Eastern Cooperative Oncology Group classification and its application in surgical treatment planning of epithelial...

Patients' physical performance status reflects the body's recovery reserve against physiological stressors like surgery. The aim of our study was to evaluate the association of clinical factors, primarily Eastern Cooperative Oncology Group (ECOG) classification, with patient performance status and their use in clinical decision-making for surgical treatment of epithelial ovarian cancer (EOC).

We retrospectively enrolled 228 patients with EOC who underwent debulking surgery (either primary or interval setting) in Kuopio University Hospital during the years 2019-2022. Physical fitness according to the ECOG scale and other clinical parameters were collected from the patients' hospital records. The association of ECOG with other variables was analyzed using Kruskal-Wallis test. Univariate survival analysis was conducted with Kaplan-Meier and multivariate survival analysis was carried out with Cox regression.

From 228 women who underwent debulking surgery, 129 (56.6%) patients belonged to ECOG 0, 76 (33%) patients were part of ECOG 1, and only 23 (10.1%) belonged to ECOG 2-4. Age, self-reported walking distance, stair climbing capacity, ASA classification, albumin, prealbumin, and number of comorbidities were statistically significantly associated with ECOG groups. Interestingly, ECOG was not associated with complications or length of hospital stay. Instead, lower ECOG predicted higher survival rates (ECOG 0 p = 0.003, ECOG 1 p = 0.005, HR = 3.785, ECOG 2-4 p = 0.002, HR = 10.231).

It is important to make precise patient selection for operative treatment in EOC. In our study, ECOG classification emerged as a useful tool in evaluating patients' physical status.