1
|
Padilla-Iserte P, Iváñez M, Muruzabal JC, Navarro R, Díaz-Feijoo B, Iacoponi S, García-Pineda V, Díaz C, Utrilla-Layna J, Gil-Moreno A, Serra A, Gilabert-Estellés J, Martínez Canto C, Tejerizo Á, Lago V, Cárdenas-Rebollo JM, Domingo S. Oncological outcomes of intraperitoneal chemotherapy in advanced ovarian cancer: BRCA mutation role. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108263. [PMID: 38492526 DOI: 10.1016/j.ejso.2024.108263] [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: 10/18/2023] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 03/18/2024]
Abstract
INTRODUCTION The knowledge of BRCA status offers a chance to evaluate the role of the intraperitoneal route in patients selected by biomolecular profiles after primary cytoreduction surgery in advanced ovarian cancer. MATERIALS AND METHODS We performed a retrospective, multicenter study to assess oncological outcomes depending on adjuvant treatment (intraperitoneal [IP] vs intravenous [IV]) and BRCA status (BRCA1/2 mutated vs. BRCA wild type [WT]). The primary endpoint was to determine progression-free survival. The secondary objectives were overall survival and toxicity. RESULTS A total of 288 women from eight centers were included: 177 in the IP arm and 111 in the IV arm, grouped into four arms according to BRCA1/2 status. Significantly better PFS was observed in BRCA1/2-mutated patients with IP chemotherapy (HR: 0.35; 95% CI, 0.16-0.75, p = 0.007), which was not present in BRCA1/2-mutated patients with IV chemotherapy (HR: 0.65; 95% CI, 0.37-1.12, p = 0.14). Significantly better OS was also observed in IP chemotherapy (HR: 0.17; 95% CI, 0.06-043, p < 0.0001), but was not present in IV chemotherapy in relation with BRCA mutation (HR: 0.52; 95% CI, 0.22-1.27, p = 0.15). For BRCA WT patients, worse survival was observed regardless of the adjuvant route used. The IP route was more toxic compared to the IV route, but toxicity was equivalent at the long-term follow-up. CONCLUSION This retrospective study suggests that BRCA status can help to offer an individualized, systematic treatment after optimal primary surgery for advanced ovarian cancer, but is limited by the small sample size. Prospective trials are essential to confirm these results.
Collapse
Affiliation(s)
- Pablo Padilla-Iserte
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain.
| | - Maria Iváñez
- Department of Gynaecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Rafael Navarro
- Department of Gynecologic Oncology, MD Anderson Cancer Center Madrid, Spain
| | - Berta Díaz-Feijoo
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain
| | - Sara Iacoponi
- Department of Obstetrics and Gynaecology, University Quirónsalud Madrid Hospital, Spain
| | | | - Cristina Díaz
- Department of Gynecology, Valencian Institute of Oncology (IVO), Spain
| | | | - Antonio Gil-Moreno
- Gynecologic Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Institut de Recerca Biomèdica en Ginecologia-VHIR, CIBERONC, Barcelona, Spain
| | - Anna Serra
- Department of Obstetrics and Gynecology, Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Spain
| | - Juan Gilabert-Estellés
- Department of Obstetrics and Gynecology, University General Hospital of Valencia Spain, Spain
| | | | - Álvaro Tejerizo
- Department of Obstetrics and Gynecology, Gynecologic Oncology Unit, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de Investigación i+12, Universidad Complutense de Madrid, Spain
| | - Víctor Lago
- Department of Gynaecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Santiago Domingo
- Department of Gynaecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| |
Collapse
|
2
|
Jia Y, Jiang Y, Fan X, Zhang Y, Li K, Wang H, Ning X, Yang X. Preoperative serum level of CA153 and a new model to predict the sub-optimal primary debulking surgery in patients with advanced epithelial ovarian cancer. World J Surg Oncol 2024; 22:64. [PMID: 38395933 PMCID: PMC10885626 DOI: 10.1186/s12957-024-03336-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVE The aim of this study was to establish a preoperative model to predict the outcome of primary debulking surgery (PDS) for advanced ovarian cancer (AOC) patients by combing Suidan predictive model with HE4, CA125, CA153 and ROMA index. METHODS 76 AOC Patients in revised 2014 International Federation of Gynecology and Obstetrics (FIGO) stage III-IV who underwent PDS between 2017 and 2019 from Yunnan Cancer Hospital were included. Clinical