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Dahm-Kähler P, Rådestad AF, Holmberg E, Borgfeldt C, Bjurberg M, Sköld C, Hellman K, Kjølhede P, Stålberg K, Åvall-Lundqvist E. Has time to chemotherapy from primary debulking surgery in advanced ovarian cancer an impact on survival? - A population-based nationwide SweGCG study. Gynecol Oncol 2024; 186:69-76. [PMID: 38603954 DOI: 10.1016/j.ygyno.2024.03.011] [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: 12/22/2023] [Revised: 02/29/2024] [Accepted: 03/12/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE The aim of the study was to investigate if time to start chemotherapy (TTC) after primary debulking surgery (PDS) impacted relative survival (RS) in advanced epithelial ovarian/fallopian tube/primary peritoneal cancer (EOC). METHODS Nationwide population-based study of women with EOC FIGO stages IIIC-IV, registered 2008-2018 in the Swedish Quality Register for Gynecologic Cancer, treated with PDS and chemotherapy. TTC was categorized into; ≤21 days, 22-28 days, 29-35 days, 36-42 days and > 42 days. Relative survival (RS) was estimated using the Pohar-Perme estimate of net survival. Multivariable analyses of excess mortality rate ratios (EMRRs) were estimated by Poisson regression models. RESULTS In total, 1694 women were included. The median age was 65.0 years. Older age and no residual disease were more common in TTC >42 days than 0-21 days. The RS at 5-years was 37.9% and did not differ between TTC groups. In the R0 (no residual disease) cohort (n = 806), 2-year RS was higher in TTC ≤21 days (91.6%) and 22-28 days (91.4%) than TTC >42 days (79.1%). TTC >42 days (EMRR 2.33, p = 0.026), FIGO stage IV (EMRR 1.83, p = 0.007) and non-serous histology (EMRR 4.20, p < 0.001) were associated with 2-year worse excess mortality compared to TTC 0-21 days, in the R0 cohort. TTC was associated with 2-year survival in the R0 cohort in FIGO stage IV but not in stage IIIC. TTC was not associated with RS in patients with residual disease. CONCLUSIONS For the entire cohort, stage IV, non-serous morphology and residual disease, but not TTC, influenced 5-year relative survival. However, longer TTC was associated with a poorer 2-year survival for those without residual disease after PDS.
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Affiliation(s)
- Pernilla Dahm-Kähler
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Regional Cancer Center Western Sweden, Gothenburg, Sweden.
| | - Angelique Flöter Rådestad
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institute, and Department of Hereditary Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Holmberg
- Regional Cancer Center Western Sweden, Gothenburg, Sweden
| | - Christer Borgfeldt
- Department of Obstetrics and Gynecology, Skåne University Hospital, and Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Maria Bjurberg
- Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden
| | - Camilla Sköld
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Kristina Hellman
- Department of Gynecologic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Preben Kjølhede
- Department of Obstetrics and Gynecology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Karin Stålberg
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Elisabeth Åvall-Lundqvist
- Department of Oncology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Miceli V, Gennarini M, Tomao F, Cupertino A, Lombardo D, Palaia I, Curti F, Riccardi S, Ninkova R, Maccioni F, Ricci P, Catalano C, Rizzo SMR, Manganaro L. Imaging of Peritoneal Carcinomatosis in Advanced Ovarian Cancer: CT, MRI, Radiomic Features and Resectability Criteria. Cancers (Basel) 2023; 15:5827. [PMID: 38136373 PMCID: PMC10741537 DOI: 10.3390/cancers15245827] [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: 10/27/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
PC represents the most striking picture of the loco-regional spread of ovarian cancer, configuring stage III. In the last few years, many papers have evaluated the role of imaging and therapeutic management in patients with ovarian cancer and PC. This paper summed up the literature on traditional approaches to the imaging of peritoneal carcinomatosis in advanced ovarian cancer, presenting classification systems, most frequent patterns, routes of spread and sites that are difficult to identify. The role of imaging in diagnosis was investigated, with particular attention to the reported sensitivity and specificity data-computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography-CT (PET-CT)-and to the peritoneal cancer index (PCI). In addition, we explored the therapeutic possibilities and radiomics applications that can impact management of patients with ovarian cancer. Careful staging is mandatory, and patient selection is one of the most important factors influencing complete cytoreduction (CCR) outcome: an accurate pre-operative imaging may allow selection of patients that may benefit most from primary cytoreductive surgery.
