Abstract
Objectives:
We assessed a conditional probability of survival (CPS) model to determine the probability of living 10 years after ovarian cancer diagnosis after having already survived 5 years.
Methods:
We identified patients newly diagnosed with high-grade epithelial ovarian cancer from 1/1/2001–12/31/2009 and treated at our institution. Patients with <3 years follow-up were excluded. CPS was defined as the probability of surviving additional years (y) based on the condition a patient had already survived a given time (x): S(x + y)/S(x). Confidence intervals were estimated using a variation of Greenwood’s formula.
Results:
Of 916 patients meeting inclusion criteria, 473 (52%) were diagnosed from 2001–2005 and 443 (48%) from 2006–2009. Median age at diagnosis was 60 years (range, 25–95). The conventional 10-year OS rate for all patients was 29% (95% CI: 26%–32%)—75% (95% CI: 68%–82%) for stage I/II disease, 22% (95% CI: 19%–26%) for stage III, and 6.9% (95% CI: 3.9%–12%) for stage IV. For patients <65 years, the 10-year CPS for 5-year survivors was 65% (95% CI: 59%–70%); for those ≥65 years, it was 48% (95% CI: 38%–57%). For patients <65 years, the 10-year CPS for 5-year survivors by stage was: stage I/II, 89% (95% CI: 81%–94%); stage III, 58% (95% CI: 50%–66%); and stage IV, 26% (95% CI: 12%–42%). For patients ≥65 years, rates by stage were 78% (95% CI: 53%–91%), 42% (95% CI: 30%–53%), and 29% (95% CI: 7%–56%), respectively.
Conclusions:
For long-term survivors with high-grade epithelial ovarian cancer, CPS provides better prediction of survival than conventional methods.
Keywords: ovarian cancer, survival outcomes, conditional probability of survival
Introduction
Ovarian cancer is the leading cause of gynecologic cancer mortality and fifth most common cause of overall cancer mortality among women in the United States [1]. In 2022, an estimated 20,000 women will be diagnosed with ovarian cancer and more than 12,000 women will die from this disease [1]. Surgical cytoreduction is a principal component in the management of ovarian (including fallopian tube and primary peritoneal) carcinomas. Evidence has shown that achieving a complete gross resection (CGR) is associated with the greatest improvement in survival outcomes [2, 3]. As a result of significant improvements in systemic therapies as well as dedicated changes to surgical practice that have led to improved cytoreductive outcomes, women with ovarian cancer are now living longer [4–10]. When a CGR is achieved, the median overall survival (OS) can reach 79 months, which is longer than the conventional 5-year OS [11]. With the increasing number of ovarian cancer survivors, clinicians require more up-to-date and accurate survival data for this patient population.
Although traditional OS rates may be useful for general comparisons at the time of diagnosis, they are not as useful into survivorship. In addition, survival probability estimates cannot be determined from a standard Kaplan-Meier curve after a patient has survived a specified number of years [12]. Conditional probability of survival (CPS) refers to the survival of patients who have already survived for a certain period of time after diagnosis [13]. CPS can provide patients with an improved estimate of their life expectancy at different time points. CPS has been used for breast, lung, and brain cancers; however, 10-year CPS estimates for gynecologic malignancies have not been reported [12–14]. Across literature, CPS has been utilized to provide an additional perspective into the effect of non-proportional hazards, treatment effects, and patient characteristics [15]. In this study, we report the estimated 10-year CPS of patients with epithelial ovarian cancer for each subsequent year survived.
Methods
Patients and Methods
This study was approved by our Institutional Review Board. We retrospectively reviewed data from a prospectively collected database of all patients diagnosed with high-grade epithelial ovarian, fallopian tube, or primary peritoneal carcinoma from 1/1/2001 to 12/31/2009 who underwent treatment at our institution. Patient stage was based on the 2014 International Federation of Gynecology and Obstetrics (FIGO) ovarian, fallopian tube, and peritoneal cancer staging classification system given the time period of retrospective review for the study [16]. OS was defined as the time from the date of pathologic diagnosis to the date of death or last follow-up. Patients were excluded if they had less than 3 years of follow-up. Age at cancer diagnosis has been identified as one of the most important predictors of long-term survival; therefore, 65 years of age was used as a cut-off for stratification, as established by previous models in the oncology literature [17].