data including the levels of preoperative serum HE4, CA125, CA153 and mid-lower abdominal CT-enhanced scan results were collected. The logistics regression analysis was performed to find factors associated with sub-optimal debulking surgery (SDS). The receiver operating characteristic curve was used to evaluate the predictive performances of selected variables in the outcome of primary debulking surgery. The predictive index value (PIV) model was constructed to predict the outcome of SDS. RESULTS Optimal surgical cytoreduction was achieved in 61.84% (47/76) patients. The value for CA125, HE4, CA153, ROMA index and Suidan score was lower in optimal debulking surgery (ODS) group than SDS group. Based on the Youden index, which is widely used for evaluating the performance of predictive models, the best cutoff point for the preoperative serum HE4, CA125, CA153, ROMA index and Suidan score to distinguish SDS were 431.55 pmol/l, 2277 KU/L, 57.19 KU/L, 97.525% and 2.5, respectively. Patients with PIV≥5 may not be able to achieve optimal surgical cytoreduction. The diagnostic accuracy, NPV, PPV and specificity for diagnosing SDS were 73.7%, 82.9%, 62.9% and 72.3%, respectively. In the constructed model, the AUC of the SDS prediction was 0.770 (95% confidence interval: 0.654-0.887), P<0.001. CONCLUSION Preoperative serum CA153 level is an important non-invasive predictor of primary SDS in advanced AOC, which has not been reported before. The constructed PIV model based on Suidan's predictive model plus HE4, CA125, CA153 and ROMA index can noninvasively predict SDS in AOC patients, the accuracy of this prediction model still needs to be validated in future studies.
Collapse
Affiliation(s)
- Yue Jia
- Department of Gynecology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, Yunnan, P. R. China, 650118
| | - Yaping Jiang
- Department of Gynecology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, Yunnan, P. R. China, 650118
| | - Xiaoqi Fan
- Department of Gynecology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, Yunnan, P. R. China, 650118
| | - Ya Zhang
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, Yunnan, P. R. China, 650118
| | - Kun Li
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, Yunnan, P. R. China, 650118
| | - Haohan Wang
- Department of Gynecology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, Yunnan, P. R. China, 650118
| | - Xianling Ning
- Department of Gynecology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, Yunnan, P. R. China, 650118
| | - Xielan Yang
- Department of Gynecology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, Yunnan, P. R. China, 650118.
| |
Collapse
|
3
|
Luis Alcázar J, Ramón Pérez-Vidal J, Tameish S, Chacón E, Manzour N, Ángel Mínguez J. Ultrasound for assessing tumor spread in ovarian cancer. A systematic review of the literature and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2024; 292:194-200. [PMID: 38042117 DOI: 10.1016/j.ejogrb.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 12/04/2023]
Abstract
In this review, we aimed to assess the diagnostic performance of ultrasound for assessing the tumor spread in the abdomen in women with ovarian cancer. A search for studies evaluating the role of ultrasound for assessing intrabdominal tumor spread in women with ovarian cancer compared to surgery from January 2011 to March 2023 was performed in PubMed/MEDLINE, Web of Science, and Scopus databases. The Quality Assessment of Diagnostic Accuracy Studies 2 evaluated the quality of the studies (QUADAS-2). All analyses were performed using MIDAS and METANDI commands in STATA 12.0 software. We identified 1552 citations. After exclusions, five studies comprising 822 women were included. Quality of studies were considered as good, except for patient selection as all studies were considered as having high risk of bias. The pooled sensitivity and specificity could be calculated for three anatomical areas (recto-sigma, major omentum and root of mesentery) and the presence of ascites. The pooled sensitivity and specificity for detecting disease in the recto-sigma, major omentum and root of mesentery were 0.83 and 0.95, 0.87 and 0.87, and 0.29 and 0.99, respectively. The pooled sensitivity and specificity for detecting ascites was 0.95 and 0.91, respectively. There is evidence that ultrasound offers good diagnostic performance for evaluating the intra-abdominal extent of disease in women with suspected ovarian cancer.
