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Pasquier J, Vidal F, Hoarau-Véchot J, Bonneau C, Daraï E, Touboul C, Rafii A. Surgical peritoneal stress creates a pro-metastatic niche promoting resistance to apoptosis via IL-8. J Transl Med 2018; 16:271. [PMID: 30285881 PMCID: PMC6171219 DOI: 10.1186/s12967-018-1643-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/24/2018] [Indexed: 12/14/2022] Open
Abstract
Background The mainstay of treatment of advanced ovarian cancer (AOC) involves chemotherapy, and debulking surgery. However, despite optimal surgical procedure and adjuvant chemotherapy, 60% of patients with AOC will relapse within 5 years. Most recurrences occur in the peritoneal cavity, suggesting the existence of occult sanctuaries where ovarian cancer cells (OCC) are protected. In murine models, surgical stress favors tumor growth; however, it has never been established that surgery may affect OCC sensitivity to subsequent chemotherapy. In this study, we investigated how the surgical stress could affect the chemosensitivity of OCC. Methods To avoid bias due to tumor burden in peritoneal cavity and duration of surgery, we used peritoneal biopsies from patients without a malignancy at precise time points. During laparotomies, peritoneal biopsies at the incision site were performed at the time of incision (H0 sample) and 1 h after initiation of surgery (H1 sample). We evaluated the chemoresistance to Taxol (0–20 µM) induced by H0 or H1 incubation (24 h) in two ovarian cancer cell lines OVCAR3 and SKOV3 and a primary cancer cell lines derived in our laboratory. Results Our results indicate that stressed peritoneum overexpressed cytokines, resulting in OCC increased resistance to therapy. Among these cytokines, IL8 was responsible for the resistance to apoptosis through the AKT pathway activation. Chemoresistance in OCC persists through the establishment of an autocrine IL8 loop. Finally, in a cohort of 32 patients, we showed an impact of IL8 tumoral overexpression on chemosensitivity and survival outcomes with a significant association to earlier recurrence. Conclusions Our study demonstrated that precision surgery where targeted treatment would be used in combination with surgery is essential to obtain better tumor control. Electronic supplementary material The online version of this article (10.1186/s12967-018-1643-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer Pasquier
- Stem Cell and Microenvironment Laboratory, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, PO: 24144, Doha, Qatar.,Department Genetic Medicine, Weill Cornell Medical College, New York, NY, USA.,INSERM U955, Equipe 7, Créteil, France
| | - Fabien Vidal
- Stem Cell and Microenvironment Laboratory, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, PO: 24144, Doha, Qatar.,Department Genetic Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Jessica Hoarau-Véchot
- Stem Cell and Microenvironment Laboratory, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, PO: 24144, Doha, Qatar
| | - Claire Bonneau
- Service de Gynécologie Obstétrique, Hopital Tenon (Assistance Publique-Hôpitaux de Paris), 4 rue de la Chine, 75020, Paris, France
| | - Emile Daraï
- Service de Gynécologie Obstétrique, Hopital Tenon (Assistance Publique-Hôpitaux de Paris), 4 rue de la Chine, 75020, Paris, France
| | - Cyril Touboul
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Faculté de médecine de Créteil UPEC-Paris XII, Centre Hospitalier Intercommunal de Créteil, 40 Avenue de Verdun, 94000, Créteil, France
| | - Arash Rafii
- Stem Cell and Microenvironment Laboratory, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, PO: 24144, Doha, Qatar. .,Department Genetic Medicine, Weill Cornell Medical College, New York, NY, USA. .,Service de chirurgie Gynécologique, Hôpital Foch, 92100, Suresnes, France.
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Vidal F, Al Thani H, Haddad P, Luyckx M, Stoeckle E, Morice P, Leblanc E, Lecuru F, Daraï E, Classe JM, Pomel C, Mahfoud Z, Ferron G, Querleu D, Rafii A. Which Surgical Attitude to Choose in the Context of Non-Resectability of Ovarian Carcinomatosis: Beyond Gross Residual Disease Considerations. Ann Surg Oncol 2015; 23:434-42. [PMID: 26542592 DOI: 10.1245/s10434-015-4890-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND In ovarian cancer, the increased rate of radical surgery comprising upper abdominal procedures has participated to improve overall survival (OS) in advanced stages by increasing the rate of complete cytoreductions. However, in the context of non-resectability, it is unclear whether radical surgery should be considered when it would lead to microscopic but visible disease (≤1 cm). We aimed to compare the survival outcomes among patients with incomplete cytoreduction according to the extent of surgery. METHODS Overall, 148 patients presenting with advanced stage ovarian carcinomas were included in this retrospective study, regardless of treatment schedule. These patients were stratified according to the extent of surgery (standard or radical). Complete cytoreduction at the time of debulking surgery could not be carried out in all cases. RESULTS Among our study population (n = 148), 96 patients underwent standard procedures (SPs) and 52 underwent radical surgeries (RP). Patients in the SP group had a lower Peritoneal Index Cancer (PCI) at baseline (12.6 vs. 14.9; p = 0.049). After PCI normalization, we observed similar OS in the SP and RP groups (39.7 vs. 43.1 months; p = 0.737), while patients in the SP group had a higher rate of residual disease >10 mm (p < 10(-3)). Patients in the RP group had an increased rate of relapse (p = 0.005) but no difference in disease-free survival compared with the SP group (22.2 for SP vs. 16.3 months; p = 0.333). Residual disease status did not impact survival outcomes. CONCLUSIONS In the context of non-resectable, advanced stage ovarian cancer, standard surgery seems as beneficial as radical surgery regarding survival outcomes and should be considered to reduce surgery-associated morbidity.
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Affiliation(s)
- Fabien Vidal
- Stem Cell and Microenvironment Laboratory, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar.,Department of Genetic Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Haya Al Thani
- Stem Cell and Microenvironment Laboratory, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Pascale Haddad
- Biostatistics Core, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Mathieu Luyckx
- Department of Gynecologic Surgery, Saint Luc Academic Hospital, Catholic University of Louvain, Bruxelles, Belgium
| | - Eberhard Stoeckle
- Comprehensive Cancer Center, Department of Surgery, Institut Bergonie, Bordeaux, France
| | - Philippe Morice
- Department of Gynecologic Surgery, Institut Gustave Roussy, Cancer Campus, Grand Paris, Villejuif, France
| | - Eric Leblanc
- Department of Gynecologic Oncology, Centre Oscar Lambret, Lille, France
| | - Fabrice Lecuru
- Department of Gynecologic Oncology, Georges Pompidou European Hospital, Paris, France
| | - Emile Daraï
- Department of Gynecologic Surgery, Tenon Hospital, Paris, France
| | - Jean-Marc Classe
- Department of Surgical Oncology, Centre Gauducheau, Comprehensive Cancer Center, Saint Herblain, France
| | - Christophe Pomel
- Department of Surgical Oncology, Jean Perrin Cancer Center, Clermont-Ferrand, France
| | - Ziyad Mahfoud
- Biostatistics Core, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Gwenael Ferron
- Comprehensive Cancer Center, Department of Surgical Oncology, Institut Claudius Regaud, Toulouse, France
| | - Denis Querleu
- Comprehensive Cancer Center, Department of Surgical Oncology, Institut Claudius Regaud, Toulouse, France
| | - Arash Rafii
- Stem Cell and Microenvironment Laboratory, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar. .,Department of Genetic Medicine, Weill Cornell Medical College, New York, NY, USA. .,Department of Genetic Medicine and Obstetrics and Gynecology, Weill Cornell Medical College in Qatar, Education City, Doha, Qatar.
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