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Affiliation(s)
- Valentina Miceli
- Department of Radiological, Oncology and Patological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy; (V.M.); (M.G.); (A.C.); (D.L.); (F.C.); (S.R.); (R.N.); (F.M.); (P.R.); (C.C.)
| | - Marco Gennarini
- Department of Radiological, Oncology and Patological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy; (V.M.); (M.G.); (A.C.); (D.L.); (F.C.); (S.R.); (R.N.); (F.M.); (P.R.); (C.C.)
| | - Federica Tomao
- Department of Gynecological, Obstetrical and Urological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy; (F.T.); (I.P.)
| | - Angelica Cupertino
- Department of Radiological, Oncology and Patological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy; (V.M.); (M.G.); (A.C.); (D.L.); (F.C.); (S.R.); (R.N.); (F.M.); (P.R.); (C.C.)
| | - Dario Lombardo
- Department of Radiological, Oncology and Patological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy; (V.M.); (M.G.); (A.C.); (D.L.); (F.C.); (S.R.); (R.N.); (F.M.); (P.R.); (C.C.)
| | - Innocenza Palaia
- Department of Gynecological, Obstetrical and Urological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy; (F.T.); (I.P.)
| | - Federica Curti
- Department of Radiological, Oncology and Patological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy; (V.M.); (M.G.); (A.C.); (D.L.); (F.C.); (S.R.); (R.N.); (F.M.); (P.R.); (C.C.)
| | - Sandrine Riccardi
- Department of Radiological, Oncology and Patological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy; (V.M.); (M.G.); (A.C.); (D.L.); (F.C.); (S.R.); (R.N.); (F.M.); (P.R.); (C.C.)
| | - Roberta Ninkova
- Department of Radiological, Oncology and Patological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy; (V.M.); (M.G.); (A.C.); (D.L.); (F.C.); (S.R.); (R.N.); (F.M.); (P.R.); (C.C.)
| | - Francesca Maccioni
- Department of Radiological, Oncology and Patological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy; (V.M.); (M.G.); (A.C.); (D.L.); (F.C.); (S.R.); (R.N.); (F.M.); (P.R.); (C.C.)
| | - Paolo Ricci
- Department of Radiological, Oncology and Patological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy; (V.M.); (M.G.); (A.C.); (D.L.); (F.C.); (S.R.); (R.N.); (F.M.); (P.R.); (C.C.)
| | - Carlo Catalano
- Department of Radiological, Oncology and Patological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy; (V.M.); (M.G.); (A.C.); (D.L.); (F.C.); (S.R.); (R.N.); (F.M.); (P.R.); (C.C.)
| | - Stefania Maria Rita Rizzo
- Clinica di Radiologia EOC, Istituto Imaging della Svizzera Italiana (IIMSI), 6900 Lugano, Switzerland;
- Facoltà di Scienze Biomediche, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Lucia Manganaro
- Department of Radiological, Oncology and Patological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy; (V.M.); (M.G.); (A.C.); (D.L.); (F.C.); (S.R.); (R.N.); (F.M.); (P.R.); (C.C.)
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Keunecke C, Kulbe H, Dreher F, Taube ET, Chekerov R, Horst D, Hummel M, Kessler T, Pietzner K, Kassuhn W, Heitz F, Muallem MZ, Lang SM, Vergote I, Dorigo O, Lammert H, du Bois A, Angelotti T, Fotopoulou C, Sehouli J, Braicu EI. Predictive biomarker for surgical outcome in patients with advanced primary high-grade serous ovarian cancer. Are we there yet? An analysis of the prospective biobank for ovarian cancer. Gynecol Oncol 2022; 166:334-343. [PMID: 35738917 DOI: 10.1016/j.ygyno.2022.06.010] [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] [Received: 01/07/2022] [Revised: 05/27/2022] [Accepted: 06/10/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND High-grade serous ovarian cancer (HGSOC) is the most common subtype of ovarian cancer and is associated with high mortality rates. Surgical outcome is one of the most important prognostic factors. There are no valid biomarkers to identify which patients may benefit from a primary debulking approach. OBJECTIVE Our study aimed to discover and validate a predictive panel for surgical outcome of residual tumor mass after first-line debulking surgery. STUDY DESIGN Firstly, "In silico" analysis of publicly available datasets identified 200 genes as predictors for surgical outcome. The top selected genes were then validated using the novel Nanostring method, which was applied for the first time for this particular research objective. 225 primary ovarian cancer patients with well annotated clinical data and a complete debulking rate of 60% were compiled for a clinical cohort. The 14 best rated genes were then validated through the cohort, using immunohistochemistry testing. Lastly, we used our biomarker expression data to predict the presence of miliary carcinomatosis patterns. RESULTS The Nanostring analysis identified 37 genes differentially expressed between optimal and suboptimal debulked patients (p < 0.05). The immunohistochemistry validated the top 14 genes, reaching an AUC Ø0.650. The analysis for the prediction of miliary carcinomatosis patterns reached an AUC of Ø0.797. CONCLUSION The tissue-based biomarkers in our analysis could not reliably predict post-operative residual tumor. Patient and non-patient-associated co-factors, surgical skills, and center experience remain the main determining factors when considering the surgical outcome at primary debulking in high-grade serous ovarian cancer patients.
