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Falzone L, Scandurra G, Lombardo V, Gattuso G, Lavoro A, Distefano AB, Scibilia G, Scollo P. A multidisciplinary approach remains the best strategy to improve and strengthen the management of ovarian cancer (Review). Int J Oncol 2021; 59:53. [PMID: 34132354 PMCID: PMC8208622 DOI: 10.3892/ijo.2021.5233] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 03/31/2021] [Indexed: 02/07/2023] Open
Abstract
Ovarian cancer represents one of the most aggressive female tumors worldwide. Over the decades, the therapeutic options for the treatment of ovarian cancer have been improved significantly through the advancement of surgical techniques as well as the availability of novel effective drugs able to extend the life expectancy of patients. However, due to its clinical, biological and molecular complexity, ovarian cancer is still considered one of the most difficult tumors to manage. In this context, several studies have highlighted how a multidisciplinary approach to this pathology improves the prognosis and survival of patients with ovarian cancer. On these bases, the aim of the present review is to present recent advantages in the diagnosis, staging and treatment of ovarian cancer highlighting the benefits of a patient‑centered care approach and on the importance of a multidisciplinary team for the management of ovarian cancer.
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Affiliation(s)
- Luca Falzone
- Epidemiology and Biostatistics Unit, National Cancer Institute‑IRCCS Fondazione G. Pascale, I‑80131 Naples, Italy
| | | | | | - Giuseppe Gattuso
- Department of Biomedical and Biotechnological Sciences, University of Catania, I‑95123 Catania, Italy
| | - Alessandro Lavoro
- Department of Biomedical and Biotechnological Sciences, University of Catania, I‑95123 Catania, Italy
| | | | - Giuseppe Scibilia
- Unit of Obstetrics and Gynecology, Cannizzaro Hospital, I‑95126 Catania, Italy
| | - Paolo Scollo
- Unit of Obstetrics and Gynecology, Cannizzaro Hospital, I‑95126 Catania, Italy
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Cohen PA, Powell A, Böhm S, Gilks CB, Stewart CJR, Meniawy TM, Bulsara M, Avril S, Brockbank EC, Bosse T, de Azevedo Focchi GR, Ganesan R, Glasspool RM, Howitt BE, Kim HS, Lee JY, Le ND, Lockley M, Manchanda R, Mandalia T, McCluggage WG, McNeish I, Midha D, Srinivasan R, Tan YY, van der Griend R, Yunokawa M, Zannoni GF, Singh N. Pathological chemotherapy response score is prognostic in tubo-ovarian high-grade serous carcinoma: A systematic review and meta-analysis of individual patient data. Gynecol Oncol 2019; 154:441-448. [PMID: 31118141 DOI: 10.1016/j.ygyno.2019.04.679] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/21/2019] [Accepted: 04/24/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE There is a need to develop and validate biomarkers for treatment response and survival in tubo-ovarian high-grade serous carcinoma (HGSC). The chemotherapy response score (CRS) stratifies patients into complete/near-complete (CRS3), partial (CRS2), and no/minimal (CRS1) response after neoadjuvant chemotherapy (NACT). Our aim was to review current evidence to determine whether the CRS is prognostic in women with tubo-ovarian HGSC treated with NACT. METHODS We established an international collaboration to conduct a systematic review and meta-analysis, pooling individual patient data from 16 sites in 11 countries. Patients had stage IIIC/IV HGSC, 3-4 NACT cycles and >6-months follow-up. Random effects models were used to derive combined odds ratios in the pooled population to investigate associations between CRS and progression free and overall survival (PFS and OS). RESULTS 877 patients were included from published and unpublished studies. Median PFS and OS were 15 months (IQR 5-65) and 28 months (IQR 7-92) respectively. CRS3 was seen in 249 patients (28%). The pooled hazard ratios (HR) for PFS and OS for CRS3 versus CRS1/CRS2 were 0·55 (95% CI, 0·45-0·66; P < 0·001) and 0·65 (95% CI 0·50-0·85, P = 0·002) respectively; no heterogeneity was identified (PFS: Q = 6·42, P = 0·698, I2 = 0·0%; OS: Q = 6·89, P = 0·648, I2 = 0·0%). CRS was significantly associated with PFS and OS in multivariate models adjusting for age and stage. Of 306 patients with known germline BRCA1/2 status, those with BRCA1/2 mutations (n = 80) were more likely to achieve CRS3 (P = 0·027). CONCLUSIONS CRS3 was significantly associated with improved PFS and OS compared to CRS1/2. This validation of CRS in a real-world setting demonstrates it to be a robust and reproducible biomarker with potential to be incorporated into therapeutic decision-making and clinical trial design.
