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Kim BR, Ko H, Son D, Shim JE, Kim YH. Effect of quality control program on surgical management in advanced ovarian cancer. J Gynecol Oncol 2024; 36:36.e21. [PMID: 39028153 DOI: 10.3802/jgo.2025.36.e21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 06/04/2024] [Accepted: 06/25/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVE We investigated the effect of our quality control (QC) program on the management strategy, completeness of the surgery, and clinical outcomes in advanced ovarian cancer. METHODS A retrospective review of medical records from January 2005 to December 2019 identified 129 patients with advanced ovarian cancer. Cases were categorized into group 1 (2005-2013) and group 2 (2014-2019) before and after implementation of the QC program. Comparisons included clinicopathological variables, operative details, recurrence and survival outcomes. RESULTS In Group 2 (n=44), after QC program implementation, primary debulking surgery (PDS) decreased (87.1% vs. 63.6%) and interval debulking surgery (IDS) increased (12.9% vs. 36.4%), indicating a shift in surgical strategy. Optimal resection rates improved significantly for PDS in group 2 (50.0% to 75.0%, p=0.007) and remained high for IDS in both groups (81.8% vs. 81.3%, p>0.999). Post-QC, advanced debulking procedures and co-operation with other departments increased in the IDS (p<0.05). Intra/post-operative complication rates were statistically comparable (p>0.05), whereas postoperative hospital stay was significantly shorter in group 2 (17 days vs. 22 days, p=0.001). Median recurrence-free survival increased after QC, although not statistically significant (19.18 months vs. 25.38 months, p=0.855). CONCLUSION With QC program, treatment strategies and clinical outcomes were significantly improved in advanced ovarian cancer. Systematic QC monitoring program should be considered as routine surveillance for better surgical outcomes.
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Affiliation(s)
- Bo Ra Kim
- Department of Obstetrics and Gynecology, Ewha Womans University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Hyejin Ko
- Department of Obstetrics and Gynecology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Dahye Son
- Department of Obstetrics and Gynecology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Ji Eun Shim
- Department of Obstetrics and Gynecology, Jeonbuk National University Hospital, Jeonju, Korea
| | - Yun Hwan Kim
- Department of Obstetrics and Gynecology, Ewha Womans University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Ewha Womans University Mokdong Hospital, Seoul, Korea.
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Prost P, Duraes M, Georgescu V, Rebel L, Mercier G, Rathat G. Impact of Ovarian Cancer Surgery Volume on Overall and Progression-Free Survival: A Population-Based Retrospective National French Study. Ann Surg Oncol 2024; 31:3269-3279. [PMID: 38393461 DOI: 10.1245/s10434-024-15050-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Data are limited on the relationship between ovarian cancer surgery volume and outcomes in France. METHODS For this retrospective, population-based study, patients with ovarian cancer that was diagnosed between January 1, 2012 and December 31, 2016 were identified from the French National Health Data System (SNDS). Hospitals were classified in function of their ovarian cancer surgery volume. Patient, tumor, hospital, and hospital stay characteristics also were evaluated. The hospital procedure volume effect on 5-year overall survival (OS) and recurrence-free survival (RFS) was determined with Cox-proportional hazards models. RESULTS This study included 8429 patients and 53.4% underwent cytoreductive surgery in hospitals with procedure volume < 20 cases/year. The 5-year OS rates were 63% and 60% in hospitals with procedure volume ≥ 20 and < 20 cases/year (p = 0.02). In multivariate analysis, OS and RFS were significantly increased when surgery was performed in hospitals doing ≥ 20 surgeries/year (vs. < 20) (hazard ratio HR = 1.18, 95% CI = 1.08-1.29 and HR = 1.10, 95% CI = 1.03-1.17). In the volume subgroup analysis, a difference was observed mainly between hospitals with < 10 surgeries/year and the other hospitals (HR = 1.27, 95% CI = 1.14-1.41 and HR = 1.14, 95% CI = 1.05-1.23). The patients' age and comorbidities, tumor stage, and hospital stay (duration, first cytoreduction surgery) were associated with OS. CONCLUSIONS Ovarian cancer surgery volume ≥ 20 cases/year was significantly associated with improved OS and RFS but only with a limited clinical benefit. The biggest differences in OS and RFS were observed between hospitals with procedure volume < 10 cases/year and all the other hospitals.
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Affiliation(s)
- Pauline Prost
- Department of Gynecological and Breast Surgery, Montpellier University Hospital, Montpellier, France.
| | - Martha Duraes
- Department of Gynecological and Breast Surgery, Montpellier University Hospital, Montpellier, France
| | - Vera Georgescu
- Health Data Science Unit, Montpellier University Hospital and UMR IDESP, INSERM, Montpellier University, Montpellier, France
| | - Lucie Rebel
- Department of Gynecological and Breast Surgery, Montpellier University Hospital, Montpellier, France
| | - Grégoire Mercier
- Health Data Science Unit, Montpellier University Hospital and UMR IDESP, INSERM, Montpellier University, Montpellier, France
| | - Gauthier Rathat
- Department of Gynecological and Breast Surgery, Montpellier University Hospital, Montpellier, France
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3
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Braun C, Grünig H, Peikert J, Strobel K, Christmann-Schmid C, Brambs C. Do PET-positive supradiaphragmatic lymph nodes predict overall survival or the success of primary surgery in patients with advanced ovarian cancer? Eur J Obstet Gynecol Reprod Biol 2024; 296:13-19. [PMID: 38394714 DOI: 10.1016/j.ejogrb.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES Compared to conventional computed tomography (CT), fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) detects higher rates of lymph node and distant metastases in patients with ovarian cancer. However, FDG-PET/CT is not routinely performed during preoperative work-up. Therefore, we investigated the prognostic value of preoperative FDG-PET/CT in advanced epithelial ovarian cancer (EOC) and its predictive value for surgical resection in patients with no residual disease. The potential significance of PET-positive supradiaphragmatic lymph nodes (SDLNs) for these parameters was evaluated. METHODS All patients with FIGO IIA-IVB EOC diagnosed between March 2014 and January 2021 at our certified gynaecological cancer centre, who underwent FDG PET/CT before primary surgery were retrospectively included. RESULTS Fifty-three consecutive patients were included in the study. Eighteen (34 %) patients had PET-positive SDLNs. We could not demonstrate a significant correlation between PET-positive SDLNs and median overall survival (OS; SDLN-positive: 58.76 months, SDLN-negative: 60.76 months; p = 0.137) or intra- or perioperative outcomes. CONCLUSIONS FDG PET/CT has a higher detection rate for SDLNs in patients with ovarian cancer than CT has, as described in the literature. Moreover, PET-positive SDLNs failed to predict intraoperative outcomes or overall survival.
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Affiliation(s)
- Christian Braun
- Department of Gynecology and Gynecologic Oncology, Luzerner Kantonsspital, Lucerne, Switzerland.
| | - Hannes Grünig
- Department of Nuclear Medicine, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Julia Peikert
- Department of Gynecology and Gynecologic Oncology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Klaus Strobel
- Department of Nuclear Medicine, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Christine Brambs
- Department of Gynecology and Gynecologic Oncology, Luzerner Kantonsspital, Lucerne, Switzerland
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4
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Ramachandran D, Tyrer JP, Kommoss S, DeFazio A, Riggan MJ, Webb PM, Fasching PA, Lambrechts D, García MJ, Rodríguez-Antona C, Goodman MT, Modugno F, Moysich KB, Karlan BY, Lester J, Kjaer SK, Jensen A, Høgdall E, Goode EL, Cliby WA, Kumar A, Wang C, Cunningham JM, Winham SJ, Monteiro AN, Schildkraut JM, Cramer DW, Terry KL, Titus L, Bjorge L, Thomsen LCV, Pejovic T, Høgdall CK, McNeish IA, May T, Huntsman DG, Pfisterer J, Canzler U, Park-Simon TW, Schröder W, Belau A, Hanker L, Harter P, Sehouli J, Kimmig R, de Gregorio N, Schmalfeldt B, Baumann K, Hilpert F, Burges A, Winterhoff B, Schürmann P, Speith LM, Hillemanns P, Berchuck A, Johnatty SE, Ramus SJ, Chenevix-Trench G, Pharoah PDP, Dörk T, Heitz F. Genome-wide association analyses of ovarian cancer patients undergoing primary debulking surgery identify candidate genes for residual disease. NPJ Genom Med 2024; 9:19. [PMID: 38443389 PMCID: PMC10915171 DOI: 10.1038/s41525-024-00395-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/15/2024] [Indexed: 03/07/2024] Open
Abstract
Survival from ovarian cancer depends on the resection status after primary surgery. We performed genome-wide association analyses for resection status of 7705 ovarian cancer patients, including 4954 with high-grade serous carcinoma (HGSOC), to identify variants associated with residual disease. The most significant association with resection status was observed for rs72845444, upstream of MGMT, in HGSOC (p = 3.9 × 10-8). In gene-based analyses, PPP2R5C was the most strongly associated gene in HGSOC after stage adjustment. In an independent set of 378 ovarian tumours from the AGO-OVAR 11 study, variants near MGMT and PPP2R5C correlated with methylation and transcript levels, and PPP2R5C mRNA levels predicted progression-free survival in patients with residual disease. MGMT encodes a DNA repair enzyme, and PPP2R5C encodes the B56γ subunit of the PP2A tumour suppressor. Our results link heritable variation at these two loci with resection status in HGSOC.
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Grants
- R21 CA267050 NCI NIH HHS
- K05 CA154337 NCI NIH HHS
- R01 CA058598 NCI NIH HHS
- UL1 TR000124 NCATS NIH HHS
- P50 CA105009 NCI NIH HHS
- K07 CA080668 NCI NIH HHS
- P30 CA076292 NCI NIH HHS
- R01 CA076016 NCI NIH HHS
- R01 CA248288 NCI NIH HHS
- U19 CA148112 NCI NIH HHS
- R01 CA149429 NCI NIH HHS
- Wellcome Trust
- UL1 TR001881 NCATS NIH HHS
- P50 CA136393 NCI NIH HHS
- M01 RR000056 NCRR NIH HHS
- R01 CA095023 NCI NIH HHS
- R01 CA054419 NCI NIH HHS
- P30 CA015083 NCI NIH HHS
- Deutsche Forschungsgemeinschaft (German Research Foundation)
- The Ovarian Cancer Association Consortium is funded by generous contributions from its research investigators and through anonymous donations. OCAC was funded by a grant from the Ovarian Cancer Research Fund (OCRF). The OCAC OncoArray genotyping project was funded through grants from the U.S. National Institutes of Health (CA1X01HG007491-01 (C.I.A.), U19-CA148112 (T.A.S.), R01-CA149429 (C.M.P.) and R01-CA058598 (M.T.G.); Canadian Institutes of Health Research (MOP-86727 (L.E.K.) and the Ovarian Cancer Research Fund (A.B.). The COGS project was funded through a European Commission’s Seventh Framework Programme grant (agreement number 223175 - HEALTH-F2-2009-223175) and in part by the US National Cancer Institute GAME-ON Post-GWAS Initiative (U19-CA148112). This study made use of data generated by the Wellcome Trust Case Control consortium that was funded by the Wellcome Trust under award 076113. The results published are in part based upon data generated by The Cancer Genome Atlas Pilot Project established by the National Cancer Institute and National Human Genome Research Institute (dbGap accession number phs000178.v8.p7). Funding for individual studies: AUS: The Australian Ovarian Cancer Study (AOCS) was supported by the U.S. Army Medical Research and Materiel Command (DAMD17-01-1-0729), National Health & Medical Research Council of Australia (199600, 400413 and 400281), Cancer Councils of New South Wales, Victoria, Queensland, South Australia and Tasmania and Cancer Foundation of Western Australia (Multi-State Applications 191, 211 and 182). AOCS gratefully acknowledges additional support from Ovarian Cancer Australia and the Peter MacCallum Foundation; BAV: ELAN Funds of the University of Erlangen-Nuremberg; BEL: National Kankerplan; CNI: Instituto de Salud Carlos III (PI 19/01730); Ministerio de Economía y Competitividad (SAF2012); HAW: U.S. National Institutes of Health (R01-CA58598, N01-CN-55424 and N01-PC-67001); HOP: University of Pittsburgh School of Medicine Dean’s Faculty Advancement Award (F. Modugno), Department of Defense (DAMD17-02-1-0669, OC20085) and United States National Cancer Institute (R21-CA267050, K07-CA080668, R01-CA95023, MO1-RR000056); LAX: American Cancer Society Early Detection Professorship (SIOP-06-258-01-COUN) and the National Center for Advancing Translational Sciences (NCATS), Grant UL1TR000124; MAC: National Institutes of Health (R01-CA2482288, P30-CA15083, P50-CA136393); Mayo Foundation; Minnesota Ovarian Cancer Alliance; Fred C. and Katherine B. Andersen Foundation; Fraternal Order of Eagles; MAL: Funding for this study was provided by research grant R01- CA61107 from the National Cancer Institute, Bethesda, MD, research grant 94 222 52 from the Danish Cancer Society, Copenhagen, Denmark, the Mermaid I project; and the Mermaid III project; MAY: National Institutes of Health (R01-CA2482288, P30-CA15083, P50-CA136393); Mayo Foundation; Minnesota Ovarian Cancer Alliance; Fred C. and Katherine B. Andersen Foundation; MOF: Moffitt Cancer Center, Merck Pharmaceuticals, the state of Florida, Hillsborough County, and the city of Tampa; NCO: National Institutes of Health (R01-CA76016) and the Department of Defense (DAMD17-02-1-0666); NEC: National Institutes of Health R01-CA54419 and P50-CA105009 and Department of Defense W81XWH-10-1-02802; NOR: Helse Vest, The Norwegian Cancer Society, The Research Council of Norway; OPL: National Health and Medical Research Council (NHMRC) of Australia (APP1025142, APP1120431) and Brisbane Women’s Club; ORE: Sherie Hildreth Ovarian Cancer (SHOC) Foundation; PVD: Canadian Cancer Society and Cancer Research Society GRePEC Program; SRO: Cancer Research UK (C536/A13086, C536/A6689) and Imperial Experimental Cancer Research Centre (C1312/A15589); UHN: Princess Margaret Cancer Centre Foundation-Bridge for the Cure; VAN: BC Cancer Foundation, VGH & UBC Hospital Foundation; VTL: NIH K05-CA154337; WMH: National Health and Medical Research Council of Australia, Enabling Grants ID 310670 & ID 628903. Cancer Institute NSW Grants 12/RIG/1-17 & 15/RIG/1-16. The AGO-OVAR 11 study was funded by Roche Pharma AG.
