ArticleGland surgery2026
Dose-response relationship between ascites volume and survival in high-grade serous ovarian cancer: a prospective cohort study.
Article in Gland surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Whether ascites volume independently predicts survival in ovarian cancer remains unresolved due to conflicting evidence, binary classification approaches, and the absence of dose-response analysis. This prospective study aimed to characterize the dose-response relationship between ascites volume and survival outcomes and identify clinically meaningful volume thresholds. Methods: We analyzed data from 293 high-grade serous ovarian cancer patients from Xiangya Hospital, Central South University [2017-2020]. Patients were stratified by intraoperative ascites volume: no ascites (0 mL), low-volume (<1,000 mL), and high-volume (≥1,000 mL). The primary outcomes were progression-free survival (PFS) and overall survival (OS). Restricted cubic spline (RCS) analysis examined dose-response relationships between ascites volume and survival outcomes. Cox proportional hazards models estimated survival associations. Results: Among 293 patients, 15.4% had no ascites, 56.0% had low-volume, and 28.7% had high-volume ascites. RCS analysis revealed significant nonlinearity for PFS, with hazard ratio (HR) increasing steeply from 0 to 1,000 mL then plateauing (P for nonlinear =0.004), while OS demonstrated a predominantly linear relationship (P for nonlinear =0.83). Multivariable Cox analysis indicated that high-volume ascites independently predicted worse outcomes (adjusted HR 1.29 for PFS, 95% confidence interval (CI): 1.02-1.64, P<0.05; adjusted HR 1.54 for OS, 95% CI: 1.07-2.23, P<0.05), whereas low-volume ascites showed no independent prognostic significance. Adjusted 3-year PFS rates were 44.2%, 40.8%, and 36.5% for the three groups, respectively, while adjusted 3-year OS rates were 83.6%, 81.9%, and 76.5%. Conclusions: Ascites volume represents a quantifiable, independent prognostic factor in ovarian cancer with distinct dose-response patterns: a nonlinear relationship with PFS characterized by a critical 1,000 mL threshold, and a continuous linear relationship with OS.
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