Collapse
Affiliation(s)
- Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, 31008 Pamplona, Spain.
| | - Juan Ramón Pérez-Vidal
- Department Obstetrics and Gynecology, University Hospital Virgen de la Arrixaca, 31120 El Palmar, Murcia, Spain
| | - Sarah Tameish
- Department of Obstetrics and Gynecology, University Hospital Sant Joan, 43204 Reus, Spain
| | - Enrique Chacón
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, 31008 Pamplona, Spain
| | - Nabil Manzour
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, 31008 Pamplona, Spain
| | - José Ángel Mínguez
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, 31008 Pamplona, Spain
| |
Collapse
|
4
|
Veneziani AC, Gonzalez-Ochoa E, Alqaisi H, Madariaga A, Bhat G, Rouzbahman M, Sneha S, Oza AM. Heterogeneity and treatment landscape of ovarian carcinoma. Nat Rev Clin Oncol 2023; 20:820-842. [PMID: 37783747 DOI: 10.1038/s41571-023-00819-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/04/2023]
Abstract
Ovarian carcinoma is characterized by heterogeneity at the molecular, cellular and anatomical levels, both spatially and temporally. This heterogeneity affects response to surgery and/or systemic therapy, and also facilitates inherent and acquired drug resistance. As a consequence, this tumour type is often aggressive and frequently lethal. Ovarian carcinoma is not a single disease entity and comprises various subtypes, each with distinct complex molecular landscapes that change during progression and therapy. The interactions of cancer and stromal cells within the tumour microenvironment further affects disease evolution and response to therapy. In past decades, researchers have characterized the cellular, molecular, microenvironmental and immunological heterogeneity of ovarian carcinoma. Traditional treatment approaches have considered ovarian carcinoma as a single entity. This landscape is slowly changing with the increasing appreciation of heterogeneity and the recognition that delivering ineffective therapies can delay the development of effective personalized approaches as well as potentially change the molecular and cellular characteristics of the tumour, which might lead to additional resistance to subsequent therapy. In this Review we discuss the heterogeneity of ovarian carcinoma, outline the current treatment landscape for this malignancy and highlight potentially effective therapeutic strategies in development.
Collapse
Affiliation(s)
- Ana C Veneziani
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Eduardo Gonzalez-Ochoa
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Husam Alqaisi
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ainhoa Madariaga
- Medical Oncology Department, 12 De Octubre University Hospital, Madrid, Spain
| | - Gita Bhat
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Marjan Rouzbahman
- Department of Laboratory Medicine and Pathobiology, Toronto General Hospital, Toronto, Ontario, Canada
| | - Suku Sneha
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Amit M Oza
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
5
|
Parpinel G, Laudani ME, Piovano E, Zola P, Lecuru F. The Use of Artificial Intelligence for Complete Cytoreduction Prediction in Epithelial Ovarian Cancer: A Narrative Review. Cancer Control 2023; 30:10732748231159553. [PMID: 36847148 PMCID: PMC9972055 DOI: 10.1177/10732748231159553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
INTRODUCTION In patients affected by epithelial ovarian cancer (EOC) complete cytoreduction (CC) has been associated with higher survival outcomes. Artificial intelligence (AI) systems have proved clinical benefice in different areas of healthcare. OBJECTIVE To systematically assemble and analyze the available literature on the use of AI in patients affected by EOC to evaluate its applicability to predict CC compared to traditional statistics. MATERIAL AND METHODS Data search was carried out through PubMed, Scopus, Ovid MEDLINE, Cochrane Library, EMBASE, international congresses and clinical trials. The main search terms were: Artificial Intelligence AND surgery/cytoreduction AND ovarian cancer. Two authors independently performed the search by October 2022 and evaluated the eligibility criteria. Studies were included when data about Artificial Intelligence and methodological data were detailed. RESULTS A total of 1899 cases were analyzed. Survival data were reported in 2 articles: 92% of 5-years overall survival (OS) and 73% of 2-years OS. The median area under the curve (AUC) resulted 0,62. The model accuracy for surgical resection reported in two articles reported was 77,7% and 65,8% respectively while the median AUC was 0,81. On average 8 variables were inserted in the algorithms. The most used parameters were age and Ca125. DISCUSSION AI revealed greater accuracy compared against the logistic regression models data. Survival predictive accuracy and AUC were lower for advanced ovarian cancers. One study analyzed the importance of factors predicting CC in recurrent epithelial ovarian cancer and disease free interval, retroperitoneal recurrence, residual disease at primary surgery and stage represented the main influencing factors. Surgical Complexity Scores resulted to be more useful in the algorithms than pre-operating imaging. CONCLUSION AI showed better prognostic accuracy if compared to conventional algorithms. However further studies are needed to compare the impact of different AI methods and variables and to provide survival informations.
