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Michel E, Mamguem Kamga A, Amet A, Padeano MM, Fumet JD, Favier L, Bengrine Lefevre L, Beltjens F, Arnould L, Dabakuyo S, Costaz H. Impact of complete surgical staging on survival of patients with early-stage (FIGO I or II) ovarian cancer: Data from the Cote d'Or Registry of Gynecological Cancers from 1998 to 2015. Bull Cancer 2023; 110:352-359. [PMID: 36805207 DOI: 10.1016/j.bulcan.2023.01.012] [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: 09/13/2022] [Revised: 01/03/2023] [Accepted: 01/12/2023] [Indexed: 02/19/2023]
Abstract
INTRODUCTION Early-stage ovarian cancer represents 20 to 33% of all ovarian cancers and is thus quite rare in France, with around 1200 new cases per year. No study to date has convincingly demonstrated the utility of lymphadenectomy in early-stage ovarian cancer. We sought to evaluate the impact on overall survival of complete surgical staging in patients management for FIGO stage I and II ovarian cancer. METHODS We performed a retrospective observational study using data from the Cote d'Or Registry of Gynecological Cancers. We included patients with invasive early stage epithelial ovarian cancer (FIGO stages I and II), diagnosed between 1 January 1998 and 31 December 2015. RESULTS A total of 179 patients were included in the study. Patients who had lymphadenectomy were younger on average (P<0.001) and had fewer comorbidities (P=0.03). Lymphadenectomy was performed during the first surgery in 59.2% of cases (58 patients) and during a second, re-staging surgery in 40.8% (n=40). When complete surgical staging was performed, the rate of up-staging (to at least FIGO stage III) was 11.2% (11/98). The median follow-up was 8.4 years. At the study, 31.6% patients with complete surgical staging had died and 48.4% patients also died in the group without lymphadenectomy, HR 0.59 CI [0.36-0.97] P<0.04. CONCLUSION In patients with early-stage ovarian cancer, complete surgical staging appears to yield a benefit in terms of overall survival. In 10 to 15% of cases, it leads to upstaging, with the resultant indication for maintenance therapy, which has also shown a survival benefit.
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Affiliation(s)
- Eloïse Michel
- Georges François Leclerc Cancer Center, Unicancer, Department of Surgical Oncology, Dijon, France
| | - Ariane Mamguem Kamga
- National Quality of Life and Cancer Clinical Research Platform, Georges François Leclerc Cancer Center, Unicancer, Dijon, France
| | - Alix Amet
- Georges François Leclerc Cancer Center, Unicancer, Department of Surgical Oncology, Dijon, France
| | - Marie-Martine Padeano
- Georges François Leclerc Cancer Center, Unicancer, Department of Surgical Oncology, Dijon, France
| | - Jean-David Fumet
- University of Burgundy-Franche Comté, Dijon, France; Georges François Leclerc Cancer Center, Unicancer, Department of Medical Oncology, Dijon, France
| | - Laure Favier
- Georges François Leclerc Cancer Center, Unicancer, Department of Medical Oncology, Dijon, France
| | - Leila Bengrine Lefevre
- Georges François Leclerc Cancer Center, Unicancer, Department of Medical Oncology, Dijon, France
| | - Françoise Beltjens
- Pathology Unit, Georges François Leclerc Cancer Center, Unicancer, Department of Tumour Biology, Pathology, Dijon, France
| | - Laurent Arnould
- Pathology Unit, Georges François Leclerc Cancer Center, Unicancer, Department of Tumour Biology, Pathology, Dijon, France
| | - Sandrine Dabakuyo
- National Quality of Life and Cancer Clinical Research Platform, Georges François Leclerc Cancer Center, Unicancer, Dijon, France
| | - Hélène Costaz
- Georges François Leclerc Cancer Center, Unicancer, Department of Surgical Oncology, Dijon, France.
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Haque A, Baig GA, Alshawli AS, Sait KHW, Hafeez BB, Tripathi MK, Alghamdi BS, Mohammed Ali HSH, Rasool M. Interaction Analysis of MRP1 with Anticancer Drugs Used in Ovarian Cancer: In Silico Approach. Life (Basel) 2022; 12:383. [PMID: 35330134 PMCID: PMC8954655 DOI: 10.3390/life12030383] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/24/2022] [Accepted: 03/03/2022] [Indexed: 12/17/2022] Open
Abstract
Multidrug resistance (MDR) is one of the major therapeutic challenges that limits the efficacy of chemotherapeutic response resulting in poor prognosis of ovarian cancer (OC). The multidrug resistance protein 1 (MRP1) is a membrane-bound ABC transporter involved in cross resistance to many structurally and functionally diverse classes of anticancer drugs including doxorubicin, taxane, and platinum. In this study, we utilize homology modelling and molecular docking analysis to determine the binding affinity and the potential interaction sites of MRP1 with Carboplatin, Gemcitabine, Doxorubicin, Paclitaxel, and Topotecan. We used AutoDock Vina scores to compare the binding affinities of the anticancer drugs against MRP1. Our results depicted Carboplatin < Gemcitabine < Topotecan < Doxorubicin < Paclitaxel as the order of binding affinities. Paclitaxel has shown the highest binding affinity whereas Carboplatin displayed the lowest affinity to MRP1. Interestingly, our data showed that Carboplatin, Paclitaxel, and Topotecan bind specifically to Asn510 residue in the transmembrane domains 1 of the MRP1. Our results suggest that Carboplatin could be an appropriate therapeutic choice against MRP1 in OC as it couples weakly with Carboplatin. Further, our findings also recommend opting Carboplatin with Gemcitabine as a combinatorial chemotherapeutic approach to overcome MDR phenotype associated with recurrent OC.