- National Health and Medical Research Council (NHMRC) of Australia (APP1025142, APP1120431) and Brisbane Women’s Club
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Affiliation(s)
| | - Jonathan P Tyrer
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Stefan Kommoss
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Anna DeFazio
- Centre for Cancer Research, The Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
- Discipline of Obstetrics and Gynaecology, The University of Sydney, Sydney, NSW, Australia
- Department of Gynaecological Oncology, Westmead Hospital, Sydney, NSW, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Marjorie J Riggan
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC, USA
| | - Penelope M Webb
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital Erlangen, Erlangen, Germany
| | - Diether Lambrechts
- Laboratory for Translational Genetics, Department of Human Genetics, KU Leuven, Leuven, Belgium
- VIB Center for Cancer Biology, VIB, Leuven, Belgium
| | - María J García
- Biochemistry and Molecular Biology area, Department of Basic Health Sciences, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Cristina Rodríguez-Antona
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Center (CNIO), Madrid, Spain
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Marc T Goodman
- Cancer Prevention and Control Program, Cedars-Sinai Cancer, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Francesmary Modugno
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Women's Cancer Research Center, Magee-Womens Research Institute and Hillman Cancer Center, Pittsburgh, PA, USA
| | - Kirsten B Moysich
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Beth Y Karlan
- David Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Jenny Lester
- David Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Susanne K Kjaer
- Department of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen, Denmark
- Department of Gynaecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Allan Jensen
- Department of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen, Denmark
| | - Estrid Høgdall
- Department of Pathology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ellen L Goode
- Department of Quantitative Health Sciences, Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - William A Cliby
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, USA
| | - Amanika Kumar
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, USA
| | - Chen Wang
- Department of Quantitative Health Sciences, Division of Computational Biology, Mayo Clinic, Rochester, MN, USA
| | - Julie M Cunningham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Stacey J Winham
- Department of Quantitative Health Sciences, Division of Computational Biology, Mayo Clinic, Rochester, MN, USA
| | - Alvaro N Monteiro
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Joellen M Schildkraut
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Daniel W Cramer
- Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics and Gyneclogy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kathryn L Terry
- Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics and Gyneclogy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Linda Titus
- Norris Cotton Cancer Center, Lebanon, NH, USA
| | - Line Bjorge
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Liv Cecilie Vestrheim Thomsen
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Tanja Pejovic
- Department of ObGyn, Providence Medical Center, Medford, OR, USA
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Claus K Høgdall
- Department of Gynaecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Iain A McNeish
- Division of Cancer and Ovarian Cancer Action Research Centre, Department Surgery & Cancer, Imperial College London, London, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Taymaa May
- Division of Gynecologic Oncology, University Health Network, Princess Margaret Hospital, Toronto, ON, Canada
| | - David G Huntsman
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, BC, Canada
| | | | - Ulrich Canzler
- University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany
| | | | - Willibald Schröder
- Klinikum Bremen-Mitte, Bremen, Germany
- Gynaekologicum Bremen, Bremen, Germany
| | - Antje Belau
- University Hospital Greifswald, Greifswald, Germany
- Frauenarztpraxis Belau, Greifswald, Germany
| | - Lars Hanker
- University Hospital Frankfurt, Frankfurt, Germany
- University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Evangelische Kliniken Essen-Mitte (KEM), Essen, Germany
| | - Jalid Sehouli
- Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Rainer Kimmig
- University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Nikolaus de Gregorio
- University Hospital Ulm, Ulm, Germany
- SLK-Kliniken Heilbronn, Klinikum am Gesundbrunnen, Heilbronn, Germany
| | | | - Klaus Baumann
- University Hospital Gießen and Marburg, Site Marburg, Marburg, Germany
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Felix Hilpert
- University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Krankenhaus Jerusalem, Mammazentrum Hamburg, Hamburg, Germany
| | | | - Boris Winterhoff
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Peter Schürmann
- Gynaecology Research Unit, Hannover Medical School, Hannover, Germany
| | - Lisa-Marie Speith
- Gynaecology Research Unit, Hannover Medical School, Hannover, Germany
| | - Peter Hillemanns
- Gynaecology Research Unit, Hannover Medical School, Hannover, Germany
| | - Andrew Berchuck
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC, USA
| | - Sharon E Johnatty
- Cancer Division, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Susan J Ramus
- School of Clinical Medicine, UNSW Medicine and Health, University of NSW Sydney, Sydney, NSW, Australia
- Adult Cancer Program, Lowy Cancer Research Centre, University of NSW Sydney, Sydney, NSW, Australia
| | | | - Paul D P Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, West Hollywood, CA, USA
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Thilo Dörk
- Gynaecology Research Unit, Hannover Medical School, Hannover, Germany.
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Evangelische Kliniken Essen-Mitte (KEM), Essen, Germany.
- Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.
- Department of Gynecology and Gynecological Oncology, HSK, Dr. Horst-Schmidt Klinik, Wiesbaden, Wiesbaden, Germany.
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5
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Allanson E, Hari A, Ndaboine E, Cohen PA, Bristow R. Medicolegal, infrastructural, and financial aspects in gynecologic cancer surgery and their implications in decision making processes: Quo Vadis? Int J Gynecol Cancer 2024; 34:451-458. [PMID: 38438180 DOI: 10.1136/ijgc-2023-004585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
Surgical decision making is complex and involves a combination of analytic, intuitive, and cognitive processes. Medicolegal, infrastructural, and financial factors may influence these processes depending on the context and setting, but to what extent can they influence surgical decision making in gynecologic oncology? This scoping review evaluates existing literature related to medicolegal, infrastructural, and financial aspects of gynecologic cancer surgery and their implications in surgical decision making. Our objective was to summarize the findings and limitations of published research, identify gaps in the literature, and make recommendations for future research to inform policy.
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Affiliation(s)
- Emma Allanson
- Division of Obstetrics and Gynaecology, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Anjali Hari
- Division of Gynecologic Oncology, University of California Irvine, Orange, California, USA
| | - Edgard Ndaboine
- Department of Obstetrics & Gynecology, Catholic University of Health and Allied Sciences, Mwanza, Mwanza, Tanzania
| | - Paul A Cohen
- Division of Obstetrics and Gynaecology, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Robert Bristow
- Division of Gynecologic Oncology, University of California Irvine, Orange, California, USA
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6
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Meurette J, Daraï E, Tajahmady A, Fouard A, Ducastel A, Collin-Bund V, Jochum F, Lecointre L, Querleu D, Akladios C. [Arguments for centralization of surgical treatment of ovarian cancer in France based on morbidity and mortality data]. Bull Cancer 2024; 111:239-247. [PMID: 36797128 DOI: 10.1016/j.bulcan.2022.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 02/16/2023]
Abstract
OBJECTIVE To examine the current state for ovarian cancer surgery in France from 2009 to 2016 and to examine the impact of the volume of activity on morbidity and mortality by institution. MATERIAL AND METHOD National retrospective study analyzing surgical sessions for ovarian cancer from the program of medicalization of information systems (PMSI), from January 2009 to December 2016. Institutions were divided according to the number of annual curative procedures into 3 groups: A<10; B: 10-19; C≥20. A propensity score (PS) and the Kaplan-Meier method were employed for statistical analyses. RESULTS In total, 27,105 patients were included. The 1-month mortality rate in group A, B and C was 1.6; 1 and 0.7 %, respectively (P<0.001). Compared to group C, the Relative Risk (RR) of death within the first month was 2.22 for group A and 1.32 for group B (P<0.01). After MS, the 3- and 5-year survival in group A+B and group C were 71.4 and 60.3% (P<0.05) and 56.6, and 60.3% (P<0.05), respectively. The 1-year recurrence rate was significantly lower in group C (P<0.0001). CONCLUSION An annual volume of activity>20 advanced stage ovarian cancers is associated with a decrease in morbidity, mortality, recurrence rate and improved survival.
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Affiliation(s)
- Jacques Meurette
- Caisse nationale d'assurance maladie, 50, avenue du Pr André-Lemierre, 93170 Paris, France
| | - Emile Daraï
- Hôpital Tenon, service de gynécologie-obstétrique, Paris, France
| | - Ayden Tajahmady
- Caisse nationale d'assurance maladie, 50, avenue du Pr André-Lemierre, 93170 Paris, France
| | - Annie Fouard
- Caisse nationale d'assurance maladie, 50, avenue du Pr André-Lemierre, 93170 Paris, France
| | - Anne Ducastel
- Caisse nationale d'assurance maladie, 50, avenue du Pr André-Lemierre, 93170 Paris, France
| | - Virginie Collin-Bund
- Hôpitaux universitaires de Strasbourg, service de gynécologie-obstétrique, Strasbourg, France
| | - Floriane Jochum
- Hôpitaux universitaires de Strasbourg, service de gynécologie-obstétrique, Strasbourg, France
| | - Lise Lecointre
- Hôpitaux universitaires de Strasbourg, service de gynécologie-obstétrique, Strasbourg, France
| | - Denis Querleu
- Hôpitaux universitaires de Strasbourg, service de gynécologie-obstétrique, Strasbourg, France
| | - Chérif Akladios
- Hôpitaux universitaires de Strasbourg, service de gynécologie-obstétrique, Strasbourg, France.
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7
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Sohel M, Zahra Shova FT, shuvo S, Mahjabin T, Mojnu Mia M, Halder D, Islam H, Roman Mogal M, Biswas P, Saha HR, Sarkar BC, Mamun AA. Unveiling the potential anti-cancer activity of calycosin against multivarious cancers with molecular insights: A promising frontier in cancer research. Cancer Med 2024; 13:e6924. [PMID: 38230908 PMCID: PMC10905684 DOI: 10.1002/cam4.6924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/11/2023] [Accepted: 12/30/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Calycosin may be a potential candidate regarding chemotherapeutic agent, because already some studies against multivarious cancer have been made with this natural compound. AIM This review elucidated a brief overview of previous studies on calycosin potential effects on various cancers and its potential mechanism of action. METHODOLOGY Data retrieved by systematic searches of Google Scholar, PubMed, Science Direct, Web of Science, and Scopus by using keywords including calycosin, cancer types, anti-cancer mechanism, synergistic, and pharmacokinetic and commonly used tools are BioRender, ChemDraw Professional 16.0, and ADMETlab 2.0. RESULTS Based on our review, calycosin is available in nature and effective against around 15 different types of cancer. Generally, the anti-cancer mechanism of this compound is mediated through a variety of processes, including regulation of apoptotic pathways, cell cycle, angiogenesis and metastasis, oncogenes, enzymatic pathways, and signal transduction process. These study conducted in various study models, including in silico, in vitro, preclinical and clinical models. The molecular framework behind the anti-cancer effect is targeting some oncogenic and therapeutic proteins and multiple signaling cascades. Therapies based on nano-formulated calycosin may make excellent nanocarriers for the delivery of this compound to targeted tissue as well as particular organ. This natural compound becomes very effective when combined with other natural compounds and some standard drugs. Moreover, proper use of this compound can reverse resistance to existing anti-cancer drugs through a variety of strategies. Calycosin showed better pharmacokinetic properties with less toxicity in human bodies. CONCLUSION Calycosin exhibits excellent potential as a therapeutic drug against several cancer types and should be consumed until standard chemotherapeutics are available in pharma markets.
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Affiliation(s)
- Md Sohel
- Biochemistry and Molecular BiologyPrimeasia UniversityDhakaBangladesh
- Biochemistry and Molecular BiologyMawlana Bhashani Science and Technology UniversityTangailBangladesh
| | - Fatema Tuj Zahra Shova
- Biotechnology and Genetic EngineeringMawlana Bhashani Science and Technology UniversityTangailBangladesh
| | - Shahporan shuvo
- Biochemistry and Molecular BiologyMawlana Bhashani Science and Technology UniversityTangailBangladesh
| | - Taiyara Mahjabin
- Biochemistry and Molecular BiologyMawlana Bhashani Science and Technology UniversityTangailBangladesh
| | - Md. Mojnu Mia
- Biotechnology and Genetic EngineeringMawlana Bhashani Science and Technology UniversityTangailBangladesh
| | - Dibyendu Halder
- Biochemistry and Molecular BiologyMawlana Bhashani Science and Technology UniversityTangailBangladesh
| | - Hafizul Islam
- Biochemistry and Molecular BiologyMawlana Bhashani Science and Technology UniversityTangailBangladesh
| | - Md Roman Mogal
- Biochemistry and Molecular BiologyMawlana Bhashani Science and Technology UniversityTangailBangladesh
| | - Partha Biswas
- Department of Genetic Engineering and Biotechnology, Faculty of Biological Science and TechnologyJashore University of Science and Technology (JUST)JashoreBangladesh
| | - Hasi Rani Saha
- Biochemistry and Molecular BiologyPrimeasia UniversityDhakaBangladesh
| | | | - Abdullah Al Mamun
- Biochemistry and Molecular BiologyMawlana Bhashani Science and Technology UniversityTangailBangladesh
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8
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Imterat M, Gebers G, Heitz F, Schneider S, Ehmann S, Welz J, du Bois A, Traut A, Walz MK, Concin N, Harter P, Ataseven B. Low anterior resection syndrome and its impact on quality of life of ovarian carcinoma patients: A prospective longitudinal study. Gynecol Oncol 2023; 178:96-101. [PMID: 37839314 DOI: 10.1016/j.ygyno.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/30/2023] [Accepted: 10/07/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVES Bowel dysfunction is frequently reported in patients with ovarian carcinoma (OC). Our aim was to evaluate the incidence of low anterior resection syndrome (LARS) like symptoms in patients with primary OC and its impact on quality of life (QoL). METHODS A prospective longitudinal observational cohort study was performed, including patients with newly diagnosed OC treated by primary or interval surgery with residual tumor <1 cm, from 2018 until 2021. Patients with a stoma or recurrence of disease were excluded. Intestinal dysfunction was assessed using the validated LARS score questionnaire pre- and postoperatively. There are 3 subgroups based on the results: no, minor, or major LARS. The impact on QoL was evaluated by an additional question to demonstrate the severity of patient's life impairment. RESULTS The questionnaire was answered by 78 patients pre- and post-operatively. LARS like symptoms were reported preoperatively in 34.6% (24.4% minor/10.2% major) and significantly increased postoperatively to 47.4% (28.2% minor/19.2% major; p = 0.011). Moderate to severe impairment of QoL correlated with LARS scores pre- (80%) and post-operatively (90%). Patients with two bowel anastomoses (mean score 18.6 pre- and 24.9 post-operatively, p = 0.041) showed a significant increase of the questionnaire score. CONCLUSIONS Major LARS like symptoms appear in 10% of OC patients preoperatively and significantly increase to almost two-fold postoperatively. Multiple bowel anastomoses had a significant risk for higher postoperative LARS score. QoL impairment correlates linearly with LARS positive scoring, independent on the timing of the complaints.
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Affiliation(s)
- Majdi Imterat
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany; Department of Gynaecologic Oncology, Hadassah Medical Centers, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Gudrun Gebers
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany; Department for Gynecology with the Center for Oncologic Surgery Charité Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Stephanie Schneider
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Sarah Ehmann
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Julia Welz
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Martin K Walz
- Department of Surgery, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Nicole Concin
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany; Bielefeld University, Medical School and University Medical Center East Westphalia-Lippe, Klinikum Lippe, Academic Department of Gynecology, Gynecologic Oncology and Obstetrics, Detmold, Germany
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9
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Quesada S, Thomas QD, Colombo PE, Fiteni F. Optimal First-Line Medico-Surgical Strategy in Ovarian Cancers: Are We There Yet? Cancers (Basel) 2023; 15:3556. [PMID: 37509219 PMCID: PMC10377152 DOI: 10.3390/cancers15143556] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
In spite of tremendous advances in advanced ovarian cancer management through the past decade, notably owing to surgical expertise and novel combination molecules (including bevacizumab and PARP inhibitors), the optimal initial sequential strategy remains a major concern. Indeed, following seminal clinical trials, primary cytoreductive surgery (PCS) followed by adjuvant systemic therapy and interval cytoreductive surgery (ICS) following neoadjuvant chemotherapy (NACT) have been positioned as validated alternatives with distinct pros and cons, although a definite response is still unassessed. In clinical practice, decisions between PCS and ICS rely on multilayer parameters: the tumor itself, the patient, and the health structure. In this state-of-the-art review, we will discuss the current evidence based on clinical trials and real-world data and highlight the remaining questions, including the fittest positioning of PCS vs. ICS and the optimal number of NACT cycles; subsequently, we will discuss current axes of research such as dedicated clinical trials and more global perspectives. These ongoing strategies and perspectives could contribute to improving the patient journey through personalized medicine.