Statistical Analysis
OS probabilities were calculated using the Kaplan-Meier method. Cumulative survival was used to determine CPS estimates using the multiplicative law of probability [13]. CPS was defined as the probability of surviving additional years (y) based on having already survived a given time (x): S(x + y)/S(x). To estimate the 10-year CPS of patients who have survived 5 years, the 10-year cumulative survival [S(x+y)] is divided by the 5-year cumulative survival [S(x)] [13]. The results were stratified by age, as age is an important predictor of survival for ovarian cancer. Confidence intervals (CIs) were estimated around the CPS rates using a variation of Greenwood’s formula for unconditional survival as described in previous lung cancer conditional probability studies (Supplemental Figure S1) [13]. CIs are developed assuming the CPS rates follow a normal distribution. Statistical analyses were performed using R Version 4.1.3 (R Foundation for Statistical Computing, Vienna, Austria).
Results
Patient Characteristics
Of 1394 patients identified, 916 met the study inclusion criteria (Supplemental Figure S2); 478 were excluded from the analysis due to loss of follow-up within 3 years of diagnosis. Patient characteristics, including stage and histology, are detailed in Table 1. The median age at diagnosis was 60 years (range, 25–95); 337 (37%) were <65 years of age and 579 (63%) were ≥65 years of age. Among all patients, 190 (21%) underwent staging with no gross evidence of metastatic disease at the time of surgery, 584 (64%) underwent a primary debulking surgery (PDS), and 142 (15%) underwent an interval debulking surgery (IDS) after neoadjuvant chemotherapy. Of 726 patients who underwent PDS or IDS, 577 (79%) underwent an optimal cytoreduction (≤1 cm of residual disease [RD]), 261 (36%) achieved a CGR of all visual disease, and 149 (21%) underwent a suboptimal cytoreduction (>1 cm RD).
Table 1:
Patient characteristics stratified by age
| Age, years |
|||
|---|---|---|---|
| ≥65, N = 337 | <65, N = 579 | p | |
|
| |||
| Year of Diagnosis | 0.048 | ||
| 2001 | 65 (11%) | 21 (6.2%) | |
| 2002 | 42 (7.3%) | 36 (11%) | |
| 2003 | 60 (10%) | 41 (12%) | |
| 2004 | 72 (12%) | 35 (10%) | |
| 2005 | 56 (9.7%) | 45 (13%) | |
| 2006 | 71 (12%) | 39 (12%) | |
| 2007 | 58 (10%) | 42 (12%) | |
| 2008 | 75 (13%) | 35 (10%) | |
| 2009 | 80 (14%) | 43 (13%) | |
| FIGO Stage | <0.001 | ||
| Stage I/II | 120 (21%) | 33 (10%) | |
| Stage III | 328 (58%) | 249 (74%) | |
| Stage IV | 116 (21%) | 55 (16%) | |
| Unknown | 15 | 0 | |
| Diagnosis | 0.001 | ||
| Fallopian tube cancer | 49 (8.5%) | 39 (12%) | |
| Ovarian cancer | 483 (83%) | 246 (73%) | |
| Peritoneum cancer NOS | 47 (8.1%) | 52 (15%) | |
| Histology | <0.001 | ||
| Adenocarcinoma | 19 (3.3%) | 17 (5.0%) | |
| Carcinoma, NOS | 17 (2.9%) | 12 (3.6%) | |
| Clear cell adenocarcinoma | 39 (6.7%) | 3 (0.9%) | |
| Endometrioid adenocarcinoma | 30 (5.2%) | 8 (2.4%) | |
| Mixed carcinoma | 30 (5.2%) | 8 (2.4%) | |
| Mucinous adenocarcinoma | 6 (1.0%) | 4 (1.2%) | |
| Serous adenocarcinoma | 438 (76%) | 285 (85%) | |
| HGS | <0.001 | ||
| HGS | 457 (79%) | 302 (90%) | |