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Affiliation(s)
- Absarul Haque
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (G.A.B.); (A.S.A.); (B.S.A.)
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Ghazanfar Ali Baig
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (G.A.B.); (A.S.A.); (B.S.A.)
- Department of Biological Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Abdulelah Saleh Alshawli
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (G.A.B.); (A.S.A.); (B.S.A.)
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Khalid Hussain Wali Sait
- Gynecology Oncology Unit, Obstetrics and Gynecology Department, Faculty of Medicine, King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia;
| | - Bilal Bin Hafeez
- Department of Immunology and Microbiology, South Texas Center of Excellence in Cancer Research, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX 78539, USA; (B.B.H.); (M.K.T.)
| | - Manish Kumar Tripathi
- Department of Immunology and Microbiology, South Texas Center of Excellence in Cancer Research, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX 78539, USA; (B.B.H.); (M.K.T.)
| | - Badrah Saeed Alghamdi
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (G.A.B.); (A.S.A.); (B.S.A.)
- Department of Physiology, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | | | - Mahmood Rasool
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Center of Excellence in Genomic Medicine Research, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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Zamani N, Mousavi AS, Akhavan S, Sheikhhasani S, Nikfar S, Feizabad E, Rezayof E, Modares Gilani M. Uterine involvement in epithelial ovarian cancer and its risk factors. J Ovarian Res 2021; 14:171. [PMID: 34876191 PMCID: PMC8653532 DOI: 10.1186/s13048-021-00925-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/20/2021] [Indexed: 11/29/2022] Open
Abstract
Background Epithelial ovarian cancer (EOC) is an extremely aggressive and lethal carcinoma. Specific data that identify high-risk groups with uterine involvement are not available. Thus, this study aimed to evaluate a gross number of women with EOC to obtain the frequency of uterine involvement and its risk factors. Methods This retrospective observational study was conducted on 1900 histologically confirmed EOC women, diagnosed and treated in our tertiary hospital from March 2009 to September 2020. Data including their demographic, medical and pathological findings were collected. Results From 1900 histologically confirmed EOC women, 347 patients were eligible for participations. The mean age of study patients was 51.31 ± 11.37 years with the age range of 25 to 87 years. Uterine involvement was detected in 49.6% (173) of the patients either macroscopic (47.4%) or microscopic (52.6%) types. Uterine involvement was significantly associated with having AUB (P-value = 0.002), histological type of ovary tumor (P-value < 0.001), ovarian cancer stage (P-value < 0.001), and abnormal CA-125 concentration (P-value = 0.004). Compared to the other study patient, the patients with metastatic uterine involvement had significantly higher stage (p-value< 0.001), higher grade of ovary tumor (p-value = 0.008), serous histological type (p-value< 0.001), and a higher level of CA-125 concentration (p-value< 0.001). on the other hand, the patients with synchronous uterine cancer were significantly younger (p-value = 0.013), nulliparous (p-value< 0.001), suffered from AUB symptoms (p-value< 0.001) and had endometroid histological type (p-value = 0.010) of ovary cancer in comparison to other study patients. Conclusion Considering the high prevalence of uterine involvement in EOC patients, ultrasound evaluation and/or endometrium biopsy assessment should be done before planning any treatment.