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Affiliation(s)
- Stanislas Quesada
- Institut Régional du Cancer de Montpellier (ICM), 34298 Montpellier, France
| | | | | | - Frederic Fiteni
- Medical Oncology Department, University Hospital of Nîmes, 30900 Nîmes, France
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10
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Sanabria D, Fernández MC, Hurtado N, Ramos A, Rodriguez J. Quality management program in epithelial ovarian cancer: proposal in a Latin American country. Int J Gynecol Cancer 2023; 33:123-125. [PMID: 36368711 PMCID: PMC9811080 DOI: 10.1136/ijgc-2022-003899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daniel Sanabria
- Department of Gynecology, Obstetrics and Human Reproduction, Section of Gynecologic Oncology, Fundacion Santa Fe de Bogota, Bogota, Colombia
| | - Maria Camila Fernández
- Department of Gynecology, Obstetrics and Human Reproduction, Section of Gynecologic Oncology, Fundacion Santa Fe de Bogota, Bogota, Colombia
| | - Natalia Hurtado
- Department of Gynecology and Obstetrics, Universidad El Bosque, Bogota, Colombia
| | - Adriana Ramos
- Department of Gynecology, Obstetrics and Human Reproduction, Section of Gynecologic Oncology, Fundacion Santa Fe de Bogota, Bogota, Colombia
| | - Juliana Rodriguez
- Department of Gynecology, Obstetrics and Human Reproduction, Section of Gynecologic Oncology, Fundacion Santa Fe de Bogota, Bogota, Colombia
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Panoskaltsis T, Papadimitriou C, Pallas N, Karamveri C, Kyziridis D, Hristakis C, Kiriakopoulos V, Kalakonas A, Vaikos D, Tzavara C, Tentes AA. Prognostic Value of En-Block Radical Bowel Resection in Advanced Ovarian Cancer Surgery With HIPEC. Cancer Control 2023; 30:10732748231165878. [PMID: 36958947 PMCID: PMC10041633 DOI: 10.1177/10732748231165878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
PURPOSE To identify prognostic factors of survival and recurrence in advanced ovarian cancer patients undergoing radical surgery and HIPEC. METHODS In a single Department of Surgical Oncology, Peritoneal Surface Malignancy Program, and over a 16-year period, from a total of 274 epithelial ovarian cancer patients, retrospectively, we identified 152 patients undergoing complete (CC-0) or near-complete (CC-1) cytoreduction, including at least one colonic resection, and HIPEC. RESULTS Mean age of patients was 58.8 years and CC-0 was possible in 72.4%. Rates of in-hospital mortality and major morbidity were 2.6% and 15.7%. Only 122 (80.3%) patients completed Adjuvant Systemic Chemotherapy (ASCH). Rates of metastatic Total Lymph Nodes (TLN), Para-Aortic and Pelvic Lymph Nodes (PAPLN) and Large Bowel Lymph Nodes (LBLN) were 58.7%, 58.5%, and 51.3%, respectively. Median, 5- and 10-year survival rates were 39 months, 43%, and 36.2%, respectively. The recurrence rate was 35.5%. On univariate analysis, CC-1, high Peritoneal Cancer Index (PCI), in-hospital morbidity, and no adjuvant chemotherapy were adverse factors for survival and recurrence. On multivariate analysis, negative survival indicators were the advanced age of patients, extensive peritoneal dissemination, low total number of TLN and no systemic PAPLN. Metastatic LBLN and segmental resection of the small bowel (SIR) were associated with a high risk for recurrence. CONCLUSION CC-O is feasible in most advanced ovarian cancer patients and HIPEC may confer a survival benefit. Radical bowel resection, with its entire mesocolon, may be necessary, as its lymph nodes often harbor metastases influencing disease recurrence and survival. The role of metastatic bowel lymph nodes has to be taken into account when assessing the impact of systemic lymphadenectomy in this group of patients.
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Affiliation(s)
- T Panoskaltsis
- Gynaecological Oncology Unit, 2nd Academic Department of Obstetrics and Gynaecology, Aretaieion Hospital, 68989The National and Kapodistrian University of Athens, Athens, Greece
- Department of Surgical Oncology, Peritoneal Surface Malignancy Program, 376520Metropolitan Hospital, Athens, Greece
| | - C Papadimitriou
- Oncology Unit, 2nd Department of Surgery Aretaieion Hospital, 68989The National and Kapodistrian University of Athens, Athens, Greece
| | - N Pallas
- Department of Surgical Oncology, Peritoneal Surface Malignancy Program, 376520Metropolitan Hospital, Athens, Greece
| | - C Karamveri
- Department of Surgical Oncology, Peritoneal Surface Malignancy Program, 376520Metropolitan Hospital, Athens, Greece
| | - D Kyziridis
- Department of Surgical Oncology, Peritoneal Surface Malignancy Program, Euromedica Kyanous Stavros, Thessaloniki, Greece
| | - C Hristakis
- Department of Surgical Oncology, Peritoneal Surface Malignancy Program, Euromedica Kyanous Stavros, Thessaloniki, Greece
| | - V Kiriakopoulos
- Department of Surgical Oncology, Peritoneal Surface Malignancy Program, 376520Metropolitan Hospital, Athens, Greece
| | - A Kalakonas
- Department of Surgical Oncology, Peritoneal Surface Malignancy Program, Euromedica Kyanous Stavros, Thessaloniki, Greece
| | - D Vaikos
- Department of Surgical Oncology, Peritoneal Surface Malignancy Program, Euromedica Kyanous Stavros, Thessaloniki, Greece
| | - C Tzavara
- Department of Hygiene, Epidemiology and Medical Statistics, Centre for Health Services Research, School of Medicine, 68989The National and Kapodistrian University of Athens, Athens, Greece
| | - A A Tentes
- Department of Surgical Oncology, Peritoneal Surface Malignancy Program, 376520Metropolitan Hospital, Athens, Greece
- Department of Surgical Oncology, Peritoneal Surface Malignancy Program, Euromedica Kyanous Stavros, Thessaloniki, Greece
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12
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Upper-Abdominal Cytoreduction for Advanced Ovarian Cancer—Therapeutic Rationale, Surgical Anatomy and Techniques of Cytoreduction. SURGICAL TECHNIQUES DEVELOPMENT 2022. [DOI: 10.3390/std12010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cytoreductive surgery (CRS) is the cornerstone of treating advanced ovarian cancer. Approximately 60–70% of patients with advanced ovarian cancer will have involvement in the upper abdomen or the supracolic compartment of the abdominal cavity. Though the involvement of this region results in poorer survival compared, complete cytoreduction benefits overall survival, making upper-abdominal cytoreduction an essential component of CRS for advanced ovarian cancer. The upper abdomen constitutes several vital organs and large blood vessels draped with the parietal or visceral peritoneum, common sites of disease in ovarian cancer. A surgeon treating advanced ovarian cancer should be well versed in upper-abdominal cytoreduction techniques, including diaphragmatic peritonectomy and diaphragm resection, lesser omentectomy, splenectomy with or without distal pancreatectomy, liver resection, cholecystectomy, and suprarenal retroperitoneal lymphadenectomy. Other procedures such as clearance of the periportal region, Glisson’s capsulectomy, clearance of the superior recess of the lesser sac, and Morrison’s pouch are essential as these regions are often involved in ovarian cancer. This manuscript covers the surgical anatomy of the upper abdomen, the techniques and therapeutic rationale of upper-abdominal cytoreduction, and specific measures for perioperative management of these patients. The main focus is the description of various peritonectomies and regional lymphadenectomies.
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13
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Kuusela K, Norppa N, Auranen A, Saarelainen S. Maximal surgical effort increases the risk of postoperative complications in the treatment of advanced ovarian cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:2525-2530. [PMID: 35717320 DOI: 10.1016/j.ejso.2022.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Surgery is the cornerstone of the treatment for advanced ovarian cancer. Reaching complete cytoreduction resulting in no gross residual disease often requires complex surgery. The aim of this study was to assess the impact of increased surgical radicality on the risk of complications in the treatment of advanced ovarian cancer. MATERIALS AND METHODS All consecutive patients with advanced ovarian cancer (FIGO Stage IIIB-IVB) who had undergone primary or interval debulking surgery during a six-year study period were identified. In the midst of the study period, a surgical practice change towards maximal surgical effort occurred. Two groups were formed for the analysis: cohort A, that consisted of patients operated before the surgical paradigm shift and cohort B, that consisted of patients operated under the period of increased surgical radicality. RESULTS 252 patients were included in the analysis. Complete resection (R0) was achieved in 21.3% of surgeries in cohort A and in 51.2% in cohort B. The total postoperative complication rate was 76.2%. Most of the complications (86.5%) were minor (Clavien-Dindo I-IIIA). The patients in cohort B were at increased risk for complications, OR 2.94 (95%CI 1.58-5.47; p = 0.001). As for the approach to cytoreduction (primary vs. interval debulking), there was no statistically significant association with the occurrence of postoperative complications (p = 0.659). CONCLUSION In the present study more extensive surgeries led to better surgical results but increased postoperative morbidity. Postoperative complication rates were similar in both primary and interval debulking surgeries.
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Affiliation(s)
| | - Niina Norppa
- Tampere University Hospital, Department of Obsteterics and Gynecology, PO BOX 2000, FI-33521, Tampere, Finland
| | - Annika Auranen
- Tampere University Hospital, Department of Obsteterics and Gynecology, PO BOX 2000, FI-33521, Tampere, Finland; Tays Cancer Centre, PO BOX 2000, FI-33521, Tampere, Finland
| | - Sami Saarelainen
- Tampere University Hospital, Department of Obsteterics and Gynecology, PO BOX 2000, FI-33521, Tampere, Finland.
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14
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Boria F, Chiva L, Chacon E, Zanagnolo V, Fagotti A, Kucukmetin A, Mom C, Chakalova G, Shamistan A, Malzoni M, Narducci F, Arencibia O, Raspagliesi F, Toptas T, Cibula D, Kaidarova D, Meydanli MM, Tavares M, Golub D, Perrone AM, Poka R, Zusterzeel PLM, Aluloski I, Goffin F, Haidopoulos D, Haller H, Jach R, Yezhova I, Bernardino M, Bharathan R, Maenpaa MM, Sukhin V, Feron JG, Fruscio R, Kukk K, Ponce J, Demirkiran F, Vorgias G, Povolotskaya N, Coronado Martín PJ, Marina T, Zapardiel I, Bizzarri N, Gorostidi M, Gutierrez M, Manzour N, Berasaluce A, Martin-Calvo N. SUCCOR quality: validation of ESGO quality indicators for surgical treatment of cervical cancer. Int J Gynecol Cancer 2022; 32:1236-1243. [PMID: 36583728 DOI: 10.1136/ijgc-2022-003790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To evaluate whether compliance with European Society of Gynaecological Oncology (ESGO) surgery quality indicators impacts disease-free survival in patients undergoing radical hysterectomy for cervical cancer. METHODS In this retrospective cohort study, 15 ESGO quality indicators were assessed in the SUCCOR database (patients who underwent radical hysterectomy for International Federation of Gynecology and Obstetrics (FIGO) stage 2009 IB1, FIGO 2018 IB1, and IB2 cervical cancer between January 2013 and December 2014), and the final score ranged between 0 and 16 points. Centers with more than 13 points were classified as high-quality indicator compliance centers. We constructed a weighted cohort using inverse probability weighting to adjust for the variables. We compared disease-free survival and overall survival using Cox proportional hazards regression analysis in the weighted cohort. RESULTS A total of 838 patients were included in the study. The mean number of quality indicators compliance in this cohort was 13.6 (SD 1.45). A total of 479 (57.2%) patients were operated on at high compliance centers and 359 (42.8%) patients at low compliance centers. High compliance centers performed more open surgeries (58.4% vs 36.7%, p<0.01). Women who were operated on at centers with high compliance with quality indicators had a significantly lower risk of relapse (HR=0.39; 95% CI 0.25 to 0.61; p<0.001). The association was reduced, but remained significant, after further adjustment for conization, surgical approach, and use of manipulator surgery (HR=0.48; 95% CI 0.30 to 0.75; p=0.001) and adjustment for adjuvant therapy (HR=0.47; 95% CI 0.30 to 0.74; p=0.001). Risk of death from disease was significantly lower in women operated on at centers with high adherence to quality indicators (HR=0.43; 95% CI 0.19 to 0.97; p=0.041). However, the association was not significant after adjustment for conization, surgical approach, use of manipulator surgery, and adjuvant therapy. CONCLUSIONS Patients with early cervical cancer who underwent radical hysterectomy in centers with high compliance with ESGO quality indicators had a lower risk of recurrence and death.
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Affiliation(s)
- Felix Boria
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
| | - Luis Chiva
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
| | - Enrique Chacon
- Department of Gynecologic Oncology, Universidad de Navarra, Pamplona, Navarra, Spain
| | | | - Anna Fagotti
- Agostino Gemelli IRCCS, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Milano, Lombardia, Italy
| | | | - Constantijne Mom
- Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | | | | | - Mario Malzoni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
| | | | - Octavio Arencibia
- Department of Gynecology, University Maternal Hospital Canary Islands, Las Palmas, Las Palmas, Spain
| | | | - Tayfun Toptas
- Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Research and Training Hospital, Antalya, Turkey
| | - David Cibula
- Department of Obstetrics and Gynecology, University of Prague, Prague, Czech Republic
| | - Dilyara Kaidarova
- Department of Oncogynecology, Kazahskij naucno-issledovatel'skij institut onkologii i radiologii, Almaty, Kazakhstan
| | - Mehmet Mutlu Meydanli
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | | | - Dmytro Golub
- Department of Surgery, LISOD - Israeli Oncological Hospital, Kyiv Region, Ukraine
| | - Anna Myriam Perrone
- Division of Gynecologic Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Robert Poka
- Department of Obstetrics and Gynecology, Unit of Gynecologic Oncology; Institute of Obstetrics and Gynecology; Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | | | - Igor Aluloski
- Department of Gynecologic Oncology, University Clinic of Gynecology and Obstetrics, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopjeskopje, Macedonia
| | - Frederic Goffin
- Department of Obstetrics and Gynecology, University of Liege, Liege, Belgium
| | - Dimitrios Haidopoulos
- Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Robert Jach
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
| | | | - Margarida Bernardino
- Department of Gynecology, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
| | - Rasiah Bharathan
- University Hospitals of Leicester NHS Trust, Leicester, Leicester, UK
| | - Minna M Maenpaa
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Vladyslav Sukhin
- Department of Oncology, Radiology and Radiation Medicine, V N Karazin Kharkiv National University, Harkiv, Ukraine.,Department of Oncogynecology, Grigoriev Institute for Medical Radiology NAMS of Ukraine, Harkiv, Ukraine
| | | | - Robert Fruscio
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.,Clinic of Obstetrics and Gynecology, Hospital San Gerardo, Monza, Italy
| | - Kersti Kukk
- North Estonia Medical Centre, Tallinn, Estonia
| | - Jordi Ponce
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
| | - Fuat Demirkiran
- Istanbul University Cerrrahpasa Medical Faculty, istanbul, Turkey
| | - George Vorgias
- Metaxa Cancer Hospital of Piraeus, Piraeus, Attika, Greece
| | - Natalia Povolotskaya
- Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth NHS Trust, Portsmouth, UK
| | - Pluvio J Coronado Martín
- Department of Obstetrics and Gynecology, Hospital Clinico San Carlos IdISSC, Complutense University, Madrid, Spain
| | - Tiermes Marina
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Ignacio Zapardiel
- Department of Gynecologic Oncology, La Paz University Hospital, Madrid, Spain
| | - Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | | | - Monica Gutierrez
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
| | - Nabil Manzour
- Department of Gynecologic Oncology, Universidad de Navarra, Pamplona, Navarra, Spain
| | - Arantxa Berasaluce
- Department of Preventive Medicine and Public Health, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Nerea Martin-Calvo
- ,Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain
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Farrell R, Liauw WS, Morris DL. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for ovarian cancer in an Australian institution: lessons from 20 years' experience. BMC Surg 2022; 22:338. [PMID: 36096791 PMCID: PMC9469563 DOI: 10.1186/s12893-022-01786-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/31/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives We report the 20-year experience of the largest Australian unit performing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for ovarian cancer and reflect on learning opportunities. Methods A retrospective review of all cases of CRS for ovarian cancer at St George Peritonectomy Unit from Jan 1998 to Jan 2018 was performed. Prospectively collected data include age, stage, histology, disease extent (PCI), completeness of cytoreduction (CC score), HIPEC regime, 30-day surgical morbidity, disease recurrence, and death. Survival was computed using Kaplan–Meier method and analysed using log-rank tests and Cox-proportional hazards models. Results Forty-one women with advanced ovarian cancer (11 primary stage III/IV, 30 recurrent) underwent CRS, 29 (71%) with HIPEC. Most (68%) had high-volume disease (PCI > 15). In 98%, CC0/CC1 (residual < 2.5 mm) was achieved. Fourteen (34%) had grade 3/4 complications, 1 patient (2%) died within 30 days and 2 patients (5%) died within 90 days. Progression-free and median overall survival was 30.0 and 67.0 months for primary cancer, and 6.7 and 18.1 months for recurrent cancer. Survival was associated with platinum-sensitivity, PCI ≤ 15, and CC score 0, but not HIPEC. Conclusion This study reports outcomes for patients with advanced ovarian cancer patients treated in an Australian centre offering CRS and HIPEC. Whilst survival and morbidity outcomes were good for primary disease, they were poorer than predicted from the literature for cases of recurrent disease. The incorporation of evidence-based predictors of survival and multidisciplinary input are essential to achieve the best survival outcomes.