| Other HG | 122 (21%) | 35 (10%) | |
| Died | 377 (65%) | 289 (86%) | <0.001 |
| PDS | 354 (61%) | 230 (68%) | 0.033 |
| IDS | 78 (14%) | 64 (19%) | 0.038 |
| BRCA | 0.01 | ||
| BRCA1+ | 39 (7.0%) | 9 (2.7%) | |
| BRCA2+ | 17 (3.1%) | 6 (1.8%) | |
| Negative | 127 (23%) | 67 (20%) | |
| Not Tested | 372 (67%) | 252 (75%) | |
| Unknown | 24 | 3 | |
| Residual Disease Status | <0.001 | ||
| Complete gross resection | 175 (24%) | 86 (12%) | |
| Optimal resection | 360 (50%) | 217 (30%) | |
| Suboptimal resection | 72 (10%) | 77 (11%) | |
FIGO, 2014 International Federation of Gynecology and Obstetrics; NOS, not otherwise specified; HGS, high-grade serous; HG, high-grade; PDS, primary debulking surgery; IDS, interval debulking surgery
Median OS
Median follow-up for survivors was 129 months. Median survival was 57 months (95% CI: 51–62 months) for all patients, 51 months (95% CI: 47–57 months) for patients with stage III disease, and 35 months (95% CI: 29–40 months) for those with stage IV disease. Median survival was 66 months (95% CI: 57–81 months) for patients who achieved a CGR, 46 months (95% CI: 40–52 months) for those who underwent an optimal cytoreduction, and 30 months (95% CI: 22–37 months) for those who underwent a suboptimal cytoreduction.
For patients <65 years of age, median survival was 69 months (95% CI: 63–81 months). Among patients <65 years of age, median survival was 65 months (95% CI: 57–74 months) for patients with stage III disease and 37 months (95% CI: 34–46 months) for those with stage IV disease. Stage I/II median survival is missing since survival probability did not go below 50%. Among patients <65 years of age, median survival was 72 months (95% CI: 58–88 months) for patients who achieved a CGR, 57 months (95% CI: 49–66 months) for those who underwent an optimal cytoreduction, and 36 months (95% CI: 30–43 months) for those who underwent a suboptimal cytoreduction.
For patients ≥65 years of age, median survival was 40 months (95% CI: 36–46 months). Among patients ≥65 years of age, median survival was 127 months (95% CI: 104 months – cannot calculate) for patients with stage I/II disease, 39 months (95% CI: 34–46 months) for those with stage III disease, and 28 months (95% CI: 22–35 months) for those with stage IV disease. Among patients ≥65 years of age, median survival was 56 months (95% CI: 46–78 months) for patients who achieved a CGR, 34 months (95% CI: 29–40 months) for those who underwent an optimal cytoreduction, and 23 months (95% CI: 18–32 months) for those who underwent a suboptimal cytoreduction (Figure 1, Supplementary Figure S3).
Figure 1:
Kaplan-Meier survival curves stratified by age.
Five-Year Conventional OS
The conventional 5-year OS rate was 47% (95% CI: 44%–51%) for all patients, 86% (95% CI: 80%–91%) for those with stage I/II disease, 42% (95% CI: 38%–47%) for those with stage III disease, and 26% (95% CI: 20%–33%) for those with stage IV disease. The 5-year OS rate was 53% (95% CI: 47%–59%) for all patients who achieved a CGR, 36% (95% CI: 31%–42%) for those who underwent an optimal cytoreduction, and 18% (95% CI: 13%–25%) for those who underwent a suboptimal cytoreduction (Supplementary Table S1).