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Affiliation(s)
- Carlotta Keunecke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Gynecology, Augustenburger Platz 1, 13353 Berlin, Germany; Tumor Bank Ovarian Cancer, ENGOT Biobank, Charité Medizinische Universität Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Hagen Kulbe
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Gynecology, Augustenburger Platz 1, 13353 Berlin, Germany; Tumor Bank Ovarian Cancer, ENGOT Biobank, Charité Medizinische Universität Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Felix Dreher
- Alacris Theranostics GmbH, Max-Planck-Straße 3, 12489 Berlin, Germany
| | - Eliane T Taube
- Tumor Bank Ovarian Cancer, ENGOT Biobank, Charité Medizinische Universität Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Pathology, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Radoslav Chekerov
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Gynecology, Augustenburger Platz 1, 13353 Berlin, Germany; Tumor Bank Ovarian Cancer, ENGOT Biobank, Charité Medizinische Universität Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - David Horst
- Tumor Bank Ovarian Cancer, ENGOT Biobank, Charité Medizinische Universität Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Pathology, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Michael Hummel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Pathology, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Thomas Kessler
- Alacris Theranostics GmbH, Max-Planck-Straße 3, 12489 Berlin, Germany
| | - Klaus Pietzner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Gynecology, Augustenburger Platz 1, 13353 Berlin, Germany; Tumor Bank Ovarian Cancer, ENGOT Biobank, Charité Medizinische Universität Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Wanja Kassuhn
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Gynecology, Augustenburger Platz 1, 13353 Berlin, Germany; Tumor Bank Ovarian Cancer, ENGOT Biobank, Charité Medizinische Universität Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Florian Heitz
- Tumor Bank Ovarian Cancer, ENGOT Biobank, Charité Medizinische Universität Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, Henricistrasse 92, 45136 Essen, Germany
| | - Mustafa Z Muallem
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Gynecology, Augustenburger Platz 1, 13353 Berlin, Germany; Tumor Bank Ovarian Cancer, ENGOT Biobank, Charité Medizinische Universität Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Susan M Lang
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ignace Vergote
- Tumor Bank Ovarian Cancer, ENGOT Biobank, Charité Medizinische Universität Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; Department of Gynecologic Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Oliver Dorigo
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Hedwig Lammert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Pathology, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Andreas du Bois
- Tumor Bank Ovarian Cancer, ENGOT Biobank, Charité Medizinische Universität Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, Henricistrasse 92, 45136 Essen, Germany
| | - Tim Angelotti
- Department of Anaesthesiology, Perioperative and Pain Medicine, 300 Pasteur Drive H3580, Stanford, CA 94305, USA
| | - Christina Fotopoulou
- Tumor Bank Ovarian Cancer, ENGOT Biobank, Charité Medizinische Universität Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; Imperial College, London, United Kingdom
| | - Jalid Sehouli
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Gynecology, Augustenburger Platz 1, 13353 Berlin, Germany; Tumor Bank Ovarian Cancer, ENGOT Biobank, Charité Medizinische Universität Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Elena I Braicu
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Gynecology, Augustenburger Platz 1, 13353 Berlin, Germany; Tumor Bank Ovarian Cancer, ENGOT Biobank, Charité Medizinische Universität Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Stanford University School of Medicine, Stanford, CA, USA.
