Factors that influence survival in high-grade serous ovarian cancer: A complex relationship between molecular subtype, disease dissemination, and operability

Diogo Torres, Chen Wang, Amanika Kumar, Jamie N. Bakkum-Gamez, Amy L. Weaver, Michaela E. McGree, Gottfried E. Konecny, Ellen L. Goode, William A. Cliby

Research output: Contribution to journalArticle

8 Scopus citations


Objective: To investigate the relationship between molecular subtype, intraperitoneal (IP) disease dissemination patterns, resectability, and overall survival (OS) in advanced high-grade serous ovarian cancer (HGSOC). Methods: Patients undergoing primary surgery for stage III-IV HGSOC at Mayo Clinic from 1994 to 2011 were categorized into three IP disease dissemination patterns: upper abdominal or miliary; lower abdominal; and pelvic. Residual disease was defined as 0 (RD0), 0.1–0.5, 0.6–1.0, or >1 cm. Molecular subtypes were derived from Agilent 4x44k tumor mRNA expression profiles and categorized as mesenchymal (MES) or non-mesenchymal (non-MES). Results: Operative and molecular data was available for 334 patients. Median OS was shorter in patients with MES compared to non-MES subtypes (34.2 vs 44.6 months; P = 0.009). Patients with MES subtype were more likely to have upper abdominal/miliary disease compared to non-MES subtype (90% vs. 72%, P < 0.001). For patients with upper abdominal/miliary disease, complete resection (RD0) was less common in MES compared to non-MES subtypes (11% vs. 27%, P = 0.004). On multivariable analysis, RD was the only factor associated with OS (P < 0.001). In patients with upper abdominal/miliary disease, though less commonly achieved, RD0 improved survival irrespective of molecular subtype (median OS of 69.2 and 57.9 months for MES and non-MES subtype). Conclusions: Our results support a paradigm in which molecular subtype is an important driver of dissemination pattern; this in turn impacts resectability and ultimately survival. Consequently mesenchymal subtype is associated with much lower rates of complete resection, though RD0 remains the most important independent predictor of survival.

Original languageEnglish (US)
Pages (from-to)227-232
Number of pages6
JournalGynecologic oncology
Issue number2
StatePublished - Aug 2018



  • Epithelial ovarian cancer
  • High-grade serous ovarian cancer
  • Mesenchymal
  • Molecular subtype
  • Residual disease
  • TCGA subtype

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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