For patients <65 years of age, the 5-year OS rate was 55% (95% CI: 51%–60%). Among patients <65 years of age, the 5-year OS rate was 88% (95% CI: 82%–94%) for patients with stage I/II disease, 52% (95% CI: 47%–58%) for those with stage III disease, and 28% (95% CI: 21%–37%) for those with stage IV disease. Among patients <65 years of age, the 5-year OS rate was 55% (95% CI: 49%–63%) for patients who achieved a CGR, 46% (95% CI: 40–54%) for those who underwent an optimal cytoreduction, and 19% (95% CI: 12%–31%) for those who underwent a suboptimal cytoreduction (Supplementary Table S1; Supplementary Figures S4 and S5).
For patients ≥65 years of age, the 5-year OS rate was 33% (95% CI: 29%–39%). Among patients ≥65 years of age, the 5-year OS rate was 79% (95% CI: 66%–94%) for those with stage I/II disease, 30% (95% CI: 25%–36%) for those with stage III disease, and 22% (95% CI: 13%–36%) for those with stage IV disease. Among patients ≥65 years of age, the 5-year OS rate was 47% (95% CI: 37%–58%) for patients who achieved a CGR, 22% (95% CI: 16%–31%) for those who underwent an optimal cytoreduction, and 17% (95% CI: 10%–28%) for those who underwent a suboptimal cytoreduction (Supplementary Table S1; Supplementary Figures S6 and S7).
Ten-Year Conventional OS
The conventional 10-year OS rate was 29% (95% CI: 26%–32%) for all patients, 75% (95% CI: 68%–82%) for those with stage I/II disease, 22% (95% CI: 19%–26%) for those with stage III disease, and 6.9% (95% CI: 3.9%–12%) for those with stage IV disease. The 10-year OS rate was 31% (95% CI: 26%–37%) for patients who achieved a CGR, 15% (95% CI: 11%–19%) for those who underwent an optimal cytoreduction, and 7.1% (95% CI: 4.0%–13%) for those who underwent a suboptimal cytoreduction (Supplementary Table S1).
For patients <65 years of age, the 10-year OS rate was 36% (95% CI: 32%–40%). Among patients <65 years of age, the 10-year OS rate was 78% (95% CI: 71%–86%) for patients with stage I/II disease, 30% (95% CI: 26%–36%) for those with stage III disease, and 7.1% (95% CI: 3.6%–14%) for those with stage IV disease. Among patients <65 years of age, the 10-year OS rate was 35% (95% CI: 29%–43%) for those who achieved a CGR, 20% (95% CI: 15%–27%) for those who underwent an optimal cytoreduction, and 9.3% (95% CI: 4.4%–19%) for those who underwent a suboptimal cytoreduction (Supplementary Table S1).
For patients ≥65 years of age, the 10-year OS rate was 16% (95% CI: 12%–20%). Among patients ≥65 years of age, the 10-year OS rate was 61% (95% CI: 46%–82%) for those with stage I/II disease, 12% (95% CI: 8.8%–17%) for those with stage III disease, and 6.4% (95% CI: 2.2%–18%) for those with stage IV disease. Among patients ≥65 years of age, the 10-year OS rate was 22% (95% CI: 15%–33%) for those who achieved a CGR, 7.2% (95% CI: 3.8%–13%) for those who underwent an optimal cytoreduction, and 5.2% (95% CI: 2.0%–13%) for those who underwent a suboptimal cytoreduction (Supplementary Table S1).
Ten-Year CPS
For patients <65 years of age, the 10-year CPS for 5-year survivors was 65% (95% CI: 59%–70%) (Figure 2). Among patients <65 years of age, the 10-year CPS for 5-year survivors was 89% (95% CI: 81%–94%) for patients with stage I/II disease, 58% (95% CI: 50%–66%) for those with stage III disease, and 26% (95% CI: 12%–42%) for those with stage IV disease. For patients <65 years of age, the 10-year CPS for 5-year survivors stratified by RD status among all patients with stage III and IV disease was as follows: CGR, 63% (95% CI: 53%–72%); optimal cytoreduction, 43% (95% CI: 32%–54%); and suboptimal cytoreduction, 48% (95% CI: 20%–71%) (Table 2; Supplementary Figures S8–S13).
