Among patients with early-stage high-risk epithelial ovarian cancer, researchers sought to evaluate the use of a clinical calculator in redefining prognosis and the need for treatment. Information on cases of high-risk ovarian cancer at stages I and II were extracted from the National Cancer Database between 2005 and 2015. Cox regression was used to construct a clinical score based on demographic, pathologic, surgical, and laboratory variables. They applied propensity score weighting to level the playing field between patients who received and did not receive chemotherapy. 

Chemotherapy was given to 6,915 (84%) of 8188 patients with early-stage, high-risk ovarian cancer and was declined by 1,273 (16%). The variables of age, stage, histology, grade, tumor size, the number of pelvic and paraaortic lymph nodes checked, the presence of malignant ascites, and CA125 were used to develop a clinical calculator. The overall survival (OS) percentages at 5 years for low, moderate, and high-risk patients were 92%, 82%, and 66%, respectively; at 10 years, these percentages were 85%, 67%, and 44%. Both 5-year and 10-year overall survival was enhanced by chemotherapy in the high-risk group (56% to 73%; P < 0.001, 34% to 48%; P < 0.001). 

The 5-year overall survival for the moderate risk group increased from 80% to 85% (P=0.01), while 10-year survival increased from 66% to 66% (P=0.13). Both the 5-year and 10-year OS for low-risk patients were unaffected by chemotherapy (93% vs. 92%, P=1.0; 86% vs. 84%, P = 0.99). High-risk early-stage ovarian cancer patients have a varied set of outcomes. The results of this calculator could be useful in patient-centered discussions about expected outcomes.