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Affiliation(s)
- Narges Zamani
- Department of Oncologic Gynecology, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Azam Sadat Mousavi
- Department of Oncologic Gynecology, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Setare Akhavan
- Department of Oncologic Gynecology, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Sheikhhasani
- Department of Oncologic Gynecology, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Somayeh Nikfar
- Department of Obstetrics and Gynecology, Taleghani Hospital, Arak University of Medical Sciences, Arak, Iran
| | - Elham Feizabad
- Department of Oncologic Gynecology, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elahe Rezayof
- Vali-Asr Reproducive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Modares Gilani
- Department of Oncologic Gynecology, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Haque A, Sait KHW, Alam Q, Alam MZ, Anfinan N, Wali AWN, Rasool M. MDR1 Gene Polymorphisms and Its Association With Expression as a Clinical Relevance in Terms of Response to Chemotherapy and Prognosis in Ovarian Cancer. Front Genet 2020; 11:516. [PMID: 32528530 PMCID: PMC7264409 DOI: 10.3389/fgene.2020.00516] [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: 12/25/2019] [Accepted: 04/28/2020] [Indexed: 01/17/2023] Open
Abstract
In spite of the significant advancements in the treatment modalities, 30% of advanced stage ovarian cancer (OC) patients do not respond to the standard chemotherapeutic regimen and most of the responders finally relapse over time due to the escalation of multidrug resistance (MDR) Phenomenon. Our present study evaluated chemotherapeutic sensitivity response among 47 ovarian tumor patients of which we found 37 (78.8%) sensitive and remaining 10 (21.2%) resistant. Among the resistant, seven tumor samples were found to be platinum resistant or refractory to platinum (CB/TX), one to carboplatin, and two to 5FU. Notably, all these resistant cases were observed in the disease recurrence group of patients identified at stage III or IV. The stage III resistant cases revealed heterozygous mutation (C/T) in exon 12 (C1236T) and 26 (C3435T) and increased level of mRNA, whereas homozygous mutation (T/T) was found at stage IV tumor patients. The genotypic difference was found to be significant (p = 0.03) for exon 12, and p = 0.003 for exon 26 mutant genotypes. No significant association between genotypes of different exons with tumor stages and tumor grade was observed (p > 0.05). However, a significant association was observed between the genotype of exon-12 and histopathology of tumor tissue (p = 0.028). Statistically, the chemotherapy response was found to be significantly associated with the tumor stage (p = 0.019). We also observed a significant difference in PFS (P = 0.019) and OS (P = 0.047) between tumor grades 1 and 3. Notably, the highest mRNA expression was observed in resistant tumor sample T-32, where interestingly we found homozygosity TT in all of the exons 12, 21, and 26. Thus, we suggest that exons 12 (C1236T) and exon 26 (C3435T) polymorphism may play a role in inducing drug resistance by altering the expression level of the MDR1 gene. To summarize, we suggest that the expression of MDR1 in OC is influenced by tumor stage and genotype variants as well as by chemotherapeutic drugs. Thus our findings suggest that inter individual variability in platinum based therapy may be anticipated by MDR1 genotypes. Further studies on a large number of samples shall eventually lead to provide beneficial information for the individualized chemotherapy.
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Affiliation(s)
- Absarul Haque
- King Fahd Medical Research Center, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khalid Hussain Wali Sait
- Gynecology Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Qamre Alam
- King Fahd Medical Research Center, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammad Zubair Alam
- King Fahd Medical Research Center, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nisreen Anfinan
- Gynecology Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Abdul Wahab Noor Wali
- King Fahd Medical Research Center, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mahmood Rasool
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.,Center of Excellence in Genomic Medicine Research, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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Falcetta FS, Lawrie TA, Medeiros LR, da Rosa MI, Edelweiss MI, Stein AT, Zelmanowicz A, Moraes AB, Zanini RR, Rosa DD. Laparoscopy versus laparotomy for FIGO stage I ovarian cancer. Cochrane Database Syst Rev 2016; 10:CD005344. [PMID: 27737492 PMCID: PMC6464147 DOI: 10.1002/14651858.cd005344.pub4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND This is an updated version of the original review that was first published in the Cochrane Database of Systematic Reviews 2008, Issue 4. Laparoscopy has become an increasingly common approach to surgical staging of apparent early-stage ovarian tumours. This review was undertaken to assess the available evidence on the benefits and risks of laparoscopy compared with laparotomy for the management of International Federation of Gynaecology and Obstetrics (FIGO) stage I ovarian cancer. OBJECTIVES To evaluate the benefits and harms of laparoscopy in the surgical treatment of FIGO stage I ovarian cancer (stages Ia, Ib and Ic) when compared with laparotomy. SEARCH METHODS For the original review, we searched the Cochrane Gynaecological Cancer Group Trials (CGCRG) Register, Cochrane Central Register of Controlled Trials (CENTRAL 2007, Issue 2), MEDLINE, Embase, LILACS, Biological Abstracts and CancerLit from 1 January 1990 to 30 November 2007. We also handsearched relevant journals, reference lists of identified studies and conference abstracts. For the first updated review, the search was extended to the CGCRG Specialised Register, CENTRAL, MEDLINE, Embase and LILACS to 6 December 2011. For this update we searched CENTRAL, MEDLINE, and Embase from November 2011 to September 2016. SELECTION CRITERIA Randomised controlled trials (RCTs), quasi-RCTs and prospective cohort studies comparing laparoscopic staging with open surgery (laparotomy) in women with stage I ovarian cancer according to FIGO. DATA COLLECTION AND ANALYSIS There were no studies to include, therefore we tabulated data from non-randomised studies (NRS) for discussion as well as important data from other meta-analyses. MAIN RESULTS We performed no meta-analyses. AUTHORS' CONCLUSIONS This review has found no good-quality evidence to help quantify the risks and benefits of laparoscopy for the management of early-stage ovarian cancer as routine clinical practice.