Figure 2:
10-year conditional probability of survival (CPS) for all patients <65 years of age.
Table 2:
Ten-year conditional probability of survival (CPS) for all patients <65 years of age
| Years | Overall | Stage I/II | Stage III | Stage IV | CGR | Optimal Resection | Suboptimal Resection |
|---|---|---|---|---|---|---|---|
| 1 | 38% (42% – 48%) | 80% (71% – 86%) | 31% (26% – 37%) | 8% (4% – 15%) | 36% (29% – 44%) | 21% (15% – 28%) | 11% (4% – 20%) |
| 2 | 43% (39% – 48%) | 81% (72% – 87%) | 36% (30% – 42%) | 11% (5% – 19%) | 41% (33% – 49%) | 25% (18% – 32%) | 14% (6% – 26%) |
| 3 | 48% (43% – 53%) | 81% (73% – 87%) | 41% (34% – 47%) | 13% (6% – 23%) | 46% (38% – 55%) | 29% (21% – 37%) | 19% (8% – 33%) |
| 4 | 57% (51% – 62%) | 87% (79% – 93%) | 48% (41% – 55%) | 20% (9% -33%) | 54% (44% – 62%) | 35% (26% – 44%) | 32% (13% – 52%) |
| 5 | 65% (59% – 70%) | 89% (81% – 94%) | 58% (50% – 66%) | 26% (12% – 42%) | 63% (53% – 72%) | 43% (32% – 54%) | 48% (20% – 71%) |
| 6 | 74% (68% – 79%) | 96% (89% – 98%) | 67% (59% – 74%) | 36% (17% – 56%) | 71% (60% – 80%) | 54% (41% – 65%) | 56% (24% – 79%) |
| 7 | 84% (78% – 88%) | 99% (84% – 100%) | 78% (69% – 84%) | 49% (23% – 71%) | 81% (69% – 88%) | 67% (52% – 78%) | 67% (28% – 88%) |
| 8 | 89% (84% – 93%) | - | 85% (76% – 90%) | 61% (29% – 81%) | 88% (77% – 94%) | 74% (58% – 84%) | 86% (13% – 99%) |
| 9 | 95% (90% – 97%) | - | 92% (85% – 96%) | 79% (31% – 95%) | 96% (86% – 99%) | 85% (68% – 93%) | 86% (33% – 98%) |
CGR, complete gross resection
Optimal and suboptimal resection only among patients with stage III or IV disease
For patients ≥65 years of age, the 10-year CPS for 5-year survivors was 48% (95% CI: 38%–57%) (Figure 3). Among patients ≥65 years of age, the 10-year CPS for 5-year survivors was 78% (95% CI: 53%–91%) for patients with stage I/II disease, 42% (95% CI: 30%–53%) for those with stage III disease, and 29% (95% CI: 7%–56%) for those with stage IV disease. For patients ≥65 years of age, the 10-year CPS for 5-year survivors stratified by RD status among all patients with stage III and IV disease was as follows: CGR, 48% (95% CI: 31%–62%); optimal cytoreduction, 32% (95% CI: 16%–50%); and suboptimal cytoreduction, 31% (95% CI: 9%–55%) (Table 3; Supplementary Figures S14–S19).
Figure 3:
10-year conditional probability of survival (CPS) for all patients ≥65 years of age.
