title: Patient-reported symptoms and survival in ovarian cancer.
abstract: OBJECTIVE
  While the development of an index of clinical symptoms to use for the detection and diagnosis of ovarian cancer is under active investigation, the role of clinical symptoms in survival after the initial diagnosis is poorly understood. The aim of this study was to correlate the type and extent of clinical symptoms with survival outcomes in ovarian cancer.
  
  
  METHODS
  Medical records of 276 cases of primary epithelial ovarian, fallopian tube, and peritoneal cancers were evaluated. Thirty-one symptoms in 5 categories were cataloged. The significance of clinical symptoms in progression-free survival (PFS) and overall survival (OS) was evaluated.
  
  
  RESULTS
  Overall, 93.5% of ovarian cancer patients expressed at least 1 symptom at the time of initial diagnosis. The 3 most common symptoms were abdominal pain (40.6%), increased abdominal size (33.7%), and bloating (21.7%). In survival analysis, weight loss (16.3%), nausea/vomiting (13.4%), and lower extremity edema (6.5%) were significantly associated with both decreased PFS and OS (all, P < 0.05). In multivariate analysis, lower extremity edema remained the strongest significant symptom, associated with increased surgical mortality rate, decreased response rate to adjuvant chemotherapy after primary cytoreductive surgery, and diminished survival outcomes (median PFS, 4.9 vs 15.3 months, P < 0.0001; and median OS, 5.9 vs 49.1 months, P < 0.001). Multiple symptoms were associated with poor survival outcomes (individual number of symptom ≤1 vs 2 vs ≥3; median PFS, 26.8 vs 17.4 vs 11.7 months [P < 0.001]; and median OS, 70 vs 41.6 vs 37.2 months [P < 0.001]).
  
  
  CONCLUSIONS
  Lower extremity edema at initial diagnosis is a strong prognostic indicator of ovarian cancer patient.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles County Medical Center, Los Angeles, CA, USA. koji.matsuo@gmail.com
authors.forename: Koji
authors.initials: K
authors.lastname: Matsuo
authors.forename: Edward H
authors.initials: EH
authors.lastname: Ahn
authors.forename: Christina P
authors.initials: CP
authors.lastname: Prather
authors.forename: Michele L
authors.initials: ML
authors.lastname: Eno
authors.forename: Dwight D
authors.initials: DD
authors.lastname: Im
authors.forename: Neil B
authors.initials: NB
authors.lastname: Rosenshein
mesh_terms: D000077216:Carcinoma, Ovarian Epithelial; D018572:Disease-Free Survival; D005185:Fallopian Tube Neoplasms / Q000175:diagnosis / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000175:diagnosis* / Q000473:pathology; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000175:diagnosis / Q000473:pathology; D015996:Survival Rate