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Affiliation(s)
- Frederico S Falcetta
- Oncology, Hospital de Clínicas de Porto Alegre, Av. Nilópolis, 125, ap. 303, Porto Alegre, Brazil, 90460-050
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Kehoe S, Hook J, Nankivell M, Jayson GC, Kitchener H, Lopes T, Luesley D, Perren T, Bannoo S, Mascarenhas M, Dobbs S, Essapen S, Twigg J, Herod J, McCluggage G, Parmar M, Swart AM. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial. Lancet 2015; 386:249-57. [PMID: 26002111 DOI: 10.1016/s0140-6736(14)62223-6] [Citation(s) in RCA: 877] [Impact Index Per Article: 97.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The international standard of care for women with suspected advanced ovarian cancer is surgical debulking followed by platinum-based chemotherapy. We aimed to establish whether use of platinum-based primary chemotherapy followed by delayed surgery was an effective and safe alternative treatment regimen. METHODS In this phase 3, non-inferiority, randomised, controlled trial (CHORUS) undertaken in 87 hospitals in the UK and New Zealand, we enrolled women with suspected stage III or IV ovarian cancer. We randomly assigned women (1:1) either to undergo primary surgery followed by six cycles of chemotherapy, or to three cycles of primary chemotherapy, then surgery, followed by three more cycles of completion chemotherapy. Each 3-week cycle consisted of carboplatin AUC5 or AUC6 plus paclitaxel 175 mg/m(2), or an alternative carboplatin combination regimen, or carboplatin monotherapy. We did the random assignment by use of a minimisation method with a random element, and stratified participants according to the randomising centre, largest radiological tumour size, clinical stage, and prespecified chemotherapy regimen. Patients and investigators were not masked to group assignment. The primary outcome measure was overall survival. Primary analyses were done in the intention-to-treat population. To establish non-inferiority, the upper bound of a one-sided 90% CI for the hazard ratio (HR) had to be less than 1.18. This trial is registered, number ISRCTN74802813, and is closed to new participants. FINDINGS Between March 1, 2004, and Aug 30, 2010, we randomly assigned 552 women to treatment. Of the 550 women who were eligible, 276 were assigned to primary surgery and 274 to primary chemotherapy. All were included in the intention-to-treat analysis; 251 assigned to primary surgery and 253 to primary chemotherapy were included in the per-protocol analysis. As of May 31, 2014, 451 deaths had occurred: 231 in the primary-surgery group versus 220 in the primary-chemotherapy group. Median overall survival was 22.6 months in the primary-surgery group versus 24.1 months in primary chemotherapy. The HR for death was 0.87 in favour of primary chemotherapy, with the upper bound of the one-sided 90% CI 0.98 (95% CI 0.72-1.05). Grade 3 or 4 postoperative adverse events and deaths within 28 days after surgery were more common in the primary-surgery group than in the primary-chemotherapy group (60 [24%] of 252 women vs 30 [14%] of 209, p=0.0007, and 14 women [6%] vs 1 woman [<1%], p=0.001). The most common grade 3 or 4 postoperative adverse event was haemorrhage in both groups (8 women [3%] in the primary-surgery group vs 14 [6%] in the primary-chemotherapy group). 110 (49%) of 225 women receiving primary surgery and 102 (40%) of 253 receiving primary chemotherapy had a grade 3 or 4 chemotherapy related toxic effect (p=0.0654), mostly uncomplicated neutropenia (20% and 16%, respectively). One fatal toxic effect, neutropenic sepsis, occurred in the primary-chemotherapy group. INTERPRETATION In women with stage III or IV ovarian cancer, survival with primary chemotherapy is non-inferior to primary surgery. In this study population, giving primary chemotherapy before surgery is an acceptable standard of care for women with advanced ovarian cancer. FUNDING Cancer Research UK and the Royal College of Obstetricians and Gynaecologists.
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Affiliation(s)
- Sean Kehoe
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Jane Hook
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Matthew Nankivell
- Medical Research Council Clinical Trials Unit, University College London, London, UK.