Table 3:
Ten-year conditional probability of survival (CPS) for all patients ≥65 years of age
| - | - | - | - | - | |||
| 1 | 18% (14% – 23%) | 61% (42% – 76%) | 14% (10% – 19%) | 9% (2% – 20%) | 24% (15% – 33%) | 8% (4% – 15%) | 7% (2% – 15%) |
| 2 | 23% (17% – 28%) | 63% (43% – 78%) | 18% (12% – 24%) | 11% (3% – 26%) | 26% (17% – 37%) | 11% (5% – 19%) | 11% (3% – 23%) |
| 3 | 30% (23% – 37%) | 68% (46% – 82%) | 23% (16% – 31%) | 19% (5% – 41%) | 33% (21% – 45%) | 16% (8% – 27%) | 15% (5% – 31%) |
| 4 | 37% (29% – 46%) | 72% (50% – 86%) | 30% (21% – 39%) | 27% (7% – 53%) | 40% (26% – 54%) | 20% (10% – 33%) | 25% (8% – 47%) |
| 5 | 48% (38% – 57%) | 78% (53% – 91%) | 42% (30% – 53%) | 29% (7% – 56%) | 48% (31% – 62%) | 32% (16% – 50%) | 31% (9% – 55%) |
| 6 | 56% (45% – 66%) | 85% (59% – 95%) | 49% (36% – 61%) | 39% (9% – 69%) | 53% (35% – 68%) | 41% (20% – 61%) | 44% (14% – 72%) |
| 7 | 68% (55% – 78%) | 89% (61% – 97%) | 63% (47% – 75%) | 50% (11% – 80%) | 65% (44% – 79%) | 56% (28% – 76%) | 67% (14% – 92%) |
| 8 | 78% (64% – 87%) | 89% (61% – 97%) | 76% (58% – 87%) | 60% (13% – 88%) | 75% (51% – 88%) | 81% (42% – 95%) | 67% (19% – 90%) |
| 9 | 90% (77% – 96%) | - | 87% (69% – 95%) | 75% (13% – 96%) | 85% (60% – 95%) | 89% (43% – 98%) | 80% (20% – 97%) |
CGR, complete gross resection
Optimal and suboptimal resection only among patients with stage III or IV disease
Discussion
In our study of 916 patients diagnosed with epithelial ovarian cancer between 2001 and 2009, and treated at our institution, we demonstrate a strong dependence of survival probability on time elapsed since diagnosis. For patients <65 years of age with stage III or IV disease, the probability of surviving a total of 10 years after having already survived 5 years was estimated at 58% and 26%, respectively, and increased with each year of survival. For patients ≥65 years of age with stage III or IV disease, the probability of surviving a total of 10 years after having already survived 5 years was estimated at 42% and 29%, respectively, and increased with each year of survival. For patients who achieved a CGR, the probability of surviving a total of 10 years after having already survived 5 years was estimated at between 48% and 63%, depending on age. For patients ≥65 years of age, CGR demonstrated a highly increased probability of 10-year CPS compared to optimal or suboptimal cytoreduction. However, for any RD present (either optimal or suboptimal cytoreduction), there were minimal differences in 10-year CPS estimates at the time of diagnosis, as well as for subsequent years. This was not represented on the Kaplan-Meier survival curve. This also suggests that additional factors beyond residual disease at the time of primary surgery are likely of impact the longer the patient survives.
Advanced ovarian cancer is associated with a poor prognosis, with a 5-year OS rate of less than 50% [18]. However, CPS estimates have shown that the probability of long-term ovarian cancer survival increases with each additional year survived. The conventional Kaplan-Meier method, which is calculated with respect to the time of initial diagnosis, may not be helpful for patients who have survived for an extended period of time and wish to know their estimated life expectancy [12]. These 10-year CPS estimates demonstrate differences in long-term survival probability, which is not exhibited with conventional OS methods. CPS provides new insight into the effect of non-proportional hazards, early and late treatment effects, and baseline patient characteristics [15]. This can be meaningfully used in scenarios in which an aggressive surgical treatment may be associated with high early mortality but may lead to increased survival or even cure after the treatment period, such as in ovarian cancer in which comprehensive surgical management is a key component for most treatment paradigms. Additionally, physicians can utilize this tool—stratified by patient age and stage at diagnosis—while counseling patients on prognosis throughout different timepoints of the disease course. As compared to the conventional Kaplan-Meier analysis with a fixed event rate, CPS can provide a different estimate of future survival annually for patients with ovarian cancer.