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Affiliation(s)
- R Farrell
- Chris O'Brien Lifehouse Hospital, Camperdown, Sydney, NSW, 2050, Australia. .,The University of Sydney, Sydney, NSW, 2006, Australia. .,Department of Surgery, UNSW, Sydney, NSW, 2033, Australia. .,Prince of Wales Private Hospital, Suite 30, Level 7, Randwick Sydney, 2031, Australia.
| | - W S Liauw
- Department of Surgery, UNSW, Sydney, NSW, 2033, Australia.,Cancer Care Centre, St George Hospital, Kogarah, NSW, 2217, Australia
| | - D L Morris
- Department of Surgery, UNSW, Sydney, NSW, 2033, Australia.,Cancer Care Centre, St George Hospital, Kogarah, NSW, 2217, Australia
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16
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Odajima S, Tanabe H, Koike Y, Yokosu K. Retrospective Analysis of Total Parietal Peritonectomy Without Systematic Lymphadenectomy for Advanced Epithelial Ovarian Cancer. CANCER DIAGNOSIS & PROGNOSIS 2022; 2:482-488. [PMID: 35813015 PMCID: PMC9254101 DOI: 10.21873/cdp.10131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND/AIM Total parietal peritonectomy (TPP) is a surgical procedure used for complete resection of microscopic peritoneal dissemination. This study analyzed the perioperative complications that developed when omitting systematic lymphadenectomy from TPP. PATIENTS AND METHODS We retrospectively analyzed perioperative complications in epithelial ovarian cancer patients with stage IIIB-IVB who underwent TPP during primary and interval cytoreductive surgeries between April 2018 and October 2021. RESULTS Thirty-three patients were enrolled in the study. The median patient age was 62 years. Of 31 patients (94%) with stage IIIC/IV disease, 24 (73%) had high-grade serous carcinoma. The median operative time and blood loss were 447 min and 2,831 ml, respectively. Complete tumor resection was performed in 30 patients (91%). Only five patients underwent partial lymphadenectomy for clinical metastatic lymph nodes. Further, grade 3 complications were observed in seven (21%) patients, and there were no fatal events in this study. Three patients (9%) had ureteric injuries, which was the most frequent complication in this study. Only one patient developed an intra-abdominal infection due to ascites. In this case, partial para-aortic and pelvic lymphadenectomies were performed. CONCLUSION TPP without systematic lymphadenectomy reduces the frequency of perioperative complications associated with ascites.
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Affiliation(s)
- Suguru Odajima
- Department of Gynecology, National Cancer Center Hospital East, Chiba, Japan
| | - Hiroshi Tanabe
- Department of Gynecology, National Cancer Center Hospital East, Chiba, Japan
| | - Yuki Koike
- Department of Gynecology, National Cancer Center Hospital East, Chiba, Japan
| | - Kota Yokosu
- Department of Gynecology, National Cancer Center Hospital East, Chiba, Japan
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17
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Muallem MZ, Kluge L, Sayasneh A, Sehouli J, Zocholl D, Muallem J, Miranda A. A Promising Approach for Primary Cytoreductive Surgery for Advanced Ovarian Cancer: Survival Outcomes and Step-by-Step Description of Total Retroperitoneal en-Bloc Resection of Multivisceral-Peritoneal Packet (TROMP). J Pers Med 2022; 12:jpm12060899. [PMID: 35743684 PMCID: PMC9225245 DOI: 10.3390/jpm12060899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/13/2022] [Accepted: 05/28/2022] [Indexed: 12/01/2022] Open
Abstract
(1) Background: A complete tumor resection during primary cytoreductive surgery has been reported to be the most important and perhaps the only independent prognostic factor in advanced ovarian cancers. The goal of complete cytoreduction needs to be weighed against the potential morbidities and long-term survival outcomes. (2) Methods: in this retrospective analysis of a prospectively obtained database, 208 consecutive patients with advanced ovarian cancer who underwent a conventional primary cytoreductive surgery (150 patients) or TROMP technique (58 patients) were included. Progression-free and overall survival rates were calculated using Kaplan–Meier analysis as well as the 95% confidence interval of the hazard ratio between treatment groups. (3) Results: After a median follow-up phase of more than 3 years (range 1–72 months), there are no statistically significant differences between both groups in progression-free and overall survival rates. Albeit, the TROMP group included statistically significant more advanced-stage cases compared to the conventional surgery group. (4) Conclusions: the TROMP technique is a promising tool for successful primary cytoreductive surgery in a selected group of patients with high tumor burdens in order to achieve optimal surgical results and survival outcomes without introducing any additional risks or complications.
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Affiliation(s)
- Mustafa Zelal Muallem
- Department of Gynecology with Center for Oncological Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Virchow Campus Clinic, Charité Medical University, 13353 Berlin, Germany; (L.K.); (J.S.); (D.Z.); (J.M.); (A.M.)
- Correspondence: or ; Tel.: +49-30-450-664373; Fax: +49-30-450-7564373
| | - Luisa Kluge
- Department of Gynecology with Center for Oncological Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Virchow Campus Clinic, Charité Medical University, 13353 Berlin, Germany; (L.K.); (J.S.); (D.Z.); (J.M.); (A.M.)
| | - Ahmad Sayasneh
- Department of Gynecological Oncology, Surgical Oncology Directorate, Guy’s and St Thomas’ NHS Foundation Trust, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, Westminster Bridge Road, London SE1 7EH, UK;
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Virchow Campus Clinic, Charité Medical University, 13353 Berlin, Germany; (L.K.); (J.S.); (D.Z.); (J.M.); (A.M.)
| | - Dario Zocholl
- Department of Gynecology with Center for Oncological Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Virchow Campus Clinic, Charité Medical University, 13353 Berlin, Germany; (L.K.); (J.S.); (D.Z.); (J.M.); (A.M.)
| | - Jumana Muallem
- Department of Gynecology with Center for Oncological Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Virchow Campus Clinic, Charité Medical University, 13353 Berlin, Germany; (L.K.); (J.S.); (D.Z.); (J.M.); (A.M.)
| | - Andrea Miranda
- Department of Gynecology with Center for Oncological Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Virchow Campus Clinic, Charité Medical University, 13353 Berlin, Germany; (L.K.); (J.S.); (D.Z.); (J.M.); (A.M.)
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18
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Khetan VU, Muderspach LI, Miller HA, Licon E, Adams CL, Brunette LL, Pham HQ, Yessaian AA, Roman LD, Matsuo K, Ciccone MA. Side-to-end reanastomosis after low-anterior resection (STELAR): Outcomes, feasibility, and description of procedure performed by a gynecologic oncology service. J Surg Oncol 2022; 126:563-570. [PMID: 35476891 DOI: 10.1002/jso.26907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/02/2022] [Accepted: 04/13/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Low anterior rectosigmoid resection for a gynecologic disease is usually performed in concert with other procedures and can result in significant morbidity should anastomotic complication occur. This study examined surgical outcomes of side-to-end reanastomosis after low anterior resection (STELAR) performed by gynecologic oncology service. METHODS This is a case series examining consecutive patients who underwent STELAR for gynecologic indications by a single gynecologic oncology group from 2009 to 2018. Prospectively collected institutional surgical database was searched for STELAR, and standard descriptive statistics were used to describe intraoperative and postoperative complications specific to reanastomosis. RESULTS A total of 69 women underwent STELAR, with median age and body mass index of 54 years and 24 kg/m2 , respectively. 63.8% of patients had ovarian cancer and 84.4% had stage III-IV disease. The median estimated blood loss was 875 ml. Four (5.8%) women underwent protective loop colostomy at the time of STELAR. Postoperatively, there was 1 (1.4%) case of abscess formation within 30 days and 1 (1.4%) case of anastomotic leak 5 weeks after STELAR that required reoperation and diversion. No cases of fistula were clinically identified. CONCLUSION Side-to-end reanastomosis may be a safe and feasible procedure to accomplish low rectosigmoid anastomosis in women with gynecologic disease.
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Affiliation(s)
- Varun U Khetan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Laila I Muderspach
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Heather A Miller
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Ernesto Licon
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Crystal L Adams
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Laurie L Brunette
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Huyen Q Pham
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Annie A Yessaian
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Marcia A Ciccone
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
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Norppa N, Staff S, Helminen M, Auranen A, Saarelainen S. Improved survival after implementation of ultra-radical surgery in advanced epithelial ovarian cancer: Results from a tertiary referral center. Gynecol Oncol 2022; 165:478-485. [DOI: 10.1016/j.ygyno.2022.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/26/2022] [Accepted: 03/27/2022] [Indexed: 11/04/2022]
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20
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Lawton FG, Pavlik EJ. Perspectives on Ovarian Cancer 1809 to 2022 and Beyond. Diagnostics (Basel) 2022; 12:791. [PMID: 35453839 PMCID: PMC9024743 DOI: 10.3390/diagnostics12040791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 11/16/2022] Open
Abstract
Unlike many other malignancies, overall survival for women with epithelial ovarian cancer has improved only modestly over the last half-century. The perspectives presented here detail the views of a gynecologic oncologist looking back and the view of the academic editor looking forward. Surgical beginnings in 1809 are merged with genomics, surgical advances, and precision therapy at present and for the future. Presentations in this special issue focus on factors related to the diagnosis of ovarian cancer: (1) markers for the preoperative assessment of primary and metastatic ovarian tumors, (2) demonstrations of the presence of pelvic fluid in ultrasound studies of ovarian malignancies, (3) the effects of age, menopausal status, and body habitus on ovarian visualization, (4) the ability of OVA1 to detect ovarian cancers when Ca125 was not informative, (5) the detection of tumor-specific changes in cell adhesion molecules by tissue-based staining, (6) presentation of a high discrimination model for ovarian cancer using IOTA Simple Rules and CA125, (7) review of low-grade serous carcinoma of the ovary, and (8) a comprehensive case report on ovarian carcinosarcoma.
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Affiliation(s)
- Frank G. Lawton
- Gynaecological Cancer Surgeon South East London Gynaecological Cancer Centre, Guy’s and St Thomas’ NHS Trust, London SE1 7EH, UK;
| | - Edward J. Pavlik
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky Chandler Medical Center-Markey Cancer Center, Lexington, KY 40536, USA
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21
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Karadağ İ, Karakaya S. Ideal Lymph Node Number for Ovarian Malignancies. Cureus 2022; 14:e20869. [PMID: 35145776 PMCID: PMC8804931 DOI: 10.7759/cureus.20869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2021] [Indexed: 11/05/2022] Open
Abstract
Objective: Although there are studies in which the ideal number of lymph nodes for early-stage ovarian cancer is specified, no study has been found on the number of lymph nodes that should ideally be removed by systematic lymph node dissection, including advanced-stage patients. The present study was aimed to retrospectively investigate the number of lymph nodes that need to be removed to detect lymph node positivity and the effect of this number on prognosis. Methodology: A total of 155 patients over the age of 18 who were diagnosed with ovarian cancer without secondary malignancy and who underwent surgical lymph node dissection were included in the study between 2015 and 2020. Results: A total of 155 patients underwent lymphadenectomy and the median number of removed lymph nodes was 24. Lymph node positivity was detected in 72 (46.4%) of these patients, while the median number of positive lymph nodes was 4 in the lymph node-positive group. A statistically significant positive correlation was found between the number of lymph nodes removed and the median overall survival (OS) (r = 0.546, p<0.001). At the same time, when the number of 24 lymph nodes, which is the median number of lymph nodes removed and the value found to detect lymph node positivity in the receiver operating characteristic (ROC) curve, is taken as cut off; mean OS was found to be statistically significantly higher in the group with adequate lymph node dissection compared to the group with insufficient lymph node dissection (46.46±35.22 vs 22.33±21.43; p < 0.001, respectively). Conclusion: it was shown that more than 24 lymph nodes are required for adequate lymph node dissection in the patients included in the study, and thus it can contribute positively to the prognosis. With the support of more comprehensive and prospective studies conducted on this subject to this study, clearer data will emerge about the number of lymph nodes that should be removed in an ideal surgery.
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22
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Thomas QD, Quesada S, D’Hondt V, Belaroussi I, Laas E, Classe JM, Fabbro M, Colombo PE, Fiteni F. Combinaison de la chirurgie et du traitement médical du cancer de l’ovaire : y a-t-il une stratégie optimale ? Bull Cancer 2022; 109:197-215. [DOI: 10.1016/j.bulcan.2021.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/18/2021] [Accepted: 11/26/2021] [Indexed: 12/19/2022]
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23
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Harter P, Mouret-Reynier MA, Pignata S, Cropet C, González-Martín A, Bogner G, Fujiwara K, Vergote I, Colombo N, Nøttrup TJ, Floquet A, El-Balat A, Scambia G, Guerra Alia EM, Fabbro M, Schmalfeldt B, Hardy-Bessard AC, Runnebaum I, Pujade-Lauraine E, Ray-Coquard I. Efficacy of maintenance olaparib plus bevacizumab according to clinical risk in patients with newly diagnosed, advanced ovarian cancer in the phase III PAOLA-1/ENGOT-ov25 trial. Gynecol Oncol 2021; 164:254-264. [PMID: 34952708 DOI: 10.1016/j.ygyno.2021.12.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/02/2021] [Accepted: 12/10/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Adding maintenance olaparib to bevacizumab provided a significant progression-free survival (PFS) benefit in patients with newly diagnosed, advanced ovarian cancer in the randomized, double-blind PAOLA-1/ENGOT-ov25 trial (NCT02477644). We analyzed PFS by clinical risk and biomarker status. METHODS Patients received olaparib 300 mg twice daily for up to 24 months plus bevacizumab 15 mg/kg every 3 weeks for up to 15 months in total, or placebo plus bevacizumab. This post hoc exploratory analysis evaluated PFS in patients classified as higher risk (stage III with upfront surgery and residual disease or neoadjuvant chemotherapy; stage IV) or lower risk (stage III with upfront surgery and no residual disease), and by biomarker status. RESULTS Of 806 randomized patients, 74% were higher risk and 26% were lower risk. After a median 22.9 months of follow-up, PFS favored olaparib plus bevacizumab versus placebo plus bevacizumab in higher-risk patients (hazard ratio [HR] 0.60; 95% confidence interval [CI] 0.49-0.74) and lower-risk patients (0.46; 0.30-0.72). Olaparib plus bevacizumab provided a substantial PFS benefit versus bevacizumab alone in the homologous recombination deficiency (HRD)-positive subgroup (higher risk: HR 0.39; 95% CI 0.28-0.54 and lower risk: 0.15; 0.07-0.30), with 24-month PFS rates in lower-risk patients of 90% versus 43%, respectively (Kaplan-Meier estimates). CONCLUSIONS In PAOLA-1, maintenance olaparib plus bevacizumab provided a substantial PFS benefit in HRD-positive patients with a reduction of risk of progression or death of 61% in the higher-risk group and of 85% in the lower-risk group compared with bevacizumab alone.