| | - Gordon C Jayson
- Department of Medical Oncology, Christie Hospital and University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Henry Kitchener
- Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | | | - David Luesley
- Pan-Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
| | - Timothy Perren
- St James's Institute of Oncology, St James's University Hospital, Leeds, UK
| | - Selina Bannoo
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Monica Mascarenhas
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Stephen Dobbs
- Department of Gynaecological Oncology, Belfast City Hospital, Belfast, UK
| | - Sharadah Essapen
- St Lukes Cancer Centre, Royal Surrey County Hospital, Guildford, UK
| | - Jeremy Twigg
- James Cook University Hospital, Middlesbrough, UK
| | - Jonathan Herod
- Department of Gynaecology, Liverpool Women's Hospital, Liverpool, UK
| | - Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK
| | - Mahesh Parmar
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Ann-Marie Swart
- Medical Research Council Clinical Trials Unit, University College London, London, UK; Department of Medicine, University of East Anglia, Norwich, UK
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Wagner U, Harter P, Hilpert F, Mahner S, Reuß A, du Bois A, Petru E, Meier W, Ortner P, König K, Lindel K, Grab D, Piso P, Ortmann O, Runnebaum I, Pfisterer J, Lüftner D, Frickhofen N, Grünwald F, Maier BO, Diebold J, Hauptmann S, Kommoss F, Emons G, Radeleff B, Gebhardt M, Arnold N, Calaminus G, Weisse I, Weis J, Sehouli J, Fink D, Burges A, Hasenburg A, Eggert C. S3-Guideline on Diagnostics, Therapy and Follow-up of Malignant Ovarian Tumours: Short version 1.0 - AWMF registration number: 032/035OL, June 2013. Geburtshilfe Frauenheilkd 2013; 73:874-889. [PMID: 24771937 PMCID: PMC3859160 DOI: 10.1055/s-0033-1350713] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Lawrie TA, Medeiros LRF, Rosa DD, da Rosa MI, Edelweiss MI, Stein AT, Zelmanowicz A, Ethur AB, Zanini RR. Laparoscopy versus laparotomy for FIGO stage I ovarian cancer. Cochrane Database Syst Rev 2013:CD005344. [PMID: 23450560 DOI: 10.1002/14651858.cd005344.pub3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND This is an updated version of the original review that was first published in the Cochrane Database of Systematic Reviews 2008, Issue 4. Laparoscopy has become an increasingly common approach to surgical staging of apparent early-stage ovarian tumours. This review was undertaken to assess the available evidence on the benefits and risks of laparoscopy compared with laparotomy for the management of International Federation of Gynaecology and Obstetrics (FIGO) stage I ovarian cancer. OBJECTIVES To evaluate the benefits and risks of laparoscopy compared with laparotomy for the surgical treatment of FIGO stage I ovarian cancer (stages Ia, Ib and Ic). SEARCH METHODS For the original review, we searched the Cochrane Gynaecological Cancer Group Trials (CGCRG) Register, Cochrane Central Register of Controlled Trials (CENTRAL 2007, Issue 2), MEDLINE, EMBASE, LILACS, Biological Abstracts and CancerLit from 1 January 1990 to 30 November 2007. We also handsearched relevant journals, reference lists of identified studies and conference abstracts. For this updated review, we extended the CGCRG Specialised Register, CENTRAL, MEDLINE, EMBASE and LILACS searches to 6 December 2011. SELECTION CRITERIA Randomised controlled trials (RCTs), quasi-RCTs and prospective case-control studies comparing laparoscopic staging with open surgery (laparotomy) in women with stage I ovarian cancer according to FIGO. DATA COLLECTION AND ANALYSIS There were no studies to include, therefore we tabulated data from non-randomised studies (NRS) for discussion. MAIN RESULTS We performed no meta-analyses. AUTHORS' CONCLUSIONS This review has found no good-quality evidence to help quantify the risks and benefits of laparoscopy for the management of early-stage ovarian cancer as routine clinical practice.
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Affiliation(s)
- Theresa A Lawrie
- The Cochrane Gynaecological Cancer Group, Royal United Hospital, Bath, UK
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Raja F, Chopra N, Ledermann J. Optimal first-line treatment in ovarian cancer. Ann Oncol 2012; 23 Suppl 10:x118-27. [DOI: 10.1093/annonc/mds315] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Role of neoadjuvant chemotherapy in the management of stage IIIC-IV ovarian cancer: survey results from the members of the European Society of Gynecological Oncology. Int J Gynecol Cancer 2012; 22:407-16. [PMID: 22367320 DOI: 10.1097/igc.0b013e31823ea1d8] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The aim of this study is to evaluate the current opinion of the members of the European Society of Gynecological Oncology (ESGO) on the use of neoadjuvant chemotherapy (NACT) in stage IIIC and IV ovarian cancer. METHODS A link to a 21-item questionnaire, with questions about the management of patients with stage IIIC and IV ovarian cancer, was sent 3 times to the ESGO members (N = 1177). RESULTS Of the 469 (40%) responding members, 70.2% believe there is sufficient evidence to use NACT followed by interval debulking for the treatment of stage IIIC and IV ovarian cancer. On the basis of a multivariable logistic regression analysis, no relationships between the belief in evidence for NACT and practice type (P = 0.15) or level of experience (P = 0.41) were observed. Only 5.3% of respondents never use NACT, and 30% uses NACT in less than 10% of their patients. Optimal debulking, defined as "no macroscopic residual tumor," is reported in more than 60% of the patients by 20% of the respondents at primary debulking, and by 34.6% of the respondents when interval debulking is performed. Whether a patient can be optimally primarily debulked is impossible to determine preoperatively according to 51.1% of the respondents. Computed tomographic scan (79.4%) and clinical examination (72.5%) are regarded as the most important modalities to predict operability. Diagnostic laparoscopy is used by 46.3% of the respondents. The most important reasons for choosing NACT are bulky disease in the upper abdomen (64.7%) and stage IV disease (58.7%). CONCLUSIONS Of the responding ESGO members, 70% believe there is sufficient evidence to treat patients with stage IIIC-IV ovarian cancer with NACT, and 30% uses NACT in less than 10% of their patients.
