Symptom-triggered testing improves the detection of early-stage and low-volume resectable advanced-stage high grade serous ovarian cancer

Objective: Symptom-triggered testing for ovarian cancer (OC) was introduced to the UK whereby symptomatic women undergo an ultrasound scan and serum CA125, and are referred to hospital within 2 weeks if these are abnormal. Compared to indolent subtypes of OC which typically present in their early stages, high grade serous OC is often detected at an advanced stage. The potential value of symptom-triggered testing in the detection of early stage disease or in the identification of a lower tumour burden remains unclear in women with high grade serous OC.

Methods: We analysed the dataset from Refining Ovarian Cancer Test accuracy Scores (ROCkeTS), a single-arm prospective diagnostic test accuracy study recruiting from 24 hospitals in the UK. The aim of ROCkeTS is to validate risk prediction models in symptomatic women. We undertook an opportunistic analysis for women recruited between June 2015 to July 2022 and who were diagnosed with high grade serous OC via the fast-track pathway. The latter was introduced to streamline referrals from primary care physicians and expedite investigations in patients with symptoms suspicious for OC. Histology details were available on all women who underwent surgery or biopsy within 3 months of recruitment. Women who did not undergo surgery or biopsy at three months were followed up for 12 months as per the national guidelines in the United Kingdom. In this descriptive study, we report on patient demographics, WHO performance status, FIGO stage at diagnosis, disease distribution and complete cytoreduction rates in women who underwent surgery.

Results: Of 1741 participants recruited via the fast-track pathway, 119 (6.8%) were diagnosed with high grade serous OC. The mean age was 65 years. Of these, 112 (94.1%) were of performance status 0 and 1, 30 (25.2%) were diagnosed at stages 1 and 2; and the disease distribution was low-to-moderate in 77 (64.7%). Complete and optimal cytoreduction were achieved in 73 (61.3%), and 18 (15.1%).

Conclusion: Our results demonstrate that one in four women identified with high grade serous OC through the fast-track pathway following symptom-triggered testing was diagnosed with early-stage disease. Symptom-triggered testing may help to identify women with a low disease burden, potentially contributing to high complete cytoreduction rates.