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Affiliation(s)
- Philipp Harter
- Ev. Kliniken Essen Mitte, Essen, and Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) Studiengruppe, Germany.
| | - Marie Ange Mouret-Reynier
- Centre Jean Perrin, Clermont, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), France
| | - Sandro Pignata
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Italy
| | | | - Antonio González-Martín
- MD Anderson Cancer Center Madrid, and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Spain
| | - Gerhard Bogner
- Paracelsus Medical University Salzburg, Salzburg, and Arbeitsgemeinschaft Gynaekologische Onkologie (AGO Austria), Austria
| | - Keiichi Fujiwara
- Saitama Medical University International Medical Center, Hidaka, and Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Japan
| | - Ignace Vergote
- University Hospital Leuven, Leuven Cancer Institute, Leuven, and Belgian Gynaecological Oncology Group (BGOG), Belgium
| | - Nicoletta Colombo
- University of Milan-Bicocca and IEO European Institute of Oncology IRCCS, Milan, and Mario Negri Gynecologic Oncology Group (MANGO), Italy
| | - Trine Jakobi Nøttrup
- Copenhagen University Hospital, Copenhagen, and Nordic Society of Gynecologic Oncology (NSGO), Denmark
| | - Anne Floquet
- Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, and GINECO, France
| | - Ahmed El-Balat
- Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt, and AGO, Germany
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica, Rome, and MITO, Italy
| | | | | | | | | | | | - Eric Pujade-Lauraine
- Association de Recherche Cancers Gynécologiques (ARCAGY), Paris, and GINECO, France
| | - Isabelle Ray-Coquard
- Centre Léon BERARD and University Claude Bernard Lyon 1, Lyon, and GINECO, France
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24
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Fotopoulou C, Rockall A, Lu H, Lee P, Avesani G, Russo L, Petta F, Ataseven B, Waltering KU, Koch JA, Crum WR, Cunnea P, Heitz F, Harter P, Aboagye EO, du Bois A, Prader S. Validation analysis of the novel imaging-based prognostic radiomic signature in patients undergoing primary surgery for advanced high-grade serous ovarian cancer (HGSOC). Br J Cancer 2021; 126:1047-1054. [PMID: 34923575 PMCID: PMC8979975 DOI: 10.1038/s41416-021-01662-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/23/2021] [Accepted: 12/01/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Predictive models based on radiomics features are novel, highly promising approaches for gynaecological oncology. Here, we wish to assess the prognostic value of the newly discovered Radiomic Prognostic Vector (RPV) in an independent cohort of high-grade serous ovarian cancer (HGSOC) patients, treated within a Centre of Excellence, thus avoiding any bias in treatment quality. METHODS RPV was calculated using standardised algorithms following segmentation of routine preoperative imaging of patients (n = 323) who underwent upfront debulking surgery (01/2011-07/2018). RPV was correlated with operability, survival and adjusted for well-established prognostic factors (age, postoperative residual disease, stage), and compared to previous validation models. RESULTS The distribution of low, medium and high RPV scores was 54.2% (n = 175), 33.4% (n = 108) and 12.4% (n = 40) across the cohort, respectively. High RPV scores independently associated with significantly worse progression-free survival (PFS) (HR = 1.69; 95% CI:1.06-2.71; P = 0.038), even after adjusting for stage, age, performance status and residual disease. Moreover, lower RPV was significantly associated with total macroscopic tumour clearance (OR = 2.02; 95% CI:1.56-2.62; P = 0.00647). CONCLUSIONS RPV was validated to independently identify those HGSOC patients who will not be operated tumour-free in an optimal setting, and those who will relapse early despite complete tumour clearance upfront. Further prospective, multicentre trials with a translational aspect are warranted for the incorporation of this radiomics approach into clinical routine.
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Affiliation(s)
- Christina Fotopoulou
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, W12 0HS, UK.
| | - Andrea Rockall
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, W12 0HS, UK.,Department of Radiology, Imperial College Healthcare NHS Trust, London, W12 0HS, UK.,Cancer Imaging Centre, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, W12 0HS, UK
| | - Haonan Lu
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, W12 0HS, UK
| | - Philippa Lee
- Department of Radiology, Imperial College Healthcare NHS Trust, London, W12 0HS, UK
| | - Giacomo Avesani
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, W12 0HS, UK.,Cancer Imaging Centre, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, W12 0HS, UK.,Department of Imaging, Oncological Radiotherapy, and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Russo
- Department of Imaging, Oncological Radiotherapy, and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Federica Petta
- Department of Imaging, Oncological Radiotherapy, and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Henricistr.92, 45136, Essen, Germany.,Department of Obstetrics and Gynecology, University Hospital, LMU Munich, München, Germany
| | - Kai-Uwe Waltering
- Department of Radiology, Kliniken Essen-Mitte, Henricistr.92, 45136, Essen, Germany
| | - Jens Albrecht Koch
- Department of Radiology, Kliniken Essen-Mitte, Henricistr.92, 45136, Essen, Germany
| | - William R Crum
- Cancer Imaging Centre, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, W12 0HS, UK.,Institute of Translational Medicine and Therapeutics (ITMAT), Imperial College, London, UK
| | - Paula Cunnea
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, W12 0HS, UK
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Henricistr.92, 45136, Essen, Germany.,Department for Gynecology with the Center for Oncologic Surgery Charité Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Henricistr.92, 45136, Essen, Germany
| | - Eric O Aboagye
- Cancer Imaging Centre, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, W12 0HS, UK
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Henricistr.92, 45136, Essen, Germany
| | - Sonia Prader
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Henricistr.92, 45136, Essen, Germany.,Department of Obstetrics and Gynecology, Brixen General Hospital, Brixen, Italy.,Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
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Joshi N, Liu D, Dickson KA, Marsh DJ, Ford CE, Stenzel MH. An organotypic model of high-grade serous ovarian cancer to test the anti-metastatic potential of ROR2 targeted Polyion complex nanoparticles. J Mater Chem B 2021; 9:9123-9135. [PMID: 34676865 DOI: 10.1039/d1tb01837j] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
High-grade serous ovarian cancer (HGSOC) is the most lethal gynaecological malignancy. Most patients are diagnosed at late stages when the tumour has metastasised throughout the peritoneal cavity. The Wnt receptor ROR2 has been identified as a promising therapeutic target in HGSOC, with limited targeting therapeutic options currently available. Small interfering RNA (siRNA)-based therapeutics hold great potential for inhibiting the function of specific biomarkers, however major challenges remain in efficient delivery and stability. The aim of this study was to investigate the ability of nanoparticles to deliver ROR2 siRNA into HGSOC cells, including platinum resistant models, and estimate the anti-metastatic effect via a 3D organotypic model for ovarian cancer. The nanoparticles were generated by conjugating poly[2-(dimethylamino) ethyl methacrylate] (PDMAEMA) of various chain length to bovine serum albumin (BSA), followed by the condensation of ROR2 siRNA into polyplexes, also termed polyion complex (PIC) nanoparticles. The toxicity and uptake of ROR2 siRNA PIC nanoparticles in two HGSOC cell lines, CaOV3 as well as its cisplatin resistant pair (CaOV3CisR), in addition to primary cells used for the 3D organotypic model were investigated. ROR2 knockdown at both transcriptional and translational levels were evaluated via real-time PCR and western blot analysis, respectively. Following 24 h incubation with the nanoparticles, functional assays were performed including proliferation (IncuCyte S3), transwell migration and 3D co-cultured transwell invasion assays. The PICs nanoparticles exhibited negligible toxicity in the paired CaOV3 cell lines or primary cells. Treating CaOV3 and CaOV3CisR cells with ROR2 siRNA containing PICs nanoparticles significantly inhibited migration and invasion ability. The biocompatible ROR2 siRNA conjugated PICs nanoparticles provide an innovative therapeutic option. ROR2 targeting therapy shows potential in treating HGSOC including platinum resistant forms.
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Affiliation(s)
- Nidhi Joshi
- School of Chemistry, University of New South Wales, Sydney, 2052, Australia.
| | - Dongli Liu
- School of Women's and Children's Health, Faculty of Medicine and Health, University of New South Wales, Australia.
| | - Kristie-Ann Dickson
- Translational Oncology Group, School of Life Sciences, Faculty of Science, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Deborah J Marsh
- Translational Oncology Group, School of Life Sciences, Faculty of Science, University of Technology Sydney, Ultimo, NSW 2007, Australia.,Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Caroline E Ford
- School of Women's and Children's Health, Faculty of Medicine and Health, University of New South Wales, Australia.
| | - Martina H Stenzel
- School of Chemistry, University of New South Wales, Sydney, 2052, Australia.
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DiSilvestro P, Colombo N, Harter P, González-Martín A, Ray-Coquard I, Coleman RL. Maintenance Treatment of Newly Diagnosed Advanced Ovarian Cancer: Time for a Paradigm Shift? Cancers (Basel) 2021; 13:5756. [PMID: 34830911 PMCID: PMC8616471 DOI: 10.3390/cancers13225756] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/01/2021] [Accepted: 11/06/2021] [Indexed: 11/16/2022] Open
Abstract
Recent data have demonstrated substantial efficacy with poly (ADP-ribose) polymerase (PARP) inhibitors as treatment and/or maintenance therapy in patients with newly diagnosed advanced epithelial ovarian cancer (EOC). Here, we review efficacy and safety results from four recent Phase III trials in newly diagnosed EOC: SOLO1 (olaparib), PAOLA-1 (olaparib in combination with bevacizumab), PRIMA (niraparib), and VELIA (veliparib). The implications of these data for current clinical practice and areas for future research are discussed, including ongoing studies of targeted agents in the newly diagnosed setting. Data from SOLO1, PAOLA-1, PRIMA, and VELIA confirm the benefit of PARP inhibitors (olaparib, niraparib, veliparib) for women with newly diagnosed EOC. The greatest benefit was seen in patients with a BRCA1 and/or BRCA2 mutation or in the homologous recombination deficiency (HRD)-test positive subgroup. These four well-conducted studies have generated practice-changing data. However, deciding how to apply these results in clinical practice is challenging, and substantial differences in trial design impede cross-trial comparisons. Recent PARP inhibitor approvals (olaparib, niraparib) in the newly diagnosed EOC setting have provided new maintenance treatment options for a broader patient population. The results of these studies call for personalized medicine based on biomarker profile and other factors, including tolerability, cost considerations, and physician and patient preference. Important areas for future research include appropriate use of both BRCA mutation and HRD testing to inform magnitude of PARP inhibitor benefit as well as exploring further options for patients who are HRD-test negative and for those who become PARP inhibitor resistant.
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Affiliation(s)
- Paul DiSilvestro
- Program in Women’s Oncology, Women & Infants Hospital, Providence, RI 02905, USA
| | - Nicoletta Colombo
- IRCCS European Institute of Oncology (IEO), University of Milan-Bicocca, 20126 Milan, Italy;
| | - Philipp Harter
- Department of Gynecology & Gynecologic Oncology, Ev. Kliniken Essen Mitte, 45136 Essen, Germany;
| | - Antonio González-Martín
- Department of Oncology, Clínica Universidad de Navarra, 28027 Madrid, Spain;
- Program in Solid Tumors, Center for Applied Medical Research (CIMA), 31008 Pamplona, Spain
| | - Isabelle Ray-Coquard
- Centre Leon Berard, Claude Bernard, Claude Bernard University, 69008 Lyon, France;
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Total Colectomy as a Part of Ultra-Radical Surgery for Ovarian Cancer-Short- and Long-Term Outcomes. Curr Oncol 2021; 28:4223-4233. [PMID: 34677276 PMCID: PMC8534540 DOI: 10.3390/curroncol28050358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 11/22/2022] Open
Abstract
(1) Background: The aim of this study was to assess the outcomes for patients who underwent total colectomy (TC) as a part of surgery for ovarian cancer (OC). (2) Methods: We performed a retrospective analysis of 1636 OC patients. Residual disease (RD) was reported using Sugarbaker’s completeness of cytoreduction score. (3) Results: Forty-two patients underwent TC during primary debulking surgery (PDS), and four and ten patients underwent TC during the interval debulking surgery (IDS) and secondary cytoreduction, respectively. The median overall survival (mOS) in OC patients following the PDS was 45.1 months in those with CC-0 (21%) resection, 11.1 months in those with CC-1 (45%) resection and 20.0 months in those with CC-2 (33%) resection (p = 0.28). Severe adverse events were reported in 18 patients (43%). In the IDS group, two patients survived more than 2 years after IDS and one patient died after 28.6 months. In the recurrent OC group, the mOS was 6.9 months. Patient age above 65 years was associated with a shortened overall survival (OS) and the presence of adverse events. (4) Conclusions: TC as a part of ultra-radical surgery for advanced OC results in high rates of optimal debulking. However, survival benefits were observed only in patients with no macroscopic disease.
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Jochum F, De Rozario T, Lecointre L, Faller E, Boisrame T, Dabi Y, Lavoué V, Coutant C, Touboul C, Bolze PA, Bricou A, Canlorbe G, Collinet P, Huchon C, Bendifallah S, Ouldamer L, Mezzadri M, Querleu D, Akladios C. Adherence to European ovarian cancer guidelines and impact on survival: a French multicenter study (FRANCOGYN). Int J Gynecol Cancer 2021; 31:1443-1452. [PMID: 34607855 DOI: 10.1136/ijgc-2021-002934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/14/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The primary objective of the study was to validate the European Society for Medical Oncology (ESMO)-European Society of Gynecologic Oncology (ESGO) ovarian cancer guideline as a method of assessing quality of care, and to identify patient characteristics predictive of non-adherence to European guideline care. The secondary objectives were to analyze the evolution of practices over the years and to evaluate heterogeneity between centers. METHODS This retrospective multicenter cohort study of invasive epithelial ovarian cancer reported to the FRANCOGYN database included data from 12 French centers between January 2000 and February 2017. The main outcome was adherence to ESMO-ESGO guidelines, defined by recommended surgical procedures according to the International Federation of Gynecology and Obstetrics (FIGO) stage and appropriate chemotherapy. Mixed multivariable logistic regression analysis with a random center effect was performed to estimate the probability of adherence to the guidelines. Survival analysis was carried out using the Kaplan-Meier method and a mixed Cox proportional hazards model. RESULTS 1463 patients were included in the study. Overall, 317 (30%) patients received complete guideline adherent care. Patients received appropriate surgical treatment in 69% of cases, while adequate chemotherapy was administered to 44% of patients. Both patient demographics and disease characteristics were significantly associated with the likelihood of receiving guideline adherent care, such as age, performance status, FIGO stage, and initial burden of disease. In univariate and multivariate survival analysis, adherence to the guidelines was a statistically significant and independent predictor of decreased overall survival. Patients receiving suboptimal care experienced an increased risk of death of more than 100% compared with those treated according to the guidelines (hazard ratio 2.14, 95% confidence interval 1.32 to 3.47, p<0.01). In both models, a significant random center effect was observed, confirming the heterogeneity between centers (p<0.001). CONCLUSIONS Adherence to ESMO-ESGO guidelines in ovarian cancer was associated with a higher overall survival and may be a useful method of assessing quality of care.
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Affiliation(s)
- Floriane Jochum
- Department of Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Tamara De Rozario
- Department of Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Lise Lecointre
- I-Cube UMR 7357-Laboratoire des Sciences de l'ingénieur, de l'informatique et de l'imagerie, Université de Strasbourg, Strasbourg, France.,Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, Strasbourg, France
| | - Emilie Faller
- Department of Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thomas Boisrame
- Department of Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Yohann Dabi
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Vincent Lavoué
- Department of Gynecologic Surgery, Hôpital Universitaire de Rennes, Université de Rennes 1 Faculté de Médecine, Rennes, France
| | - Charles Coutant
- Department of Surgical Oncology, Georges-Francois Leclerc Centre, Dijon, France
| | - Cyril Touboul
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | | | - Alexandre Bricou
- Department of Obstetrics and Gynecology, Hôpital Jean Verdier, Bondy, France
| | - Geoffroy Canlorbe
- Department of Gynecologic and Breast Surgery and Oncology, Hopital Universitaire Pitie Salpetriere Bibliotheque de La Pitie, Paris, France
| | - Pierre Collinet
- Department of Gynecological Surgery, Hopital Jeanne de Flandre, Lille, France
| | - Cyrille Huchon
- Department of Gynecology, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye Site Hospitalier de Poissy, Poissy, France
| | | | - Lobna Ouldamer
- Department of Gynecology, Hôpital Universitaire de Tours, Tours, France
| | | | - Denis Querleu
- Department of Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Chérif Akladios
- Department of Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Ataseven B, Tripon D, Schwameis R, Harter P, Rhiem K, Schneider S, Heikaus S, Baert T, Francesco AP, Heitz F, Traut A, Groeben HT, Schmutzler R, du Bois A. Clinical outcome in patients with primary epithelial ovarian cancer and germline BRCA1/2-mutation - real life data. Gynecol Oncol 2021; 163:569-577. [PMID: 34565600 DOI: 10.1016/j.ygyno.2021.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND We evaluated the clinical impact of germline (g)BRCA1/2-mutation on initial disease presentation, surgical implications, surgical morbidity and survival in patients with advanced epithelial ovarian cancer (EOC) undergoing debulking surgery (DS). METHODS Data of all consecutive EOC patients with stage III/IV, high-grade serous disease and known gBRCA1/2 status (gBRCA; non-gBRCA), who underwent DS at our department between 01/2011 and 06/2019 were analyzed. Associations between gBRCA-status and severe postoperative complications and survival were analyzed. RESULTS gBRCA-status was determined in 50.1% (612/1221) of all patients. gBRCA was present in 21.9% (134/612). Significant differences were observed in terms of median age (p = 0.001) and histology (high-grade serous histology gBRCA: 98.5%, non-gBRCA 76.2%; p < 0.001). gBRCA-status had no impact on intraoperative disease presentation, surgical complexity or complete resection rate (gBRCA: 74.4%, non-gBRCA: 69.0%; p = 0.274). gBRCA-status was not predictive for severe postoperative complication (gBRCA: 12.0%, non-gBRCA: 19.1%; p = 0.082). Median PFS and OS was 31/22 and 71/53 months in patients with/without gBRCA-mutation, respectively. gBRCA was a significant prognostic factor for PFS (HR 0.57 p < 0.001) and for OS (HR 0.64, p = 0.048) after adjusting for established prognostic factors. CONCLUSIONS gBRCA-status had no impact on initial disease presentation, surgical results or postoperative complications. gBRCA patients have a significantly longer PFS but the impact on the long term prognosis is unclear. Complete resection remains the most important prognostic factor in patients with EOC independent of gBRCA-status.