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Eckstein N. Platinum resistance in breast and ovarian cancer cell lines. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2011; 30:91. [PMID: 21967738 PMCID: PMC3197542 DOI: 10.1186/1756-9966-30-91] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 10/04/2011] [Indexed: 12/25/2022]
Abstract
Breast and ovarian cancers are among the 10 leading cancer types in females with mortalities of 15% and 6%, respectively. Despite tremendous efforts to conquer malignant diseases, the war on cancer declared by Richard Nixon four decades ago seems to be lost. Approximately 21,800 women in the US will be diagnosed with ovarian cancer in 2011. Therefore, its incidence is relatively low compared to breast cancer with 207.090 prognosed cases in 2011. However, overall survival unmasks ovarian cancer as the most deadly gynecological neoplasia. Platinum-based chemotherapy is emerging as an upcoming treatment modality especially in triple negative breast cancer. However, in ovarian cancer Platinum-complexes for a long time are established as first line treatment. Emergence of a resistant phenotype is a major hurdle in curative cancer therapy approaches and many scientists around the world are focussing on this issue. This review covers new findings in this field during the past decade.
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Affiliation(s)
- Niels Eckstein
- Federal Institute for Drugs and Medical Devices, Kurt-Georg-Kiesinger-Allee 3, 53175 Bonn, Germany.
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Gmyrek LJ, Jonska-Gmyrek J, Sobiczewski P, Panek G, Bidzinski M. Evaluation of intraoperative and postoperative complications related to lymphadenectomy in ovarian cancer patients. Oncol Lett 2011; 2:537-541. [PMID: 22866117 DOI: 10.3892/ol.2011.281] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 03/01/2011] [Indexed: 11/05/2022] Open
Abstract
Assessment of the regional lymph node status is an integral part of diagnostics for ovarian cancer patients. Due to the risk of complications, lymphadenectomy for ovarian cancer patients, as a routine treatment procedure, is still a subject of controversy. Therefore, the present study aimed to evaluate the frequency and nature of intraoperative and postoperative complications in ovarian cancer patients treated with surgery. In addition, a comparison of the frequency and nature of surgical complications between patients who underwent lymphadenectomy and those who did not was carried out. A retrospective analysis of 211 consecutive ovarian cancer patients treated with surgery with pelvic and aortic lymphadenectomy (group I), and 258 ovarian cancer patients treated with surgery but without lymphadenectomy (group II) was carried out. All of the patients were treated with complementary chemotherapy. The frequency and nature of the intraoperative and postoperative complications were determined. The most frequent intraoperative complications in the two groups were haemorrhage, urinary system damage and digestive tract damage. The difference in the frequency and nature between the groups was not statistically significant (p=0.683). The most frequent postoperative complications were haemorrhage, intestinal junction dehiscence, eventrations, wound dehiscence, anaemia, wound healing complications and intestinal fistulas. Haemorrhage, eventrations and wound healing complications were more frequent in group I. The difference was statistically significant (p=0.002). Due to postoperative complications, reoperative procedures were necessary in two women in group II (0.78) and in 15 women (7.11%) in group I. The difference was statistically significant (p=0.000). In conclusion, the most frequent intraoperative complications were haemorrhage, urinary system damage and digestive tract damage. The frequency of complication was found to be similar in the two groups. A statistically significant higher rate of postoperative complications, such as haemorrhage, eventrations and wound healing complications was confirmed in the lymphadenectomy group.
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Affiliation(s)
- Leszek Jaroslaw Gmyrek
- Department of Gynecological Oncology, Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland
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Menczer J, Chetrit A, Sadetzki S. Uterine metastases in ovarian carcinoma: frequency and survival in women who underwent hysterectomy. J Gynecol Oncol 2010; 21:191-5. [PMID: 20922143 DOI: 10.3802/jgo.2010.21.3.191] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 06/21/2010] [Accepted: 06/30/2010] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Possible reasons for hysterectomy in the initial surgical management of advanced invasive epithelial ovarian carcinoma (EOC) might be a high frequency of uterine involvement and its impact on survival. The aim of the present study was to describe the frequency of uterine involvement and its association with survival in an unselected population of EOC patients who underwent hysterectomy. METHODS All incident cases of EOC diagnosed in Israeli Jewish women between March 1994 to June 1999, were identified within the framework of a nationwide case-control epidemiological study. The target population of the present report includes all stage II-IV EOC patients who had a uterus at the time of diagnosis. Of the 822 such patients, 695 fulfilled the inclusion criterion. Excluded were 141 patients for various reasons. The present analysis is based on the remaining 554 patients. RESULTS Uterine involvement was present in 291 (52.5%) of the patients and it was macroscopic in only 78 (14.1%). The serosa was the most common site of isolated metastases. Multivariate analysis showed that advanced stage significantly increased the risk for uterine involvement. The overall median survival with any uterine involvement was significantly lower compared to those with no involvement (38.9 months vs. 58.0 months; p<0.001). CONCLUSION There is an association between uterine involvement, whether macro- or microscopic, and lower survival even after hysterectomy although residual tumor could not be included in the analysis. Further studies are required to establish whether uterine involvement itself is an unfavorable risk factor or merely a marker of other unfavorable prognostic factors.