Collapse
Affiliation(s)
- Giulia Parpinel
- Department of Surgical Sciences, University of Turin, Torino, Italy,Giulia Parpinel, MD, Department of Surgical
Sciences, University of Turin, Via Ventimiglia 3, Torino 10126, Italy.
| | | | - Elisa Piovano
- Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Paolo Zola
- Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Fabrice Lecuru
- Breast, Gynecology and
Reconstructive Surgery Unit, Curie Institute, Paris, France
| |
Collapse
|
6
|
Lee J, Hong DG. Does protracted chemotherapy have an influence on the clinical outcomes in advanced epithelial ovarian cancer? Medicine (Baltimore) 2022; 101:e29967. [PMID: 35960085 PMCID: PMC9371530 DOI: 10.1097/md.0000000000029967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
In epithelial ovarian cancer, first-line adjuvant chemotherapy is necessary, and patients sometimes require protraction; however, there are only a few recent studies to show its influence. In this study, we investigated whether the protraction of the total period of first-line chemotherapy has a negative influence on the survival outcomes. Of the 101 patients we recruited from February 2011 to February 2021, 70 (69.3%) and 31 (30.7%) were classified into the not protracted and protracted groups, respectively. They underwent surgery and adjuvant chemotherapy for epithelial ovarian cancer. Protraction was defined as the overall duration of the first-line chemotherapy being more than 20 days longer than intended. Number of patients who underwent additional treatments such as bevacizumab or poly(adenosine diphosphate ribose) polymerase inhibitors or pembrolizumab was compared between both groups. Kaplan-Meier survival analysis and Cox regression analysis were used for survival outcomes. There was no significant difference for additional treatments. The progression-free survival (PFS) in the total follow-up period in the protracted group was significantly shorter than that in the not protracted group (P = .037); however, the difference in the overall survival between the 2 groups was not significant (P = .223). For the PFS, the hazard ratio of protraction was 1.646 in the univariate analysis (95% confidence interval, 1.020-2.658; P = .041). Excessive protraction of chemotherapy over 20 days or more can result in significantly shorter PFS within 5 years. A better therapeutic strategy is required for patients requiring protracted first-line chemotherapy in advanced epithelial ovarian cancer.
Collapse
Affiliation(s)
- Juhun Lee
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Dae Gy Hong
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
- *Correspondence: Dae Gy Hong, Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Republic of Korea (e-mail: )
| |
Collapse
|
7
|
McFadden M, Singh SK, Oprea-Ilies G, Singh R. Nano-Based Drug Delivery and Targeting to Overcome Drug Resistance of Ovarian Cancers. Cancers (Basel) 2021; 13:cancers13215480. [PMID: 34771642 PMCID: PMC8582784 DOI: 10.3390/cancers13215480] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/19/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022] Open
Abstract
Ovarian cancer (OvCa) is a destructive malignancy due to difficulties in early detection and late advanced-stage diagnoses, leading to high morbidity and mortality rates for women. Currently, the quality treatment for OvCa includes tumor debulking surgery and intravenous platinum-based chemotherapy. However, numerous patients either succumb to the disease or undergo relapse due to drug resistance, such as to platinum drugs. There are several mechanisms that cause cancer cells' resistance to chemotherapy, such as inactivation of the drug, alteration of the drug targets, enhancement of DNA repair of drug-induced damage, and multidrug resistance (MDR). Some targeted therapies, such as nanoparticles, and some non-targeted therapies, such as natural products, reverse MDR. Nanoparticle targeting can lead to the reversal of MDR by allowing direct access for agents to specific tumor sites. Natural products have many anti-cancer properties that adversely regulate the factors contributing to MDR. The present review displays the current problems in OvCa treatments that lead to resistance and proposes using nanotechnology and natural products to overcome drug resistance.
Collapse
Affiliation(s)
- Melayshia McFadden
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA; (M.M.); (S.K.S.)
| | - Santosh Kumar Singh
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA; (M.M.); (S.K.S.)
| | - Gabriela Oprea-Ilies
- Department of Pathology & Laboratory Medicine, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Rajesh Singh
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA; (M.M.); (S.K.S.)