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Antiangiogenic Strategies in Epithelial Ovarian Cancer: Mechanism, Resistance, and Combination Therapy. JOURNAL OF ONCOLOGY 2022; 2022:4880355. [PMID: 35466318 PMCID: PMC9019437 DOI: 10.1155/2022/4880355] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/23/2022] [Indexed: 12/24/2022]
Abstract
Angiogenesis is one of the hallmarks of cancer and plays a crucial role in carcinogenesis and progression of epithelial ovarian cancer. Antiangiogenic agent is the first approved targeted agent in ovarian cancer. Anti-angiogenic agents mainly include agents target VEGF/VEGFR pathway, such as bevacizumab and agents target receptor tyrosine kinase, and non-VEGF/VEGFR targets of angiogenesis. Antiangiogenic agents demonstrate certain effects in ovarian cancer treatment either as monotherapy or combined with chemotherapy. Unfortunately, antiangiogenic agents, such as bevacizumab, integrated into the ovarian cancer treatment paradigm do not increase cures. Thus, the benefits of anti-angiogenic agents must be carefully weighed against the cost and associated toxicities. Antiangiogenic agents drug resistance and short of predictive biomarkers are main obstacles in ovarian cancer treatment. A combination of poly (ADP-ribose) polymerase inhibitors or immune checkpoint inhibitors might be great strategies to overcome resistance as well as enhance anti-tumor activity of anti-angiogenic drugs. Predictive biomarkers of antiangiogenic agents are in urgent need.
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Lim H, In Shim J, Park SJ, Noh J, Kim TM, Lee M, Choi CH, Chung HH, Kim TJ, Lee JW, Kim JW, Kim BG, Park NH, Song YS, Kim SY, Park SY, Kim HS, Lee YY. Impact of no residual disease on postoperative computed tomography on survival in patients with optimally debulked advanced high-grade serous ovarian cancer during upfront surgery. Gynecol Oncol 2022; 165:493-499. [PMID: 35367074 DOI: 10.1016/j.ygyno.2022.03.014] [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: 10/24/2021] [Revised: 03/17/2022] [Accepted: 03/19/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We sought to investigate the impact of size of residual tumors as determined by postoperative computed tomography (CT) on survival of patients with advanced, high-grade serous ovarian carcinoma (HGSC) who achieved residual disease less than 1 cm after primary debulking surgery (PDS). METHODS We collected data of patients with stage III HGSC who had residual tumor less than 1 cm after PDS between 2013 and 2018. Surgeon-assessed residual disease during surgery was defined as sR0 (no gross residual) or sR1 (gross residual <1 cm), and radiologist-assessed residual disease on postoperative CT was defined as rR0 (no evidence of disease) or rRany (existing residual disease). All patients were classified into the following groups: sR0/rR0, sR1/rR0, sR0/rRany, and sR1/rRany. RESULTS A total of 436 patients was placed into the sR0/rR0 (n = 187, 42.9%), sR1/rR0 (n = 59, 13.5%), sR0/rRany (n = 79, 18.1%), or sR1/rRany group (n = 111, 25.5%). Discrepancies between surgical and radiological assessments were recorded for 176 patients (40.4%) including 38 cases of sR1/rRany group with discordant residual tumor location indicated between two methods. During multivariate analysis, patients with ascites on preoperative CT, sR0/rRany group inclusion, and sR1/rRany group inclusion showed unfavorable progression-free and overall survival. CONCLUSIONS The incorporation of surgical and radiological evaluations for determining the size of residual tumors was more accurate than surgical evaluation only for predicting survival among patients with advanced ovarian cancer who underwent PDS to residual disease less than 1 cm.
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Affiliation(s)
- Hyunji Lim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Jung In Shim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Soo Jin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Joseph Noh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Taek Min Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Maria Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Chel Hun Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Tae-Joong Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Jeong-Won Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Byoung-Gie Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Noh Hyun Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Yong Sang Song
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Sung Yoon Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea.
| | - Yoo-Young Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea.