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Affiliation(s)
- Joseph Menczer
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Israel
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Can Surgical Debulking Reverse Platinum Resistance in Patients With Metastatic Epithelial Ovarian Cancer? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009; 31:42-7. [DOI: 10.1016/s1701-2163(16)34052-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Salet-Lizée D, Alsary S. [Not Available]. ACTA ACUST UNITED AC 2008; 145S4:12S45-9. [PMID: 22793985 DOI: 10.1016/s0021-7697(08)74722-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
D. Salet-Lizée, S. Alsary Ovarian cancer often invades regional lymph nodes but the patterns of involvement are variable; spread to para-aortic and pelvic lymph nodes can be unilateral, contralateral or bilateral. For staging purposes, complete lymph node dissection seems more reasonable and effective than simple lymph node sampling. In early stage disease, lymph node dissection has both diagnostic and therapeutic value allowing identification and optimal management of Stage IIIc tumors with retroperitoneal spread; it may also have direct therapeutic value by removing retroperitoneal micrometastatic disease including cell clones which may be resistant to chemotherapy. Therefore, complete lymph node dissection is recommended in early-stage disease with the exception of stage I mucinous ovarian cancer. In advanced-stage disease, lymph node involvement is an additional factor of poor prognosis correlating with increased tumor aggressivity. Optimal debulking resection of all visible tumor offers the best chance for a prolonged disease-free interval if patient condition permits and morbidity can be limited. Survival benefit for complete lymph node dissection has not been evaluated by randomized controlled trials; but several non-randomized studies and two long-term prospective trials have shown objective improvement in disease-free survival and improved quality of life when debulking surgery leaves no residual tumor larger than 1 cm.
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Salet-Lizée D, Alsary S. [Not Available]. ACTA ACUST UNITED AC 2008; 145:12S45-9. [PMID: 22794072 DOI: 10.1016/s0021-7697(08)45009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
D. Salet-Lizée, S. Alsary Ovarian cancer often invades regional lymph nodes but the patterns of involvement are variable; spread to para-aortic and pelvic lymph nodes can be unilateral, contralateral or bilateral. For staging purposes, complete lymph node dissection seems more reasonable and effective than simple lymph node sampling. In early stage disease, lymph node dissection has both diagnostic and therapeutic value allowing identification and optimal management of Stage IIIc tumors with retroperitoneal spread; it may also have direct therapeutic value by removing retroperitoneal micrometastatic disease including cell clones which may be resistant to chemotherapy. Therefore, complete lymph node dissection is recommended in early-stage disease with the exception of stage I mucinous ovarian cancer. In advanced-stage disease, lymph node involvement is an additional factor of poor prognosis correlating with increased tumor aggressivity. Optimal debulking resection of all visible tumor offers the best chance for a prolonged disease-free interval if patient condition permits and morbidity can be limited. Survival benefit for complete lymph node dissection has not been evaluated by randomized controlled trials; but several non-randomized studies and two long-term prospective trials have shown objective improvement in disease-free survival and improved quality of life when debulking surgery leaves no residual tumor larger than 1 cm.