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Affiliation(s)
- Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany; Department of Obstetrics and Gynecology, University Hospital, LMU, Munich, Germany.
| | - Denise Tripon
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany; Department of Obstetrics and Gynecology, University Hospital, LMU, Munich, Germany
| | - Richard Schwameis
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany; Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Austria
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Stephanie Schneider
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany
| | | | - Thaïs Baert
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany; Department of Oncology, Laboratory of Tumour Immunology and Immunotherapy, ImmunOvar Research Group, KU Leuven, Leuven, Belgium
| | | | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany; Department of Gynecology, Campus Virchow Clinic, Charité Medical University, Berlin, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany
| | - Harald-Thomas Groeben
- Department of Anesthesiology and Intensive Care, Kliniken Essen-Mitte, Essen, Germany
| | - Rita Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany
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30
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Gajarawala S, Pelkowski J, Dorian R, Stanton A, Dinh T. Hyperthermic intraperitoneal chemotherapy for treating ovarian cancer. JAAPA 2021; 34:50-53. [PMID: 34320542 DOI: 10.1097/01.jaa.0000735800.98948.bb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Hyperthermic intraperitoneal chemotherapy (HIPEC) has been used for decades as a treatment for disseminated abdominal malignancies, including pseudomyxoma peritonei and peritoneal mesothelioma. HIPEC had been used to treat recurrent ovarian cancer only when curative options were lacking, but new data indicate that it may be suitable as a primary treatment for patients with late-stage epithelial ovarian cancer, increasing the recurrence-free time interval and improving quality of life. However, treatment can be challenging because of patient trauma from surgery, combined with the toxicity and high temperature of the chemotherapeutic agents. This article reviews HIPEC and its targeted intraoperative and postoperative management.
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Affiliation(s)
- Shilpa Gajarawala
- Shilpa Gajarawala is lead PA in the Department of Medical and Surgical Gynecology and an assistant professor of obstetrics and gynecology at Mayo Clinic Florida College of Medicine and Science in Jacksonville, Fla. She also is an adjunct faculty member in the doctor of medical science program at Rocky Mountain University of Health Science in Provo, Utah. Jessica Pelkowski practices in the Department of Orthopedic Surgery at the Mayo Clinic Florida. Rose Dorian practices in the Department of Blood and Marrow Transplantation and Cellular Immunotherapy at Moffitt Cancer Center in Tampa, Fla. Amanda Stanton practices in the Department of Medical and Surgical Gynecology and is an instructor in obstetrics and gynecology at the Mayo Clinic Florida. Tri Dinh is an assistant professor of obstetrics and gynecology at the Mayo Clinic Florida. The authors have disclosed no potential conflicts of interest, financial or otherwise
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31
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Kim SI, Kim JW. Role of surgery and hyperthermic intraperitoneal chemotherapy in ovarian cancer. ESMO Open 2021; 6:100149. [PMID: 33984680 PMCID: PMC8314869 DOI: 10.1016/j.esmoop.2021.100149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 12/24/2022] Open
Abstract
Ovarian cancer is one of the deadliest gynaecological malignancies and tends to be diagnosed at an advanced stage. Similar to many malignancies, surgery plays a critical role in many aspects of ovarian cancer management. Hyperthermic intraperitoneal chemotherapy (HIPEC) involves the induction of hyperthermia and delivery of intraperitoneal chemotherapy directly into the peritoneal cavity. Combined with cytoreductive surgery, HIPEC is an emerging treatment modality for ovarian cancer. Ovarian cancer survival outcomes can be improved by treatment with surgery and HIPEC in selected patients. Thus, this study aimed to review the current role of surgery and HIPEC in epithelial ovarian cancer. Evidence from the monumental and recent literature will be introduced. Surgery plays a critical role in many aspects of ovarian cancer management. Combined with cytoreductive surgery, HIPEC is an emerging modality for ovarian cancer. Improvement of survival outcomes is expected by applying individualised surgery and HIPEC for each ovarian cancer patient.
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Affiliation(s)
- S I Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - J-W Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
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YÜKSEL ŞİMŞEK S, AKILLI H, ALYAZICI KÜÇÜKYILDIZ İ, AYHAN A. Rekürren over kanseri hastalarında uygulanan tersiyer ve kuaterner sitoredüksiyon cerrahilerinin sağ kalıma etkisi ve morbiditesi. EGE TIP DERGISI 2021. [DOI: 10.19161/etd.887137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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33
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Alejandra M, Gertych W, Pomel C, Ferron G, Lusque A, Angeles MA, Lambaudie E, Rouzier R, Bakrin N, Golfier F, Glehen O, Canis M, Bourdel N, Pouget N, Colombo PE, Guyon F, Meurette J, Querleu D. Adherence to French and ESGO Quality Indicators in Ovarian Cancer Surgery: An Ad-Hoc Analysis from the Prospective Multicentric CURSOC Study. Cancers (Basel) 2021; 13:cancers13071593. [PMID: 33808284 PMCID: PMC8037412 DOI: 10.3390/cancers13071593] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/18/2021] [Accepted: 03/25/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Quality Indicators for ovarian cancer (OC) have been developed by the European Society of Gynaecological Oncology (ESGO) and by the French National Cancer Institute (Institut National du Cancer, INCa). The aim of the study was to characterize OC care distribution in France by case-volume and to prospectively evaluate the adherence of high-volume institutions to INCa/ESGO quality indicators. METHODS The cost-utility of radical surgery in ovarian cancer (CURSOC) trial is a prospective, multicenter, comparative and non-randomized study that includes patients with stage IIIC-IV epithelial OC treated in nine French health care tertiary institutions. Adherence to institutional quality indicators were anonymously assessed by an independent committee. OC care distribution in France were provided by the nationwide database of hospital procedures. RESULTS More than half of patients are treated in low-volume institutions. Among the nine high-volume centers participating in the study, four (44.4%) met all institutional INCa/ESGO quality indicators. The other five (55.6%) did not fulfil one of the quality indicator criteria. CONCLUSIONS Access to high-volume OC providers in France is restricted to a minority of patients, and yet half of the referral institutions included in this study failed to meet all recommended institutional quality indicators. It is mandatory that national authorities work both to improve OC centralization and to incorporate quality assurance programs into certified centers.
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Affiliation(s)
- Martinez Alejandra
- Surgical Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer—Toulouse Oncopole, 59500 Toulouse, France; (G.F.); (M.A.A.)
- Cancer Research Center of Toulouse (CRCT), INSERM UMR 1037, 31037 Toulouse, France
- Correspondence:
| | - Witold Gertych
- Obstetrics and Gynecology Department, University Hospital Lyon Sud, 69008 Lyon, France; (W.G.); (F.G.)
| | - Christophe Pomel
- Surgical Oncology Department, Centre Jean Perrin, 63000 Clermont Ferrand, France;
| | - Gwenael Ferron
- Surgical Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer—Toulouse Oncopole, 59500 Toulouse, France; (G.F.); (M.A.A.)
- Cancer Research Center of Toulouse (CRCT), INSERM UMR 1037, 31037 Toulouse, France
| | - Amelie Lusque
- Biostatistics Department, Institut Claudius Regaud, Institut Universitaire du Cancer—Toulouse Oncopole, 59500 Toulouse, France;
| | - Martina Aida Angeles
- Surgical Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer—Toulouse Oncopole, 59500 Toulouse, France; (G.F.); (M.A.A.)
| | - Eric Lambaudie
- Surgical Oncology Department, Institut Paoli Calmettes, 13009 Marseille, France;
| | - Roman Rouzier
- Surgical Oncology Department, Institut Curie, 75248 Paris, France; (R.R.); (N.P.)
| | - Naoual Bakrin
- Visceral and Digestive Surgery, University Hospital of Lyon Sud, 69008 Lyon, France; (N.B.); (O.G.)
| | - Francois Golfier
- Obstetrics and Gynecology Department, University Hospital Lyon Sud, 69008 Lyon, France; (W.G.); (F.G.)
| | - Olivier Glehen
- Visceral and Digestive Surgery, University Hospital of Lyon Sud, 69008 Lyon, France; (N.B.); (O.G.)
| | - Michel Canis
- Obstetrics and Gynecology, University Hospital Clermont Ferrand, 63000 Clermont Ferrand, France; (M.C.); (N.B.)
| | - Nicolas Bourdel
- Obstetrics and Gynecology, University Hospital Clermont Ferrand, 63000 Clermont Ferrand, France; (M.C.); (N.B.)
| | - Nicolas Pouget
- Surgical Oncology Department, Institut Curie, 75248 Paris, France; (R.R.); (N.P.)
| | | | - Frédéric Guyon
- Surgical Oncology, Institut Bergonié, 33000 Bordeaux, France;
| | | | - Denis Querleu
- Department of Gynecologic Oncology, Agostino Gemelli University Hospital, 00168 Rome, Italy;
- Department of Obstetrics and Gynecology, University Hospital of Strasbourg, 67091 Strasbourg, France
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Ponzone R. BRCA1/2 status and chemotherapy response score to tailor ovarian cancer surgery. Crit Rev Oncol Hematol 2020; 157:103128. [PMID: 33137578 DOI: 10.1016/j.critrevonc.2020.103128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/29/2020] [Accepted: 10/09/2020] [Indexed: 12/13/2022] Open
Abstract
In advanced ovarian cancer (AOC) the complete eradication of all macroscopic disease at primary debulking surgery (PDS) is associated with the best outcome. If this cannot be achieved, neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) can make complete cytoreduction possible while reducing postoperative morbidity. It is still debated if PDS and NACT- IDS are associated with similar survival and if they provide different outcomes when optimal cytoreduction is achieved. For a tailored surgical planning, accurate prediction of tumor's resectability, assessment of patient's performance status and in-depth knowledge of tumor biology are required. Both BRCA1/2 status and the "chemotherapy response score" are reliable markers of chemosensitivity and may thus improve our way to triage patients to PDS or NACT-IDS; furthermore, they could be used to modulate our surgical approach and define appropriate subgroups of patients for whom new therapies should be tested.
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Affiliation(s)
- Riccardo Ponzone
- Gynaecological Oncology, Candiolo Cancer Institute, FPO - IRCCS, Strada Provinciale 142, Km 3.95, 10060, Candiolo, Italy.
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Bååth M, Westbom-Fremer S, Martin de la Fuente L, Ebbesson A, Davis J, Malander S, Måsbäck A, Kannisto P, Hedenfalk I. SOX2 is a promising predictor of relapse and death in advanced stage high-grade serous ovarian cancer patients with residual disease after debulking surgery. Mol Cell Oncol 2020; 7:1805094. [PMID: 33235906 PMCID: PMC7671002 DOI: 10.1080/23723556.2020.1805094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The transcription factor SOX2 is a well-established and important stem cell marker. Its role in cancer biology remains unclear, but it has been proposed to also be a marker of cancer stem cells. We investigated the role of SOX2 protein expression in women with high-grade serous ovarian cancer (HGSOC) to determine its potential prognostic and treatment predictive value. We constructed a tissue microarray of 130 advanced stage HGSOC tumors with an average of 6 cores each, stained for SOX2 protein expression and evaluated survival outcomes. We also treated two HGSOC cell lines with carboplatin and paclitaxel and measured SOX2 expression by RT-PCR and immunoblotting at different doses and time-points. Among patients with non-radical debulking surgery overall and progression-free survival were shorter for patients with SOX2 positive tumors (mean 26 vs. 39 months, log-rank test: p = .0076, and mean 14 vs. 19 months, p = .055, respectively). Knockdown of SOX2 in cell lines did not affect growth inhibition following chemotherapy treatment. Our results show that SOX2 has a strong prognostic potential among HGSOC patients with residual tumor tissue after debulking surgery and suggest that SOX2 expressing cells remaining after non-radical debulking surgery may constitute a subpopulation of cancer stem cells with greater tumor-initiating potential.
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Affiliation(s)
- Maria Bååth
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Sofia Westbom-Fremer
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Surgical Pathology, Division of Laboratory Medicine, Skåne University Hospital, Lund, Sweden
| | | | - Anna Ebbesson
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Juliette Davis
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Susanne Malander
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anna Måsbäck
- Department of Surgical Pathology, Division of Laboratory Medicine, Skåne University Hospital, Lund, Sweden
| | - Päivi Kannisto
- Department of Obstetrics and Gynaecology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Ingrid Hedenfalk
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden
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Straubhar AM, Filippova OT, Cowan RA, Lakhman Y, Sarasohn DM, Nikolovski I, Torrisi JM, Ma W, Abu-Rustum NR, Gardner GJ, Sonoda Y, Zivanovic O, Chi DS, Long Roche K. A multimodality triage algorithm to improve cytoreductive outcomes in patients undergoing primary debulking surgery for advanced ovarian cancer: A Memorial Sloan Kettering Cancer Center team ovary initiative. Gynecol Oncol 2020; 158:608-613. [PMID: 32518012 PMCID: PMC7487016 DOI: 10.1016/j.ygyno.2020.05.041] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/26/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To describe outcomes using a multimodal algorithm to triage patients with advanced epithelial ovarian cancer (EOC) to primary debulking surgery (PDS) versus neoadjuvant chemotherapy (NACT). METHODS All patients with EOC treated at our institution from 04/2015-08/2018 were identified. We included patients without contraindication to PDS who underwent prospective calculation of a Resectability (R)-score. A low risk score for suboptimal cytoreduction was defined as ≤6, and a high risk score ≥7. Patients were triaged to laparotomy/PDS, laparoscopic evaluation of resectability (LSC), or NACT depending on R-score. RESULTS Among 299 participants, 226 (76%) had a low risk score and 73 (24%) a high risk score. For patients with a low risk score, management included laparotomy/PDS, 181 (80%); LSC, 43 (19%) (with subsequent triage: PDS, 31; NACT, 12); and NACT, 2 (1%). For patients with a high risk score, management included laparotomy/PDS, 9 (12%); LSC, 51 (70%) (with subsequent triage: PDS, 28; NACT, 23); and NACT, 13 (18%). Overall, 83% underwent PDS, with a 75% CGR rate and 94% optimal cytoreduction rate. Use of the algorithm resulted in a 31% LSC rate and a 6% rate of suboptimal PDS. CONCLUSIONS The multimodal algorithm led to excellent surgical results; 94% of patients achieved an optimal resection, with a very low rate of suboptimal cytoreduction.
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Affiliation(s)
- Alli M Straubhar
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Olga T Filippova
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Renee A Cowan
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Debra M Sarasohn
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ines Nikolovski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jean M Torrisi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Weining Ma
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics & Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Ginger J Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics & Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics & Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics & Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics & Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics & Gynecology, Weill Cornell Medical College, New York, NY, USA.
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Stachs A, Engel K, Stubert J, Reimer T, Gerber B, Dieterich M. The Significance of Preoperative Computed Tomography for Predicting Optimal Cytoreduction in Advanced Ovarian Cancer. Geburtshilfe Frauenheilkd 2020; 80:915-923. [PMID: 32905205 PMCID: PMC7467804 DOI: 10.1055/a-1226-6505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/21/2020] [Indexed: 10/31/2022] Open
Abstract
Introduction Optimal cytoreduction is the most important prognostic factor in advanced ovarian cancer. Although staging and assessment of operability are made by exploratory surgery, preoperative computed tomography (CT) of the abdomen is regarded as standard. The aim of this study was to examine various CT parameters with regard to prediction of optimal cytoreduction. Patients and Methods The retrospective study included 131 patients with ovarian cancer newly diagnosed between 2010 and 2014. Of these, n = 36 with FIGO stage I to IIB were excluded from the study. A preoperative abdominal CT was available for n = 75 of the 95 patients with FIGO stage IIC to IV. The CT scans underwent blinded review. The 11 evaluated CT parameters were examined by means of χ 2 test and logistic regression analysis with regard to the endpoints of macroscopic residual tumour and residual tumour > 1 cm. Survival analyses used the Kaplan-Meier method and log rank test. Results Of 75 patients, 28 (37.3%) had complete tumour resection and 26 (34.7%) had residual tumour ≤ 1 cm. Residual tumours > 1 cm were found in 21 (28%) patients, five of which were not resectable. Overall survival with residual tumour > 1 cm differed significantly from the group with no macroscopic residual tumour (p = 0.003) and with residual tumour ≤ 1 cm (p = 0.04). The CT parameters tumour foci in the diaphragm, mesocolon, greater omentum and peritoneum as well as ascites correlated with macroscopic residual tumour. In the multivariate logistic regression analysis only the CT parameter intraparenchymal liver metastasis was statistically significant with regard to prediction of suboptimal tumour resection (> 1 cm) (OR 8.04; 95% CI 1.57 - 42.4; p = 0.0134). The sensitivity, specificity, PPV and NPV were 37.5, 89.7, 66.7 and 72.2%. Conclusion Although risk parameters for suboptimal tumour reduction can be identified by CT of the abdomen, surgical exploration with histological confirmation of the diagnosis is essential because of the poor diagnostic accuracy.