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du Manoir S, Delpech H, Orsetti B, Jacot W, Pirot N, Noel J, Colombo PE, Sardet C, Theillet C. In high grade ovarian carcinoma, platinum-sensitive tumor recurrence and acquired-resistance derive from quiescent residual cancer cells that overexpress CRYAB, CEACAM6 and SOX2. J Pathol 2022; 257:367-378. [PMID: 35302657 DOI: 10.1002/path.5896] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/01/2022] [Accepted: 03/17/2022] [Indexed: 11/08/2022]
Abstract
Most High-Grade Ovarian Carcinomas (HGOCs) are sensitive to carboplatin (CBP)-based chemotherapy but frequently recur within 24 months. Recurrent tumors remain CBP-sensitive and acquire resistance only after several treatment rounds. Recurrences arise from a small number of residual tumor cells hardly amenable to investigation in patients. We developed Patient-Derived Xenografts (PDXs) that allow the study of these different stages of CBP-sensitive recurrence and acquisition of resistance. We generated PDX models from CBP-sensitive and intrinsically resistant HGOC. PDXs were CBP- or mock-treated and tumors were sampled, after treatment and at recurrence. We also isolated models with acquired-resistance from CBP-sensitive PDXs. All tumors were characterized at the histological and transcriptome levels. PDX models reproduced treatment response seen in the patients. CBP-sensitive residual tumors contained non-proliferating tumor cells clusters embedded in a fibrotic mesh. In non-treated PDX tumors and treated CBP-resistant tumors fibrotic tissue was not prevalent. Residual tumors had marked differences in gene expression when compared to naïve and recurrent tumors, indicating downregulation of cell cycle and proliferation and upregulation of interferon response and epithelial-mesenchymal transition. This gene expression pattern resembled that described in embryonal diapause and 'drug-tolerant persister' states. Residual and acquired-resistance tumors share the overexpression of three genes: CEACAM6, CRYAB, and SOX2.Immunostaining analysis showed strong CEACAM6, CRYAB, and SOX2 protein expression in CBP-sensitive residual and acquired resistance PDX, thus, confirming RNA profiling results. In HGOC PDX, CBP-sensitive recurrences arise from a small population of quiescent, drug-tolerant, residual cells embedded in a fibrotic mesh. These cells overexpress CEACAM6, CRYAB and SOX2, whose overexpression is also associated with acquired resistance and poor patient prognosis. CEACAM6, CRYAB and SOX2 may, thus, serve as a biomarker to predict recurrence and emergence of resistant disease in CBP-treated HGOC patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Hélène Delpech
- IRCM U1194, INSERM, University of Montpellier, Montpellier, France
| | - Béatrice Orsetti
- IRCM U1194, INSERM, University of Montpellier, Montpellier, France
| | - William Jacot
- IRCM U1194, INSERM, University of Montpellier, Montpellier, France
| | - Nelly Pirot
- IRCM U1194, INSERM, University of Montpellier, Montpellier, France
| | - Jean Noel
- BCM, University of Montpellier, CNRS, INSERM, Montpellier, France
| | | | - Claude Sardet
- IRCM U1194, INSERM, Univ Montpellier, ICM, CNRS, Montpellier, France
| | - Charles Theillet
- IRCM U1194, INSERM, University of Montpellier, Montpellier, France
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Batista TP, Carneiro VCG, Tancredi R, Badiglian Filho L, Rangel RLC, Lopes A, Sarmento BJQ, Leão CS. A phase 2 trial of short-course Hyperthermic IntraPeritoneal Chemotherapy (HIPEC) at interval cytoreductive surgery (iCRS) for advanced ovarian cancer. Rev Col Bras Cir 2022; 49:e20223135. [PMID: 35239855 PMCID: PMC10578806 DOI: 10.1590/0100-6991e-20223135] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/06/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to report the final analysis of a phase 2 trial assessing the efficacy and safety of short-course hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with advanced epithelial ovarian cancer (EOC). METHODS this was an open-label, multicenter, single-arm trial of HIPEC in patients with advanced EOC who underwent interval cytoreductive surgery (iCRS) after neoadjuvant chemotherapy (NACT). HIPEC was performed as a concentration-based regimen of platinum-based chemotherapy for 30 minutes. Primary endpoint was the rate of disease progression occurring at nine months following iCRS plus HIPEC (PD9). Secondary endpoints were postoperative complications, time to start adjuvant chemotherapy, length of hospital and ICU stay, quality of life (QoL) over treatment, and ultimately 2-year progression-free survival (PFS) and overall survival (OS). Analysis was by intention-to-treat with final database lock for survival outcomes on February 23, 2021. RESULTS fifteen patients with stage III EOC were enrolled between February 2015 and July 2019, in four centers. The intention to treat PD9 was 6.7%. With a median follow-up of 33 months (IQR, 24.3-46.5), the median PFS was 18.1 months and corresponding 2-year rates of PFS and OS was 33.3% and 93.3%, respectively. Three patients (20%) experienced graded III complications. Median length of hospital and ICU stay was 5 (IQR, 4-6.5) and 1 (IQR, 1-1) days, respectively. Time to restart systemic chemotherapy was 39 (IQR, 35-49.3) days and no significant difference over time in QoL was observed. CONCLUSIONS we demonstrate preliminary efficacy and safety of short-course HIPEC in patient with advanced EOC.
