Impact of Sepsis on the Oncologic Outcomes of Advanced Epithelial Ovarian Cancer Patients: A Multicenter Observational Study

SIMPLE SUMMARY: There has been a growing interest in the interplay between the immune system and the prognosis of epithelial ovarian cancer (EOC). It has become clear that EOC has the ability to escape destruction by the immune system by creating a highly immunosuppressive microenvironment in the abdominal cavity. The first case of an advanced-stage EOC patient who experienced the complete disappearance of her cancer following sepsis without undergoing cancer treatment was reported in 2018. Sepsis has the ability to both activate and suppress the immune system, presenting potential beneficial as well as detrimental effects. It is still unclear what impact sepsis has on the prognosis of advanced-stage EOC. This study’s aim was to assess the impact of sepsis on the oncologic outcomes of advanced-stage EOC patients. Of 215 OC patients, a total of 18 advanced-stage EOC patients experienced sepsis. Their survival outcomes were compared with 3988 unmatched and 54 matched patients from the Netherlands Cancer Registry (NCR). The overall and progression-free survival was similar between the sepsis and (un)matched patients from the NCR. Our study suggests that sepsis and its subsequent immune response, overall, does not substantially influence the prognosis of EOC patients. ABSTRACT: Objective: The sepsis-induced inflammatory response may potentially affect malignant cells. Recently, a case of spontaneous regression of a histologically confirmed International Federation of Gynecology and Obstetrics (FIGO) stage IIIC epithelial ovarian cancer (EOC) following sepsis was reported. The aim of our study was to assess the impact of sepsis on the oncologic outcomes of advanced-stage EOC patients. Methods: Gynecologic oncologic patients admitted to the Intensive Care Unit of three oncologic centers between 2006 and 2019 were identified and patients who experienced sepsis following advanced-stage EOC diagnosis were selected. Survival outcomes were compared with advanced-stage EOC patients from the Netherlands Cancer Registry (NCR). To correct for case-mix differences, propensity score matching using 1:3 nearest neighbor matching was conducted after which survival analyses were repeated. Results: A total of 18 of 215 patients with advanced-stage EOC experienced sepsis. Sepsis patients had similar distributions of patient, tumor, and treatment characteristics to 3988 patients from the NCR cohort. A total of 3 of 18 patients died from the complications of sepsis. While the remaining patients initially responded to treatment, 14/15 patients relapsed. The median (IQR) overall survival was 31 (24–44) and 35 (20–60) months for the sepsis and unmatched NCR cohort (p = 0.56), respectively. The median (IQR) progression-free survival was 16 (11–21) and 16 (11–27) months (p = 0.90), respectively. Survival outcomes did not differ following propensity matching (overall survival of 31 (24–44) vs. 36 (20–56) months, p = 0.40; progression-free survival of 16 (11–21) and 16 (12–21) months, p = 0.72). Conclusion: In this observational study, the occurrence of sepsis did not affect the oncologic and survival outcomes of advanced-stage EOC patients.