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Affiliation(s)
- Angrit Stachs
- Gynäkologische Radiologie, University of Rostock, Rostock, Germany
| | | | - Johannes Stubert
- Universitätsfrauenklinik, University of Rostock, Rostock, Germany
| | - Toralf Reimer
- Universitätsfrauenklinik, University of Rostock, Rostock, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik, University of Rostock, Rostock, Germany
| | - Max Dieterich
- Universitätsfrauenklinik, University of Rostock, Rostock, Germany
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Reverdy T, Sajous C, Péron J, Glehen O, Bakrin N, Gertych W, Lopez J, You B, Freyer G. Front-Line Maintenance Therapy in Advanced Ovarian Cancer-Current Advances and Perspectives. Cancers (Basel) 2020; 12:E2414. [PMID: 32854393 PMCID: PMC7564452 DOI: 10.3390/cancers12092414] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 12/27/2022] Open
Abstract
Ovarian tumor is the gynecological cancer associated with the highest mortality. Most diseases are diagnosed at an advanced stage, which impairs the chances of prolonged complete remission. The standard front-line treatment of advanced stages combines surgery in an expert center with platinum-based chemotherapy. Most patients experience a relapse in the years following the initial treatment. During the last decade, anti-angiogenic agents used in the maintenance setting improved progression free survival (PFS) over chemotherapy alone. More recently, PARP inhibitors demonstrated substantial efficacy, mainly in patients with germinal or somatic BRCA mutations or other homologous recombination deficiencies (HRD), all involved in double strand DNA Damage Repair (DDR). Other therapeutic paradigms are currently being explored, including combinations of immune-checkpoints inhibitors, chemotherapy, bevacizumab and PARP inhibitors. In addition to these clinical advances, molecular characterization of the tumors and their correlations with drugs efficacy are needed to better understand which patient will benefit the most from the various treatments available to date.
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Affiliation(s)
- Thibaut Reverdy
- Oncology Department, Hôpital Lyon Sud, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL) and Université de Lyon, 69310 Lyon, France; (C.S.); (J.P.); (B.Y.); (G.F.)
| | - Christophe Sajous
- Oncology Department, Hôpital Lyon Sud, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL) and Université de Lyon, 69310 Lyon, France; (C.S.); (J.P.); (B.Y.); (G.F.)
| | - Julien Péron
- Oncology Department, Hôpital Lyon Sud, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL) and Université de Lyon, 69310 Lyon, France; (C.S.); (J.P.); (B.Y.); (G.F.)
| | - Olivier Glehen
- Departement of Surgical Oncology, Centre Hospitalier Lyon-Sud, 69310 Lyon, France; (O.G.); (N.B.)
- EA CICLY, Lyon 1 University, 69310 Lyon, France;
| | - Naoual Bakrin
- Departement of Surgical Oncology, Centre Hospitalier Lyon-Sud, 69310 Lyon, France; (O.G.); (N.B.)
- EA CICLY, Lyon 1 University, 69310 Lyon, France;
| | - Witold Gertych
- EA CICLY, Lyon 1 University, 69310 Lyon, France;
- Department of Gynecological Surgery, Centre Hospitalier Lyon-Sud, 69310 Lyon, France
| | - Jonathan Lopez
- Biochemistry and Molecular Biology Department, Hopital Lyon Sud, Hospices Civils de Lyon, 69310 Lyon, France;
| | - Benoit You
- Oncology Department, Hôpital Lyon Sud, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL) and Université de Lyon, 69310 Lyon, France; (C.S.); (J.P.); (B.Y.); (G.F.)
- EA CICLY, Lyon 1 University, 69310 Lyon, France;
| | - Gilles Freyer
- Oncology Department, Hôpital Lyon Sud, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL) and Université de Lyon, 69310 Lyon, France; (C.S.); (J.P.); (B.Y.); (G.F.)
- EA CICLY, Lyon 1 University, 69310 Lyon, France;
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Gac MM, Loaec C, Silve J, Vaucel E, Augereau P, Wernert R, Bourgin C, Aireau X, Lortholary A, Descamps P, Priou F, Deblaye P, Bourgeois H, Delecroix V, Empereur F, Campion L, Classe JM. Quality of advanced ovarian cancer surgery: A French assessment of ESGO quality indicators. Eur J Surg Oncol 2020; 47:360-366. [PMID: 32863097 DOI: 10.1016/j.ejso.2020.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/28/2020] [Accepted: 08/05/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES In 2016, the European Society of Gynecology Oncology (ESGO) published indicators defining the quality of surgical management of advanced ovarian cancer. The objective of the study was to assess the quality of ovarian cancer patient management in regional centers authorized for gynecological cancer, based on the ESGO list of quality indicators. METHODS A multicenter retrospective observational cohort study was conducted from January 1 to June 30, 2016. The following quality indicators 1 "rate of complete surgical resection", 4 "center participating in clinical trials in gynecologic oncology", 5 "treatment planned and reviewed at a multidisciplinary team meeting", 6 "required preoperative workup", 8 "minimum required elements in operative reports" and 9 "minimum required elements in pathology reports" were selected. RESULTS 91 patients were evaluated in 16 centers. The required preoperative workup was incomplete in 25% of cases. Treatment was not planned at a multidisciplinary team meeting for 24%. An evaluation score of peritoneal involvement was included in 40% of the operative reports and the quality of surgical resection was reported in 72%. Primary surgery was most often performed in a peripheral hospital (48%), interval surgery in a private center (37%), and closure surgery in a regional cancer center (43%). No institution respected the six quality indicators evaluated. One regional cancer center respected five items and two private centers did not respect any. CONCLUSION Whilst the ESGO quality indicators provide objective, validated and evaluable support which centers can use to improve quality of care, we observed heterogeneous practices amongst the centers evaluated.
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Affiliation(s)
- Marie-Mélanie Gac
- Department of Surgical Oncology, Institut Cancérologie de L'Ouest, Nantes, Saint Herblain, France
| | - Cécile Loaec
- Department of Surgical Oncology, Institut Cancérologie de L'Ouest, Nantes, Saint Herblain, France.
| | - Johanna Silve
- Onco Pays de La Loire, Plateau des écoles, 50 Route de Saint-Sébastien, 44093, Nantes, France
| | - Edouard Vaucel
- Department of Obstetrics and Gynecology, CHU de Nantes, France
| | - Paule Augereau
- Department of Medical Oncology, Institut de Cancérologie de L'Ouest, Angers, France
| | - Romuald Wernert
- Department of Surgical Oncology, Institut de Cancérologie de L'Ouest, Angers, France
| | - Charlotte Bourgin
- Department of Surgical Oncology, Institut Cancérologie de L'Ouest, Nantes, Saint Herblain, France
| | - Xavier Aireau
- Department of Obstetrics and Gynecology, Centre Hospitalier de Cholet, France
| | - Alain Lortholary
- Confluent Private Hospital, Institut de Cancérologie Catherine de Sienne, Nantes, France
| | | | - Frank Priou
- CHD Vendee-Hopital Les Oudairies, La Roche Sur Yon, France
| | | | - Hugues Bourgeois
- Department of Medical Oncology, Clinique Victor Hugo, Le Mans, France
| | | | - Fabienne Empereur
- Onco Pays de La Loire, Plateau des écoles, 50 Route de Saint-Sébastien, 44093, Nantes, France
| | - Loïc Campion
- Biometrics, Institut de Cancérologie de L'Ouest, Centre René Gauducheau, Saint-Herblain, France; CRCINA, University of Nantes, INSERM UMR1232, CNRS-ERL6001, Nantes, France
| | - Jean-Marc Classe
- Department of Surgical Oncology, Institut Cancérologie de L'Ouest, Nantes, Saint Herblain, France
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Luyckx A, Wyckmans L, Bonte AS, Trinh XB, van Dam PA. Acceptability of quality indicators for the management of endometrial, cervical and ovarian cancer: results of an online survey. BMC Womens Health 2020; 20:151. [PMID: 32703282 PMCID: PMC7376904 DOI: 10.1186/s12905-020-00999-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/18/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Measuring quality indicators (QI's) is a tool to improve the quality of care. The aim of this study was to evaluate the acceptability of 36 QI's, defined after a literature search for the management of endometrial, cervical and ovarian cancer. Relevant specialists in the field of interest were surveyed. METHODS To quantify the opinions of these specialists, an online survey was sent out via mailing to members of gynaecological or oncological societies. The relevance of each QI was questioned on a scale from one to five (1 = irrelevant, 2 = less relevant, 3 = no opinion/neutral, 4 = relevant, 5 = very relevant). If a QI received a score of 4 or 5 in 65% or more of the answers, we state that the respondents consider this QI to be sufficiently relevant to use in daily practice. RESULTS The survey was visited 238 times and resulted in 53 complete responses (29 Belgian, 24 other European countries). The majority of the specialists were gynaecologists (45%). Five of the 36 QI's (13,9%) did not reach the cut-off of 65%: referral to a tertiary center, preoperative staging of endometrial cancer by MRI, preoperative staging of cervical cancer by positron-emission tomography, incorporation of intracavitary brachytherapy in the treatment of cervical cancer, reporting ASA and WHO score for each patient. After removing the 5 QI's that were not considered as relevant by the specialists and 3 additional 3 QI's that we were considered to be superfluous, we obtained an optimized QI list. CONCLUSION As QI's gain importance in gynecological oncology, their use can only be of value if they are universally interpreted in the same manner. We propose an optimized list of 28 QI's for the management of endometrial, cervical and ovarian cancer which responders of our survey found relevant. Further validation is needed to finalize and define a set of QI's that can be used in future studies, audits and benchmarking.
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Affiliation(s)
- Annemie Luyckx
- Multidisciplinary Oncologic Centre Antwerp (MOCA), Antwerp University Hospital, Wilrijkstraat 10, B2650, Edegem, Belgium
| | - Leen Wyckmans
- Multidisciplinary Oncologic Centre Antwerp (MOCA), Antwerp University Hospital, Wilrijkstraat 10, B2650, Edegem, Belgium
| | - Anne-Sophie Bonte
- Multidisciplinary Oncologic Centre Antwerp (MOCA), Antwerp University Hospital, Wilrijkstraat 10, B2650, Edegem, Belgium
| | - Xuan Bich Trinh
- Multidisciplinary Oncologic Centre Antwerp (MOCA), Antwerp University Hospital, Wilrijkstraat 10, B2650, Edegem, Belgium
- Centre for Oncological Research (CORE), University of Antwerp, B2610, Wilrijk, Belgium
| | - Peter A van Dam
- Multidisciplinary Oncologic Centre Antwerp (MOCA), Antwerp University Hospital, Wilrijkstraat 10, B2650, Edegem, Belgium.
- Centre for Oncological Research (CORE), University of Antwerp, B2610, Wilrijk, Belgium.
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Rethinking Radical Surgery in Interval Debulking Surgery for Advanced-Stage Ovarian Cancer Patients Undergoing Neoadjuvant Chemotherapy. J Clin Med 2020; 9:jcm9041235. [PMID: 32344611 PMCID: PMC7231092 DOI: 10.3390/jcm9041235] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/13/2020] [Accepted: 04/22/2020] [Indexed: 01/11/2023] Open
Abstract
The aim of this study is to evaluate the effects on survival outcomes of the disease burden before interval debulking surgery (IDS), surgical complexity, and residual disease after IDS in advanced-stage ovarian cancer treated with neoadjuvant chemotherapy (NAC). We reviewed the data of 268 epithelial ovarian cancer patients who had received three or four cycles of NAC and undergone optimal resections through IDS. The Kaplan–Meier method and Cox regression analysis were used to assess the effects of disease burden (peritoneal cancer index (PCI)), degree of complexity of surgery (surgical complexity score/s (SCS)), and extent of residual disease. In no residual disease (R0) patients, those with intermediate/high SCS had shorter progression-free survival (PFS; p = 0.001) and overall survival (OS; p = 0.001) than patients with low SCS. An analysis of a subset of patients with R0 and low PCIs showed those with intermediate/high SCS had worse PFS and OS than patients with low SCS (p = 0.049) and OS (p = 0.037). In multivariate analysis, patients with R0 as a result of intermediate/high SCS fared worse than patients whose R0 was achieved by low SCS (PFS hazard ratio (HR) 1.80, 95% CI 1.05–3.10; OS HR 5.59, 95% CI 1.70–18.39). High PCIs at the time of IDS, high SCS, and residual disease signal poor prognoses for patients treated with NAC.
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Narasimhulu DM, Kumar A, Weaver AL, Langstraat CL, Cliby WA. Less guessing, more evidence in identifying patients least fit for cytoreductive surgery in advanced ovarian cancer: A triage algorithm to individualize surgical management. Gynecol Oncol 2020; 157:572-577. [PMID: 32247602 DOI: 10.1016/j.ygyno.2020.03.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/20/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE We previously reported an algorithm that identifies women at high risk of postoperative morbidity & mortality (M/M) as a tool to triage between neoadjuvant chemotherapy and primary surgery for epithelial ovarian cancer (EOC). We sought to independently validate its performance using multicenter data. METHODS Women who underwent surgery for stage IIIC/IV EOC between 1/1/2014 and 12/31/2017 were identified from the National Surgical Quality Improvement Program database and classified as "high risk" or "triage appropriate" using our algorithm. Outcomes were compared between triage appropriate and high-risk women using the chi-square test. RESULTS 1777 women met inclusion criteria; the mean age was 62.6 years and 81.9% had stage IIIC disease. Nationally, the surgical complexity scores were low (69.8% low, 25.2% intermediate and 5.0% high). "High risk" women had 2-fold higher rate of severe 30-day complication or death (6.2% vs 3.5%; p = 0.01), a 3-fold higher rate of 30-day mortality (1.4% vs 0.5%; p = 0.08), and a higher risk of death following a severe complication (11.1% vs. 0%, p = 0.11). A sensitivity analysis excluding women with unknown albumin who didn't meet other high risk criteria showed similar results: severe 30-day complications or death (6.2% vs 3.5%; p = 0.02) and 30-day mortality (1.4% vs 0.3%; p = 0.04) for "high risk" vs "triage appropriate" women. CONCLUSIONS Primary cytoreductive surgery to minimal residual disease remains the goal for EOC. We verify that our algorithm can identify women at risk of M/M using national multicenter data, despite a low complexity surgical setting and using 30-day mortality (vs. 90-day). Objective surgical risk assessment for ovarian cancer should be standard of care and can be incorporated into practice using the Mayo triage algorithm.
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Affiliation(s)
- Deepa Maheswari Narasimhulu
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Amanika Kumar
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Amy L Weaver
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Carrie L Langstraat
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - William A Cliby
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States.