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Affiliation(s)
- Thales Paulo Batista
- - IMIP - Instituto de Medicina Integral Professor Fernando Figueira, Department of Surgery/Oncology - Recife - PE - Brasil
- - UFPE - Universidade Federal de Pernambuco, Center of Medical Science - Recife - PE - Brasil
| | - Vandré Cabral Gomes Carneiro
- - IMIP - Instituto de Medicina Integral Professor Fernando Figueira, Department of Surgery/Oncology - Recife - PE - Brasil
- - HCP - Hospital de Câncer de Pernambuco, Department of Gynecology - Recife - PE - Brasil
| | - Rodrigo Tancredi
- - IMIP - Instituto de Medicina Integral Professor Fernando Figueira, Department of Clinical Oncology - Recife - PE - Brasil
- - HCP - Hospital de Câncer de Pernambuco, Department of Clinical Oncology - Recife - PE - Brasil
| | | | | | - André Lopes
- - IBCC - Instituto Brasileiro de Controle do Câncer, Department of Gynecology - São Paulo - SP - Brasil
| | - Bruno José Queiroz Sarmento
- - IHBDF - Instituto Hospital de Base do Distrito Federal, Serviço de Oncologia Cirúrgica - Brasília - DF - Brasil
| | - Cristiano Souza Leão
- - IMIP - Instituto de Medicina Integral Professor Fernando Figueira, Departamento de Cirurgia - Recife - PE - Brasil
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Heitz F, Lakis S, Harter P, Heikaus S, Sehouli J, Talwar J, Menon R, Ataseven B, Bertrand M, Schneider S, Mariotti E, Bommert M, Müller JN, Prader S, Leenders F, Hengsbach A, Gloeckner C, Braicu EI, Heukamp LC, du Bois A, Heuckmann JM. Cell-free tumor DNA, CA125 and HE4 for the objective assessment of tumor burden in patients with advanced high-grade serous ovarian cancer. PLoS One 2022; 17:e0262770. [PMID: 35130283 PMCID: PMC8820624 DOI: 10.1371/journal.pone.0262770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 01/04/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The present prospective study aimed at determining the impact of cell-free tumor DNA (ct-DNA), CA125 and HE4 from blood and ascites for quantification of tumor burden in patients with advanced high-grade serous epithelial ovarian cancer (EOC). METHODS Genomic DNA was extracted from tumor FFPE and ct-DNA from plasma before surgery and on subsequent post-surgical days. Extracted DNA was subjected to hybrid-capture based next generation sequencing. Blood and ascites were sampled before surgery and on subsequent post-surgical days. 20 patients (10 undergoing complete resection (TR0), 10 undergoing incomplete resection (TR>0)) were included. RESULTS The minor allele frequency (MAF) of TP53 mutations in ct-DNA of all patients with TR0 decreased significantly, compared to only one patient with TR>0. It was not possible to distinguish between patients with TR0 and patients with TR>0, using CA125 and HE4 from blood and ascites. CONCLUSIONS Based upon the present findings, ct-DNA assessment in patients with high-grade serous EOC might help to better determine disease burden compared to standard tumor markers. Further studies should prospectively evaluate whether this enhancement of accuracy can help to optimize management of patients with EOC.