A limitation of our study is that it was a single-institution study in which all patients were treated at a large comprehensive cancer center in a metropolitan setting, and therefore, our results may not be generalizable across institutions. Future CPS studies in gynecologic malignancies should consider a multi-center or database approach. In addition, patients were selected based on initial diagnosis from 2001–2009 and followed until 2019. Between 2001 and 2019, there have been various changes in the standard management of both primary and recurrent disease; these include intraperitoneal chemotherapy, testing for BRCA and homologous recombination deficiency (HRD) status, and use of bevacizumab, poly (ADP-ribose) polymerase (PARP) inhibitors, and immunotherapies. While this is a homogenous population treated at a single institution over time, differences in year of diagnosis and treatment could have affected survival outcomes. It should be noted, in the current era of rapid development of innovative therapies, CPS for the understanding long-term survival when applied to older cohorts may underestimate survival in the current timeframe. The objective of this study was not to compare survival throughout different time periods with different treatment modalities but rather provide important information for prognosis and survival estimates. The authors did not stratify patients based on year of diagnosis, as this would have significantly limited the population size. We recommend future studies with multiple larger populations to investigate the effect of year of treatment on survival estimates.
To the authors’ knowledge, this is the first study demonstrating 10-year CPS estimates among patients with ovarian cancer. Ten-year CPS estimates offer more relevant information regarding subsequent survival for survivors of ovarian cancer and can be instrumental for patient education, shared decision making, and clinical trial planning. CPS should be used in the clinical setting to demonstrate more accurate prognoses for our patients, especially since OS continues to improve among women with ovarian cancer.
Supplementary Material
Highlights.
Traditional 5-year overall survival rates do not account for changes in survival probability over time.
For survivors with ovarian cancer, survival probability strongly depends upon the amount of time elapsed since diagnosis.
Ten-year conditional probability of survival (CPS) gives a more accurate prediction of survival than conventional methods.
CPS can be utilized to benefit patient counseling and prospective trial planning.
Funding:
Anjile An, MPH, is partially supported by the following grant: Clinical and Translational Science Center at Weill Cornell Medical College (UL1 TR002384). Drs. Zivanovic, Gardner, O’Cearbhaill, Tew, Grisham, Sonoda, Long Roche, Abu-Rustum, and Chi are supported in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.
Footnotes
Conflict of Interest Statement
R.E.O. reports personal fees from Tesaro/GSK, personal fees from Regeneron, personal fees from Seattle Genetics, other from AstraZeneca Pharmaceuticals, personal fees from Fresenius Kabi, personal fees from Gynecologic Oncology Foundation, personal fees from Bayer, personal fees from Curio, advisor for Carina Biotech outside the submitted work; and non-compensated steering committee member for the PRIMA, Moonstone (Tesaro/GSK), ARTISTRY7 (Arkemes) and DUO-O (AstraZeneca) studies. Her institute receives funding for clinical research from Bayer/Celgene/Juno, Tesaro/GSK, Ludwig Cancer Institute, Abbvie/StemCentrx, Merck, Regeneron, TCR2 Therapeutics, Atara Biotherapeutics, MarkerTherapeutics, Syndax Pharmaceuticals, Genmab/Seagen Therapeutics, Sellas Therapeutics, Genentech, Kite Pharma, Gynecologic Oncology Foundation. N.A.R. reports research funding paid to the institution by GRAIL. R.N.G. reports honoraria from GSK, AstraZeneca, Natera, Springworks, Corcept, MJH, and PER; D.S.C reports personal fees from Apyx Medical, Verthermia Inc., Biom ‘Up, and AstraZeneca, as well as recent or current stock/options ownership of Apyx Medical, Verthemia, Intuitive Surgical, Inc., TransEnterix, Inc., Doximity, Moderna, and BioNTech SE; The other authors do not have potential conflicts of interest to declare.
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