, and the areas under the curve were 0.775, 0.783 and 0.749, 0.764, respectively.
Conclusion Identifying the independent prognostic factors of patients with ovarian cancer with lung metastasis and establishing a quantitative Nomogram prediction model will help clinicians evaluate the prognosis more accurately.
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