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Affiliation(s)
- Florian Heitz
- Evangelische Kliniken Essen-Mitte Klinik für Gynäkologie und gynäkologische Onkologie, Essen, Germany
- Department for Gynecology with the Center for Oncologic Surgery Charité Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Corporate member of Freie Universität Berlin, Berlin, Germany
- Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sotirios Lakis
- NEO New Oncology GmbH, Cologne, Germany
- ULTIVUE, Segrate Milan, Italy
| | - Philipp Harter
- Evangelische Kliniken Essen-Mitte Klinik für Gynäkologie und gynäkologische Onkologie, Essen, Germany
| | - Sebastian Heikaus
- Evangelische Kliniken Essen-Mitte, Center for Pathology, Essen, Germany
| | - Jalid Sehouli
- Department for Gynecology with the Center for Oncologic Surgery Charité Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Corporate member of Freie Universität Berlin, Berlin, Germany
- Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany
| | | | | | - Beyhan Ataseven
- Evangelische Kliniken Essen-Mitte Klinik für Gynäkologie und gynäkologische Onkologie, Essen, Germany
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Miriam Bertrand
- NEO New Oncology GmbH, Cologne, Germany
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Stephanie Schneider
- Evangelische Kliniken Essen-Mitte Klinik für Gynäkologie und gynäkologische Onkologie, Essen, Germany
| | | | - Mareike Bommert
- Evangelische Kliniken Essen-Mitte Klinik für Gynäkologie und gynäkologische Onkologie, Essen, Germany
| | | | - Sonia Prader
- Evangelische Kliniken Essen-Mitte Klinik für Gynäkologie und gynäkologische Onkologie, Essen, Germany
- Department of Obstetrics and Gynecology, General Hospital (SABES-ASDAA), Brixen–Bres-sanone, Italy
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Inns-bruck, Austria
| | | | - Alexandra Hengsbach
- Evangelische Kliniken Essen-Mitte Klinik für Gynäkologie und gynäkologische Onkologie, Essen, Germany
| | | | | | | | - Andreas du Bois
- Evangelische Kliniken Essen-Mitte Klinik für Gynäkologie und gynäkologische Onkologie, Essen, Germany
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Joneborg U, Palsdottir K, Farm E, Johansson H, Salehi S. Time-interval to adjuvant chemotherapy and postoperative management after upper abdominal surgical procedures in advanced ovarian cancer. Eur J Surg Oncol 2020; 47:353-359. [PMID: 32778486 DOI: 10.1016/j.ejso.2020.07.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/12/2020] [Accepted: 07/17/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION In advanced epithelial ovarian cancer (EOC), longer time-interval from surgery to initiation of adjuvant chemotherapy (TITC) is associated with decreased survival. Adding upper abdominal surgical procedures (UAP) increases rates of both complete gross resection and postoperative complications in EOC. Our objective was to investigate the association of UAP and TITC. Moreover, if specific postoperative monitoring after the most prevalent UAP increases early detection and management of complications. MATERIAL AND METHODS Women diagnosed with EOC 2014-2016 in the Stockholm/Gotland Region in Sweden were identified in the Swedish Quality Registry for Gynaecologic Cancer. The association between UAP and TITC was investigated by multivariable linear regression and adjusted for predefined confounders. The follow-up and detection of postoperative complications after diaphragm resection, splenectomy and cholecystectomy was examined. RESULTS 240 women were selected for analysis. The TITC in women subjected to UAP was similar with a median of 30 days (p = 0.99). Moreover, despite a higher rate of postoperative and major complications (p < 0.001) and longer hospital stay (p < 0.001), in the adjusted analysis there was no association between UAP and prolonged TITC, with a mean difference of -2.27 days (95% Confidence Interval (CI), -5.99 to -1.45, p = 0.23). After the most prevalent UAP (diaphragm resection, splenectomy and cholecystectomy), eventual postoperative interventions were based on routine clinical management rather than procedure-specific postoperative surveillance. CONCLUSION UAP does not prolong TITC despite an increased rate of postoperative complications and longer length of hospital stay. Clinical non-specific surveillance is sufficient to detect postoperative complications after the most prevalent UAP.
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Affiliation(s)
- Ulrika Joneborg
- Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska Institutet, Sweden; Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.