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Muallem MZ, Sehouli J, Miranda A, Richter R, Muallem J. Total retroperitoneal en bloc resection of multivisceral-peritoneal packet (TROMP operation): a novel surgical technique for advanced ovarian cancer. Int J Gynecol Cancer 2020; 30:648-653. [PMID: 32221020 DOI: 10.1136/ijgc-2019-001161] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND A Total Retroperitoneal en bloc resection Of Multivisceral-Peritoneal packet (TROMP operation) is a no-touch isolation technique in a retroperitoneal space to resect the parietal peritoneum and the affected organs in advanced ovarian cancer. The study prescribed and analysed the results of this novel technique for primary cytoreductive surgery. METHODS The study included 208 patients operated between January 2015 and December 2017 in Charité, Berlin. The TROMP operation was performed in 58 patients, whereas the other 150 patients were operated with the conventional cytoreductive method. RESULTS The complete tumor resection rate accounts for 87.9% in TROMP group and 61.3% in the conventional surgery group. (p=0.001). This difference was even stronger in the sub-group of very advanced stages (T3c+T4) (85.1% of TROMP group and in only 53.1% in the conventional surgery group, p=0.001). The duration of the primary cytoreductive surgery was about 33 minutes shorter in TROMP group (median: 335 minutes vs 368 minutes; TROMP vs conventional, respectively) in spite of the fact that the most advanced cytoreductive procedures were performed statically significant more in TROMP operation arm in comparison with the conventional surgery arm. There was no statistically significant difference between the groups regarding the postoperative complication, blood loss or the length of stay in intensive care unit. CONCLUSION Total retroperitoneal en bloc resection of multivisceral-peritoneal packet (TROMP operation) is a feasible and very effective technique of surgical therapy in advanced ovarian cancer. This technique increased the complete tumor resection rate to 87.9% without increasing the blood loss, postoperative complications or the duration of surgery. A prospective randomized study is advised to validate these results.
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Affiliation(s)
- Mustafa Zelal Muallem
- Department of Gynecology with Center for Oncological Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Virchow Campus Clinic, Charité Medical University, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Virchow Campus Clinic, Charité Medical University, Berlin, Germany
| | - Andrea Miranda
- Ovarian Cancer Tumor Bank, Virchow Campus Clinic, Charité Medical University, Berlin, Germany
| | - Rolf Richter
- Department of Gynecology with Center for Oncological Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Virchow Campus Clinic, Charité Medical University, Berlin, Germany
| | - Jumana Muallem
- Department of Gynecology with Center for Oncological Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Virchow Campus Clinic, Charité Medical University, Berlin, Germany.,Ovarian Cancer Tumor Bank, Virchow Campus Clinic, Charité Medical University, Berlin, Germany
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Steinberga I, Jansson K, Sorbe B. Quality Indicators and Survival Outcome in Stage IIIB-IVB Epithelial Ovarian Cancer Treated at a Single Institution. In Vivo 2020; 33:1521-1530. [PMID: 31471400 DOI: 10.21873/invivo.11632] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/28/2019] [Accepted: 07/03/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND/AIM To investigate the overall survival rate, quality indicators and treatment outcome in FIGO stage IIIB-IVB epithelial ovarian cancer at a University Hospital in Sweden between 2006 and 2015. MATERIALS AND METHODS A cohort of 110 patients was followed-up for 3-12 years after cancer diagnosis. Three main groups (primary surgery, neoadjuvant chemotherapy, palliative treatment), and six subgroups were defined according to treatment modality. RESULTS The mean age was 65 years. Patients were observed for a mean of 50 months. The total resection frequency was 83%. Significant differences in overall survival at 5 years were observed between the groups varying from 60% to 12%. CONCLUSION Patient age, tumor stage and complete tumor removal at surgery were significant, independent prognostic factors of overall survival. Complication rate was a significant adverse prognostic factor in univariate analysis. Data discrepancy was observed between public quality reports and locally obtained data.
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Affiliation(s)
- Inga Steinberga
- Department of Obstetrics and Gynecology, Orebro University Hospital, Orebro, Sweden
| | - Kjell Jansson
- Department of Surgery, Orebro University Hospital, Orebro, Sweden
| | - Bengt Sorbe
- Department of Oncology, Orebro University Hospital, Orebro, Sweden
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Nishikimi K, Tate S, Matsuoka A, Shozu M. Learning curve of high-complexity surgery for advanced ovarian cancer. Gynecol Oncol 2020; 156:54-61. [DOI: 10.1016/j.ygyno.2019.10.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 10/29/2019] [Accepted: 10/31/2019] [Indexed: 12/20/2022]
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Factors associated with surgical morbidity of primary debulking in epithelial ovarian cancer. Obstet Gynecol Sci 2019; 63:64-71. [PMID: 31970129 PMCID: PMC6962589 DOI: 10.5468/ogs.2020.63.1.64] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/04/2019] [Accepted: 09/09/2019] [Indexed: 12/16/2022] Open
Abstract
Objective Epithelial ovarian cancer (EOC) requires an aggressive surgical approach. The important part of literature on ovarian cancer surgery emphasize residual tumor and survival analyses. Morbidity issue keeps in background. Therefore, we aimed to report on morbidity of cytoreductive surgery for EOC in this study. Methods EOC patients who underwent primary debulking were evaluated. Intraoperative and postoperative complications that occurred within 30 days after the surgery and factors that affect morbidity were considered. Results The study involved 359 patients. Forty-six intraoperative complications occurred in 42 (11.6%) patients. Advanced stage and cancer antigen level of 125 were independently and significantly associated with operative complications (hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.01–2,73; P=0.044, and HR, 1.47; 95% CI, 1.05–2.06; P=0.025, respectively). The need for intensive care unit admission was significantly higher in patients with intraoperative complications (28.6% vs. 8.8%, P=0.001). Intraoperative and postoperative complication rates were significantly higher in extended surgery than in standard surgery (18.9%vs. 8.5%, P=0.005 and 38.7% vs. 10.9%, P<0.001, respectively). Intraoperative and postoperative transfusion need, hospital stay duration, and chemotherapy start day were also significantly higher in extended surgery than in standard surgery. Hundred postoperative complications occurred in 70 patients. Age, extended surgery, presence of ascites, and presence of operative complications were independently and significantly associated with postoperative complications. Conclusion Morbidity of extensive surgical approach should be kept in mind in ovarian cancer surgery aimed at leaving no residual tumor. Patient-based management with an appropriate preoperative evaluation may avoid morbidity of extended/extensive surgical approaches.
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Liberale G, Pop CF, Polastro L, Kerger J, Moreau M, Chintinne M, Larsimont D, Nogaret JM, Veys I. A radical approach to achieve complete cytoreductive surgery improve survival of patients with advanced ovarian cancer. J Visc Surg 2019; 157:79-86. [PMID: 31837942 DOI: 10.1016/j.jviscsurg.2019.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Cytoreductive surgery of locally advanced ovarian cancer has evolved in the last few years from surgery to remove macroscopic residual disease (<1cm; R2b) to macroscopic complete cytoreductive surgery with no gross residual disease (R1). The aim of this study was to evaluate the impact of the adoption of a maximalist surgical approach on postoperative complications, disease recurrence and survival. MATERIALS AND METHODS This was a retrospective study using prospectively collected data on patients who received either conservative approach (CA) or radical approach (RA) surgical treatment for primary ovarian cancer stage IIIc/IVa/IVb between June 2006 and June 2013. RESULTS Data for 114 patients were included, 33 patients in the CA group and 68 patients in the RA group were consequently analysed. In the RA group, operative time was longer, in relation to more complex surgical procedures; with more blood losses and a higher rate of compete macroscopic resection. Totally, 77% of the patients had postoperative complications, with more grade I/II complications in the RA group but the same rates of grade III/IV complications in the both groups (P=0.14). For all patient study population, the overall and disease-free survivals were improved in case of no macroscopic residual disease. Overall survival was improved in the RA group (P=0.05), with no difference in terms of disease-free survival (P=0.29) CONCLUSION: A radical approach in advanced ovarian cancer allows a higher rate of complete cytoreductive surgery impacting overall survival. However, a non-significant trend for increased mild complications (grade I/II) rate is observed in this group.
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Affiliation(s)
- G Liberale
- Surgical Oncology, Institut Jules-Bordet, Université libre de Bruxelles, 121, boulevard de Waterloo, 1000 Brussels, Belgium.
| | - C-F Pop
- Surgical Oncology, Institut Jules-Bordet, Université libre de Bruxelles, 121, boulevard de Waterloo, 1000 Brussels, Belgium
| | - L Polastro
- Medical Oncology, Institut Jules-Bordet, Université libre de Bruxelles, 1000 Brussels, Belgium
| | - J Kerger
- Medical Oncology, Institut Jules-Bordet, Université libre de Bruxelles, 1000 Brussels, Belgium
| | - M Moreau
- Statistics Department, Institut Jules-Bordet, Université libre de Bruxelles, 1000 Brussels, Belgium
| | - M Chintinne
- Pathology Department, Institut Jules-Bordet, Université libre de Bruxelles, 1000 Brussels, Belgium
| | - D Larsimont
- Pathology Department, Institut Jules-Bordet, Université libre de Bruxelles, 1000 Brussels, Belgium
| | - J M Nogaret
- Surgical Oncology, Institut Jules-Bordet, Université libre de Bruxelles, 121, boulevard de Waterloo, 1000 Brussels, Belgium
| | - I Veys
- Surgical Oncology, Institut Jules-Bordet, Université libre de Bruxelles, 121, boulevard de Waterloo, 1000 Brussels, Belgium
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Feasibility of a large multi-center translational research project for newly diagnosed breast and ovarian cancer patients with affiliated biobank: the BRandO biology and outcome (BiO)-project. Arch Gynecol Obstet 2019; 301:273-281. [PMID: 31781887 DOI: 10.1007/s00404-019-05395-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Large translational research projects may contribute to further progress in cancer treatment by exploring molecular biology, immunologic approaches and identification of new prognostic and predictive factors. Therefore, the BRandOBio-project combines a clinical registry for collection of patient and tumor characteristics with a biobank comprising tumor and liquid biopsies. In addition, sociodemographic, environmental and lifestyle factors of included patients with primary newly diagnosed breast or ovarian cancer, other rare malignant ovarian tumors or gestational trophoblastic disease are prospectively collected. METHODS The target population includes the German "Alb-Allgäu-Bodensee Region" which constitutes the outreach area of the University Hospital Ulm with affiliated academic centers and private practices. Clinical data combined with primary tumor tissue samples and longitudinal repeatedly collected blood samples [before, 6 (in high-risk situations), 12, 36 and 60 months after treatment and at relapse] will be acquired from more than 4000 patients within the next years. Standardized questionnaires are given to patients of the University Hospital Ulm and eight selected external sites for assessing life style and cancer risk factors. Concomitantly, storage of paraffin-embedded tumor samples as well as liquid biopsy samples will allow translational research projects, for example in terms of investigating circulating DNA and germ line DNA from cell pellets. RESULTS Starting in January 2016 at the University Hospital Ulm, 19 additional external sites started recruiting patients in March 2017. As of September 15th 2019, 2151 patients with newly diagnosed cancers could be recruited (2044 breast cancer; 107 ovarian cancer). Nearly all patients provided biological samples (tumor and liquid biopsy) and about 80% returned the standardized questionnaire. After 1 year follow-up, blood samples were available from more than 80% of the participating patients. CONCLUSIONS The BRandO BIO study is a large prospective cohort study with integrated comprehensive biobank and evaluation of sociodemographic and life style factors of gynecological cancer patients in a well-defined geographical area in the South West of Germany. Continuous high patient recruitment and stable rates over 80% for returned questionnaires as well as for repeated blood sampling show high acceptance of the BRandO study program and confirms feasibility of the project.
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De Jaeghere EA, Gremonprez FB, Tummers PG, Willaert WC, Ceelen WP, Amant FC, Denys HG. Treatment of Ovarian Cancer With Intraperitoneal Platinum: Heating Up the Debate. J Clin Oncol 2019; 37:3169-3170. [PMID: 31553679 DOI: 10.1200/jco.19.01179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Emiel A De Jaeghere
- Emiel A. De Jaeghere, MD; Félix B. Gremonprez, MD, PhD; Philippe G. Tummers, MD, PhD; Wouter C. Willaert, MD, PhD; and Wim P. Ceelen, MD, PhD, Ghent University Hospital, Ghent, Belgium; Frédéric C. Amant, MD, PhD, Netherlands Cancer Institute, Amsterdam, the Netherlands; and Hannelore G. Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium
| | - Félix B Gremonprez
- Emiel A. De Jaeghere, MD; Félix B. Gremonprez, MD, PhD; Philippe G. Tummers, MD, PhD; Wouter C. Willaert, MD, PhD; and Wim P. Ceelen, MD, PhD, Ghent University Hospital, Ghent, Belgium; Frédéric C. Amant, MD, PhD, Netherlands Cancer Institute, Amsterdam, the Netherlands; and Hannelore G. Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium
| | - Philippe G Tummers
- Emiel A. De Jaeghere, MD; Félix B. Gremonprez, MD, PhD; Philippe G. Tummers, MD, PhD; Wouter C. Willaert, MD, PhD; and Wim P. Ceelen, MD, PhD, Ghent University Hospital, Ghent, Belgium; Frédéric C. Amant, MD, PhD, Netherlands Cancer Institute, Amsterdam, the Netherlands; and Hannelore G. Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium
| | - Wouter C Willaert
- Emiel A. De Jaeghere, MD; Félix B. Gremonprez, MD, PhD; Philippe G. Tummers, MD, PhD; Wouter C. Willaert, MD, PhD; and Wim P. Ceelen, MD, PhD, Ghent University Hospital, Ghent, Belgium; Frédéric C. Amant, MD, PhD, Netherlands Cancer Institute, Amsterdam, the Netherlands; and Hannelore G. Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium
| | - Wim P Ceelen
- Emiel A. De Jaeghere, MD; Félix B. Gremonprez, MD, PhD; Philippe G. Tummers, MD, PhD; Wouter C. Willaert, MD, PhD; and Wim P. Ceelen, MD, PhD, Ghent University Hospital, Ghent, Belgium; Frédéric C. Amant, MD, PhD, Netherlands Cancer Institute, Amsterdam, the Netherlands; and Hannelore G. Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium
| | - Frédéric C Amant
- Emiel A. De Jaeghere, MD; Félix B. Gremonprez, MD, PhD; Philippe G. Tummers, MD, PhD; Wouter C. Willaert, MD, PhD; and Wim P. Ceelen, MD, PhD, Ghent University Hospital, Ghent, Belgium; Frédéric C. Amant, MD, PhD, Netherlands Cancer Institute, Amsterdam, the Netherlands; and Hannelore G. Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium
| | - Hannelore G Denys
- Emiel A. De Jaeghere, MD; Félix B. Gremonprez, MD, PhD; Philippe G. Tummers, MD, PhD; Wouter C. Willaert, MD, PhD; and Wim P. Ceelen, MD, PhD, Ghent University Hospital, Ghent, Belgium; Frédéric C. Amant, MD, PhD, Netherlands Cancer Institute, Amsterdam, the Netherlands; and Hannelore G. Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium
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Muallem MZ, Sehouli J, Richter R, Babayeva A, Gasimli K, Parashkevova A. Pre-operative serum CA125, peritoneal cancer index and intra-operative mapping score as predictors of surgical results in primary epithelial ovarian cancer. Int J Gynecol Cancer 2019; 30:62-66. [DOI: 10.1136/ijgc-2019-000778] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/23/2019] [Accepted: 09/26/2019] [Indexed: 01/01/2023] Open
Abstract
ObjectivePrediction of post-operative residual disease after ovarian cancer cytoreductive surgery remains a topic of interest to gynecologic oncologists. The aim of this study was to explore the correlation between serum CA125, peritoneal cancer index, and intra-operative mapping of ovarian cancer and their predictive value for post-operative outcome.MethodsA total of 70 patients with primary epithelial ovarian cancer, who underwent primary cytoreductive surgery at Charité, Berlin between January 2013 and February 2014 were included. In all patients, pre-operative CA125 values, intra-operative peritoneal cancer index, and intra-operative mapping of ovarian cancer were determined.ResultsUsing a receiver operating characteristic analysis, cut-off values for CA125, peritoneal cancer index, and intra-operative mapping of ovarian cancer score could be defined. Patients with pre-operative serum CA125 >600 U/mL had a three times higher risk for residual tumor after primary cytoreductive surgery (p=0.037). A peritoneal cancer index score >20 indicated a nine times increased risk for residual tumor (p=0.003). More than six affected abdominopelvic fields on the intra-operative mapping of ovarian cancer was associated with a 25 times higher risk of residual tumor after primary cytoreductive surgery (p≤0.05). The combination of all three values predicted residual tumor in up to 90% of patients.ConclusionWe found that pre-operative CA125 >600 U/mL, peritoneal cancer index >20, and intra-operative mapping of ovarian cancer score >6 could be used as predictors of complete tumor resection. The combination of all these three values predicted the incomplete resection of disease in up to 90% of patients even in experienced centers.
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