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Medeiros LRF, Rosa DD, Bozzetti MC, Rosa MI, Edelweiss MI, Stein AT, Zelmanowicz A, Ethur AB, Zanini RR. Laparoscopy versus laparotomy for FIGO Stage I ovarian cancer. Cochrane Database Syst Rev 2008:CD005344. [PMID: 18843688 DOI: 10.1002/14651858.cd005344.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Over the past ten years laparoscopy has become an increasingly common approach for the surgical removal of early stage ovarian tumours. There remains uncertainty about the value of this intervention. This review has been undertaken to assess the available evidence of the benefits and harms of laparoscopic surgery for the management of early stage ovarian cancer compared to laparotomy. OBJECTIVES To evaluate the benefits and harms of laparoscopy in the surgical treatment of FIGO stage I ovarian cancer (stages Ia, Ib and Ic) when compared with laparotomy. SEARCH STRATEGY Trials were identified by searching the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library Issue 2, 2007, MEDLINE (January 1990 to November 2007), EMBASE (1990 to November 2007), LILACS (1990 to November 2007), BIOLOGICAL ABSTRACTS (1990 to November 2007) and Cancerlit (1990 to November 2007). We also searched our own publication archives, based on prospective handsearching of relevant journals from November 2007. Reference lists of identified studies, gynaecological cancer handbooks and conference abstract were also scanned. SELECTION CRITERIA Studies including patients with histologically proven stage I ovarian cancer according to the International Federation of Gynaecology and Obstetrics (FIGO).Studies comparing laparoscopic surgery with laparotomy for early stage ovarian cancer were only available from 1990. It was anticipated that a very small number of randomised controlled trials (RCTs) were conducted studying the management of early stage ovarian cancer. Therefore, non-randomised comparative studies, cohort studies and case-controls studies, but not studies with historical controls, were also considered. DATA COLLECTION AND ANALYSIS Data extraction was performed independently by five review authors (LRM, DDR, MIR, MCB and MIE) who assessed study quality and quality of extracted data. Extracted data included trial characteristics, characteristics of the study participants, interventions and outcomes. The quality of non RCTs was assessed using appropriate quality evaluations tools from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) and from the Newcastle-Ottawa tool for observational studies (NOS). MAIN RESULTS No RCTs were identified. Three observational studies were identified. AUTHORS' CONCLUSIONS This review has found no evidence to help quantify the value of laparoscopy for the management of early stage ovarian cancer as routine clinical practice.
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Affiliation(s)
- Lídia R F Medeiros
- Social Medicine/Epidemiology, Federal University of Rio Grande do Sul, Jose de Alencar 1244, 1009 Menino Deus, Porto Alegre, Rio Grande do Sul, Brazil, 90880-480.
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Brun JL, Cortez A, Rouzier R, Callard P, Bazot M, Uzan S, Daraï E. Factors influencing the use and accuracy of frozen section diagnosis of epithelial ovarian tumors. Am J Obstet Gynecol 2008; 199:244.e1-7. [PMID: 18486086 DOI: 10.1016/j.ajog.2008.04.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Revised: 12/27/2007] [Accepted: 04/02/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The objective of the study was to study factors influencing the use and accuracy of frozen section diagnosis (FSD) of ovarian tumors. STUDY DESIGN Surgery was performed in 414 patients with epithelial ovarian tumors between 2001 and 2006. Factors were identified by univariate and multivariate analysis. RESULTS FSD was requested in 274 patients: 152 benign, 55 borderline, and 67 malignant tumors. Age 50 years or older, tumor size 10 cm or greater, and preoperative evidence of malignancy were associated with FSD request. The sensitivity and specificity of FSD for benign, borderline, and malignant tumors were 97% and 81%, 62% and 96%, and 88% and 99%, respectively. The histologic type (mucinous), tumor size (less than 10 cm), the borderline component (less than 10%), and the pathologist's experience predicted misdiagnosis of borderline tumors. Spread outside the ovary was the only significant predictor of accurate FSD of malignant tumors. CONCLUSION FSD is less accurate for borderline than benign and malignant ovarian tumors. The pathologist's experience is a major determinant of diagnostic accuracy.
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Williams TI, Toups KL, Saggese DA, Kalli KR, Cliby WA, Muddiman DC. Epithelial ovarian cancer: disease etiology, treatment, detection, and investigational gene, metabolite, and protein biomarkers. J Proteome Res 2007; 6:2936-62. [PMID: 17583933 DOI: 10.1021/pr070041v] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cancer research in recent years has immensely benefited from the development of novel technologies that enable scientists to perform detailed investigations of genomes, transcriptomes, proteomes, and metabolomes. This has invariably furthered knowledge of tumorigenesis and etiology of cancer. The resulting information can, in the foreseeable future, effect a significant change in the pace of cancer research, thereby producing improvements in patient care. Ovarian cancer in particular has received the interest of the scientific community, being the most frequent cause of death from gynecological cancers, characterized by few early symptoms, diagnosis at an advanced stage, as well as poor prognosis. Ovarian cancer is a malignancy in which normal ovarian cells begin to grow in an uncontrolled, abnormal manner and produce tumors in one or both ovaries. Epithelial cancers, the most common ovarian cancers (>80%), develop from cells lining the ovarian surface. Most ovarian cancer research is primarily focused on the early detection and treatment of epithelial ovarian cancer, the more common ovarian malignancy. This review offers an introduction to ovarian cancer, with particular emphasis on human epithelial ovarian cancer. Current methods of detection and therapy are discussed. A survey of promising new protein, gene, and metabolite biomarkers on the horizon is provided. Future prospects for improved diagnosis are offered.
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Affiliation(s)
- Taufika Islam Williams
- W.M. Keck FT-ICR Mass Spectrometry Laboratory, Department of Chemistry, North Carolina State University, Raleigh, North Carolina 27695, USA
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