- Cancer Health Equity Institute, Morehouse School of Medicine, Atlanta, GA 30310, USA
- Correspondence:
| |
Collapse
|
8
|
Heong V, Tan TZ, Miwa M, Ye J, Lim D, Herrington CS, Iida Y, Yano M, Yasuda M, Ngoi NY, Wong SJ, Okamoto A, Gourley C, Hasegawa K, Tan DS, Huang RY. A multi-ethnic analysis of immune-related gene expression signatures in patients with ovarian clear cell carcinoma. J Pathol 2021; 255:285-295. [PMID: 34322886 PMCID: PMC9539643 DOI: 10.1002/path.5769] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/07/2021] [Accepted: 07/23/2021] [Indexed: 11/23/2022]
Abstract
Little is known about the immune environment of ovarian clear cell carcinoma (OCCC) and its impact on various ethnic backgrounds. The aim of this OCCC immune‐related gene expression signatures (irGES) study was to address the interaction between tumour and immune environment of ethnically‐diverse Asian and Caucasian populations and to identify relevant molecular subsets of biological and clinical importance. Our study included 264 women from three different countries (Singapore, Japan, and the UK) and identified four novel immune subtypes (PD1‐high, CTLA4‐high, antigen‐presentation, and pro‐angiogenic subtype) with differentially expressed pathways, and gene ontologies using the NanoString nCounter PanCancer Immune Profiling Panel. The PD1‐high and CTLA4‐high subtypes demonstrated significantly higher PD1, PDL1, and CTLA4 expression, and were associated with poorer clinical outcomes. Mismatch repair (MMR) protein expression, assessed by immunohistochemistry, revealed that about 5% of OCCCs had deficient MMR expression. The prevalence was similar across the three countries and appeared to cluster in the CTLA4‐high subtype. Our results suggest that OCCC from women of Asian and Caucasian descent shares significant clinical and molecular similarities. To our knowledge, our study is the first study to include both Asian and Caucasian women with OCCC and helps to shine light on the impact of ethnic differences on the immune microenvironment of OCCC. © 2021 The Authors. The Journal of Pathology published by John Wiley & Sons, Ltd. on behalf of The Pathological Society of Great Britain and Ireland.
Collapse
Affiliation(s)
- Valerie Heong
- Department of Medical Oncology, Tan Tock Seng Hospital, Singapore
| | - Tuan Z Tan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Maiko Miwa
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Jieru Ye
- School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Diana Lim
- Department of Pathology, National University Hospital, Singapore
| | - C Simon Herrington
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC IGMM, University of Edinburgh, Edinburgh, UK
| | - Yasushi Iida
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC IGMM, University of Edinburgh, Edinburgh, UK
| | - Mitsutake Yano
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka-shi, Japan
| | - Masanori Yasuda
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka-shi, Japan
| | - Natalie Yl Ngoi
- Department of Haematology and Oncology, National University Cancer Institute Singapore, Singapore
| | - Sb Justin Wong
- Department of Pathology, National University Hospital, Singapore
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Charlie Gourley
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC IGMM, University of Edinburgh, Edinburgh, UK
| | - Kosei Hasegawa
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - David Sp Tan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore.,Department of Haematology and Oncology, National University Cancer Institute Singapore, Singapore
| | - Ruby Yj Huang
- School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
9
|
Abstract
The mainstay management of advanced ovarian cancer is maximal cytoreductive surgery followed by chemotherapy. Neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS) are alternative treatments for patients with comorbidity, poor performance status, and predicted for suboptimal debulking surgery. It is the invariable principle in any situation that no residual disease after the completion of surgery is useful for patients with ovarian cancer. Therefore, the prediction of optimal debulking before the treatment of ovarian cancer is of utmost importance. Many studies have reported on the use of serum biomarkers, such as cancer antigen 125 (CA125) or human epididymis 4 (HE4), and imaging studies, such as computed tomography (CT), diffusion-weighted magnetic resonance imaging (DW-MRI), and positron emission tomography (PET)/CT, to identify adequate surgical candidates for primary debulking surgery (PDS). Laparoscopy has also been studied as a reliable tool for the prediction of optimal debulking. Here, we summarize a review of the related literature.