| | - Kolbrun Palsdottir
- Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska Institutet, Sweden; Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Farm
- Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska Institutet, Sweden; Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Hemming Johansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Sahar Salehi
- Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska Institutet, Sweden; Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
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10
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Heitz F, Kommoss S, Tourani R, Grandelis A, Uppendahl L, Aliferis C, Burges A, Wang C, Canzler U, Wang J, Belau A, Prader S, Hanker L, Ma S, Ataseven B, Hilpert F, Schneider S, Sehouli J, Kimmig R, Kurzeder C, Schmalfeldt B, Braicu EI, Harter P, Dowdy SC, Winterhoff BJ, Pfisterer J, du Bois A. Dilution of Molecular-Pathologic Gene Signatures by Medically Associated Factors Might Prevent Prediction of Resection Status After Debulking Surgery in Patients With Advanced Ovarian Cancer. Clin Cancer Res 2019; 26:213-219. [PMID: 31527166 DOI: 10.1158/1078-0432.ccr-19-1741] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/08/2019] [Accepted: 09/11/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Predicting surgical outcome could improve individualizing treatment strategies for patients with advanced ovarian cancer. It has been suggested earlier that gene expression signatures (GES) might harbor the potential to predict surgical outcome. EXPERIMENTAL DESIGN Data derived from high-grade serous tumor tissue of FIGO stage IIIC/IV patients of AGO-OVAR11 trial were used to generate a transcriptome profiling. Previously identified molecular signatures were tested. A theoretical model was implemented to evaluate the impact of medically associated factors for residual disease (RD) on the performance of GES that predicts RD status. RESULTS A total of 266 patients met inclusion criteria, of those, 39.1% underwent complete resection. Previously reported GES did not predict RD in this cohort. Similarly, The Cancer Genome Atlas molecular subtypes, an independent de novo signature and the total gene expression dataset using all 21,000 genes were not able to predict RD status. Medical reasons for RD were identified as potential limiting factors that impact the ability to use GES to predict RD. In a center with high complete resection rates, a GES which would perfectly predict tumor biological RD would have a performance of only AUC 0.83, due to reasons other than tumor biology. CONCLUSIONS Previously identified GES cannot be generalized. Medically associated factors for RD may be the main obstacle to predict surgical outcome in an all-comer population of patients with advanced ovarian cancer. If biomarkers derived from tumor tissue are used to predict outcome of patients with cancer, selection bias should be focused on to prevent overestimation of the power of such a biomarker.See related commentary by Handley and Sood, p. 9.
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Affiliation(s)
- Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Kliniken-Essen-Mitte, Germany. .,Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Gynecology, Berlin, Germany.,AGO Study Group
| | - Stefan Kommoss
- AGO Study Group.,Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Roshan Tourani
- Institute for Health Informatics (IHI), Academic Health Center, University of Minnesota, Minneapolis, Minnesota
| | - Anthony Grandelis
- Department of Gynecology, Obstetrics and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, Minnesota
| | - Locke Uppendahl
- Department of Gynecology, Obstetrics and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, Minnesota
| | - Constantin Aliferis
- Institute for Health Informatics (IHI), Academic Health Center, University of Minnesota, Minneapolis, Minnesota
| | - Alexander Burges
- AGO Study Group.,Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Germany
| | - Chen Wang
- Division of Gynecologic Surgery, Department of Obstetrics and Gynecology; Mayo Clinic, Rochester, Minnesota
| | - Ulrich Canzler
- AGO Study Group.,Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany
| | - Jinhua Wang
- Institute for Health Informatics (IHI), Academic Health Center, University of Minnesota, Minneapolis, Minnesota
| | - Antje Belau
- AGO Study Group.,Ernst Moritz Arndt Universität Greifswald - Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Greifswald, Germany
| | - Sonia Prader
- Department of Gynecology and Gynecologic Oncology, Kliniken-Essen-Mitte, Germany
| | - Lars Hanker
- AGO Study Group.,Klinik für Frauenheilkunde und Geburtshilfe, University of Schleswig-Holstein, Lübeck, Germany
| | - Sisi Ma
- Institute for Health Informatics (IHI), Academic Health Center, University of Minnesota, Minneapolis, Minnesota
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Kliniken-Essen-Mitte, Germany.,Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Germany
| | - Felix Hilpert
- AGO Study Group.,Krankenhaus Jerusalem Hamburg, Hamburg, Germany
| | - Stephanie Schneider
- Department of Gynecology and Gynecologic Oncology, Kliniken-Essen-Mitte, Germany
| | - Jalid Sehouli
- Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Gynecology, Berlin, Germany
| | - Rainer Kimmig
- AGO Study Group.,Department of Gynecology and Obstetrics, University of Duisburg-Essen, Essen, Germany
| | - Christian Kurzeder
- AGO Study Group.,Universitätsspital Basel, Basel, Switzerland.,Department of Obstrics and Gynecology, University of Ulm, Ulm, Germany
| | - Barbara Schmalfeldt
- AGO Study Group.,Technical University of Munich - Klinikum rechts der Isar, Munich, Germany.,Department of Gynecology and Obstetrics, Technical University of Munich, Munich, Germany
| | - Elena I Braicu
- Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Gynecology, Berlin, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Kliniken-Essen-Mitte, Germany.,AGO Study Group
| | - Sean C Dowdy
- Division of Gynecologic Surgery, Department of Obstetrics and Gynecology; Mayo Clinic, Rochester, Minnesota
| | - Boris J Winterhoff
- Department of Gynecology, Obstetrics and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, Minnesota
| | | | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Kliniken-Essen-Mitte, Germany.,AGO Study Group
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