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MESH Headings
- Antineoplastic Agents
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- Carboplatin/therapeutic use
- Disease-Free Survival
- Fallopian Tube Neoplasms/drug therapy
- Fallopian Tube Neoplasms/mortality
- Fallopian Tube Neoplasms/pathology
- Female
- Humans
- Neoadjuvant Therapy
- Neoplasms, Cystic, Mucinous, and Serous/drug therapy
- Neoplasms, Cystic, Mucinous, and Serous/mortality
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Ovarian Neoplasms/drug therapy
- Ovarian Neoplasms/mortality
- Ovarian Neoplasms/pathology
- Treatment Outcome
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Affiliation(s)
- Paul A Cohen
- Department of Gynaecological Oncology, Bendat Family Comprehensive Cancer Centre, St John of God Subiaco Hospital, 12 Salvado Rd, Subiaco, Western Australia 6008, Australia; Division of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia; Institute for Health Research, The University of Notre Dame Australia, 32 Mouat Street Fremantle, Western Australia 6160, Australia.
| | - Aime Powell
- Department of Gynaecological Oncology, Bendat Family Comprehensive Cancer Centre, St John of God Subiaco Hospital, 12 Salvado Rd, Subiaco, Western Australia 6008, Australia; Institute for Health Research, The University of Notre Dame Australia, 32 Mouat Street Fremantle, Western Australia 6160, Australia
| | - Steffen Böhm
- Department of Medical Oncology, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, United Kingdom
| | - C Blake Gilks
- Department of Anatomic Pathology, Vancouver General Hospital, 899 W 12th Ave, Vancouver, BC V5Z 1M9, Canada
| | - Colin J R Stewart
- Department of Histopathology, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, Western Australia 6008, Australia
| | - Tarek M Meniawy
- School of Medicine and Pharmacology, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia; Department of Medical Oncology, Sir Charles Gairdner Hospital, Gairdner Drive Nedlands, Western Australia 6009, Australia
| | - Max Bulsara
- Institute for Health Research, The University of Notre Dame Australia, 32 Mouat Street Fremantle, Western Australia 6160, Australia
| | - Stefanie Avril
- Department of Pathology, School of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center and Case Comprehensive Cancer Center, Wolstein Research Building, Room 6524, 2103 Cornell Road, Cleveland, OH 44106, United States of America; Institute of Pathology, Technische Universität München, Ismaninger Str. 22, Munich 81675, Germany
| | - Eleanor C Brockbank
- Department of Gynaecological Oncology, Barts Health NHS Trust, Whitechapel Rd, London E1 1BB, United Kingdom
| | - Tjalling Bosse
- Department of Pathology, Leiden University Medical Centre, Albinusdreef 2, PO Box 9600, 2333 ZA, Leiden, the Netherlands
| | | | - Raji Ganesan
- Department of Cellular Pathology, Birmingham Women's NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TG, United Kingdom
| | - Rosalind M Glasspool
- Cancer Research UK Clinical Trials Unit, Glasgow, The Beatson West of Scotland Cancer Centre, University of Glasgow, 1053 Great Western Road, Glasgow G12 0YN, United Kingdom
| | - Brooke E Howitt
- Department of Pathology, School of Medicine, Stanford University, 300 Pasteur Drive, H2128E, Stanford, CA 94305, United States of America
| | - Hyun-Soo Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Jung-Yun Lee
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Nhu D Le
- Cancer Control Research, British Columbia Cancer Research Centre, 675 West 10th Ave, Vancouver, BC V5Z1L3, Canada
| | - Michelle Lockley
- Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, United Kingdom; University College London Hospital, 235 Euston Rd, Fitzrovia, London NW1 2BU, United Kingdom
| | - Ranjit Manchanda
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, 10th Floor, South Block, Whitechapel Road, London E1 1BB, United Kingdom
| | - Trupti Mandalia
- Department of Histopathology, Royal Devon and Exeter NHS Foundation Trust, Royal Devon and Exeter Hospital (Wonford), Old Pathology Building, Church Lane, Exeter, Devon EX2 5AD, United Kingdom
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Grosvenor Road Belfast, BT12 6BA, United Kingdom
| | - Iain McNeish
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, IRDB Building, Hammersmith Hospital, London W12 0NN, United Kingdom
| | - Divya Midha
- Department of Pathology, Tata Medical Center, 14 MAR, Rajarhat, Kolkata 700160, India
| | - Radhika Srinivasan
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Yun Yi Tan
- Department of Medical Oncology, Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow G12 0YN, United Kingdom
| | - Rachael van der Griend
- Department of Anatomical Pathology, Canterbury Health Laboratories, 2 Riccarton Ave, Christchurch 8011, New Zealand
| | - Mayu Yunokawa
- Department of Breast and Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Gian F Zannoni
- Department of Pathology, Women and Child Health, Fondazione Policlinico Gemelli, Università Cattolica del Sacro Cuore, Largo F Vito 1, 00168 Roma, Italy
| | - Naveena Singh
- Department of Cellular Pathology, Barts Health NHS Trust, Whitechapel Rd, London E1 1BB, United Kingdom
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