Collapse
Affiliation(s)
- Yong Jung Song
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea
| |
Collapse
|
10
|
Isolated Splenic Metastasis from Ovarian Carcinoma. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-020-00446-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
11
|
Ono T, Kishimoto K, Tajima S, Maeda I, Takagi M, Suzuki N, Mimura H. Apparent diffusion coefficient (ADC) values of serous, endometrioid, and clear cell carcinoma of the ovary: pathological correlation. Acta Radiol 2020; 61:992-1000. [PMID: 31698924 DOI: 10.1177/0284185119883392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Primary epithelial ovarian cancer is divided into several subtypes. The relationships between apparent diffusion coefficient (ADC) values and their subtypes have not yet been established. PURPOSE To investigate whether ADC values of epithelial ovarian cancer vary according to histologic tumor cellularity and evaluate the difference of clear cell carcinoma (CCC), high-grade serous carcinoma (HGSC), and endometrioid carcinoma (EC). MATERIAL AND METHODS This retrospective study included 51 cases of epithelial ovarian cancer (17 CCC, 20 HGSC, and 14 EC) identified by magnetic resonance imaging with pathological confirmation. All patients underwent diffusion-weighted imaging and the ADC values of lesions were measured. We counted the tumor cells in three high-power fields and calculated the average for each case. The Spearman's correlation coefficient test was used to analyze correlation between ADC values and tumor cellularity. The ADC values of HGSC, EC, and CCC were compared using the Steel-Dwass test. RESULTS The ADC values of all cases were significantly inversely correlated with tumor cellularity (rs = -0.761; P < 0.001). The mean ± SD ADC values (×10-3 mm2/s) of CCC, HGSC, and EC were 1.24 ± 0.17 (range 0.98--1.65), 0.84 ± 0.10 (range 0.67--1.06), and 0.84 ± 0.10 (range 0.67--1.07). The mean ± SD tumor cellularity of CCC, HGSC, and EC was 162.88 ± 63.28 (range 90.33--305.67), 440.60 ± 119.86 (range 204.67--655.67), and 461.02 ± 81.86 (range 333.33--602.33). CONCLUSION There is a significant inverse correlation between ADC values and tumor cellularity in epithelial ovarian cancer. The mean ADC value of CCC was higher than those of HGSC and EC, seemingly due to the low cellularity of CCC.
Collapse
Affiliation(s)
- Takafumi Ono
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Keiko Kishimoto
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shinya Tajima
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ichiro Maeda
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masayuki Takagi
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hidefumi Mimura
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| |
Collapse
|
12
|
Angeles MA, Ferron G, Cabarrou B, Balague G, Martínez-Gómez C, Gladieff L, Pomel C, Martinez A. Prognostic impact of celiac lymph node involvement in patients after frontline treatment for advanced ovarian cancer. Eur J Surg Oncol 2019; 45:1410-1416. [PMID: 30857876 DOI: 10.1016/j.ejso.2019.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/09/2019] [Accepted: 02/14/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Completeness of cytoreduction is the most important prognostic factor in patients with advanced ovarian cancer (OC). Extensive upper abdominal surgery has allowed to increase the rate complete cytoreduction and the feasibility of resection of celiac lymph nodes (CLN) and porta hepatis disease in these patients has been demonstrated. The aim of our study was to assess the prognostic impact of CLN involvement in patients with primary advanced OC undergoing a complete cytoreductive surgery (CRS). MATERIAL AND METHODS We designed a retrospective unicentric study. We reviewed data from patients who underwent CLN resection with or without porta hepatis disease resection, within upfront or interval complete CRS in the frontline treatment of advanced epithelial OC between January 2008 and December 2015. Patients were classified in two groups according to CLN status. Univariate and multivariate analyses were conducted. Survival rates were estimated using Kaplan-Meier method. RESULTS Forty-three patients were included and positive CLN were found in 39.5% of them. The median disease-free survival in the group of patients with positive and negative CLN were 11.3 months and 25.8 months, respectively. In multivariable analysis, both CLN involvement and high peritoneal cancer index were independently associated with decreased disease-free survival. Computed tomography re-reading by an expert radiologist has good sensitivity for detection of positive CLN. CONCLUSION CLN involvement and high preoperative tumor burden are independently associated with decreased survival after complete cytoreduction for OC. CLN involvement is a marker of diffuse disease and an independent risk factor for early recurrent disease.
Collapse
Affiliation(s)
- Martina Aida Angeles
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT), Oncopole, Toulouse, France
| | - Gwénaël Ferron
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT), Oncopole, Toulouse, France; INSERM CRCT 19, Toulouse, France
| | - Bastien Cabarrou
- Biostatistics Unit, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT), Oncopole, Toulouse, France
| | - Gisèle Balague
- Department of Radiology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT), Oncopole, Toulouse, France
| | - Carlos Martínez-Gómez
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT), Oncopole, Toulouse, France; INSERM CRCT 1, Toulouse, France
| | - Laurence Gladieff
- Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT), Oncopole, Toulouse, France
| | - Christophe Pomel
- Department of Surgical Oncology, CRLCC Jean Perrin, Clermont-Ferrand, France
| | - Alejandra Martinez
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT), Oncopole, Toulouse, France; INSERM CRCT 1, Toulouse, France.
| |
Collapse
|
13
|
Hu TWY, Nie D, Gou JH, Li ZY. Predictive significance of preoperative CT findings for suboptimal cytoreduction in advanced ovarian cancer: a meta-analysis. Cancer Manag Res 2018; 10:2019-2030. [PMID: 30038518 PMCID: PMC6053262 DOI: 10.2147/cmar.s166658] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Computed tomography (CT) has been extensively used in predicting suboptimal cytoreduction (SCR) in advanced ovarian cancer (OC). However, disagreements remain in literatures on the predictive value of CT findings for SCR. This meta-analysis was designed to determine the ability of eight preoperative CT findings to predict SCR in advanced OC. Materials and methods A comprehensive literature search was conducted for eligible studies to identify the association between the eight preoperative CT findings and SCR in advanced OC. The predictive performances of preoperative CT findings were expressed in terms of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR) with pooled proportion. Results A total of 10 studies and 1,614 patients were included in this meta-analysis. Large volume ascites had the highest sensitivity (64%, CI 56–71%), with a PLR of 1.3 (CI 1.1–1.5) and an NLR of 0.73 (0.59–0.90), while lymph node involvement had the highest specificity (89%, CI 79–94%). The highest DOR of 3 (CI 2–4) was achieved in peritoneal involvement and large bowel mesentery involvement. The other CT findings had poorer predictive performance. Conclusion Preoperative CT findings have a poor discriminative capacity to predict SCR in advanced OC. Preoperative CT predictors should be used with caution amid clinical decision-making.
Collapse
Affiliation(s)
- Ting Wen Yi Hu
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China,
| | - Dan Nie
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China, .,Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jin Hai Gou
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China, .,The State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, People's Republic of China,
| | - Zheng Yu Li
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China, .,The State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, People's Republic of China,
| |
Collapse
|
14
|
Arab M, Jamdar F, Sadat Hosseini M, Ghodssi- Ghasemabadi R, Farzaneh F, Ashrafganjoei T. Model for Prediction of Optimal Debulking of Epithelial Ovarian Cancer. Asian Pac J Cancer Prev 2018; 19:1319-1324. [PMID: 29802693 PMCID: PMC6031811 DOI: 10.22034/apjcp.2018.19.5.1319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 01/16/2018] [Indexed: 12/01/2022] Open
Abstract
Background: Primary cytoreduction surgery followed by chemotherapy is the cornerstone treatment for epithelial ovarian cancer (EOC). In patients with a low probability of optimal primary surgical debulking, neoadjuvant chemotherapy (NACT) followed by interval debulking increases the chance of optimal surgery. The aim of this study was to develop a model to identify preoperative predictors for suboptimal cytoreduction. Methods: Medical records of patients with EOC who underwent primary cytoreductive surgery in a referral tertiary gyneco-oncology center were reviewed from 2007 to 2017. Data were collected on a range of characteristics including demographic features, comorbidities, serum tumor markers, hematologic markers, preoperative imaging, surgical procedures, and pathologic reports. Univariate and multivariate analyses were performed to clarify the ability of preoperative factors to predict suboptimal primary surgery. Results: The majority of patients (71.3%) who underwent primary cytoreductive surgery were optimally debulked. Based on the Youden index, the best cut-off point for the serum CA125 level to distinguish suboptimal debulking was 420U/ml with 0.730 (95%CI:0.559 to 0.862) sensitivity and 0.783 (0.684 to 0.862) specificity. Multiple logistic regression results showed that serum CA125 level >420 U/ ml (p value <0.001), the presence of liver metastasis on preoperative imaging (p value: 0.041) and ascites (p value: 0.032) or massive ascites (p value:0.010) significantly increased the risk of suboptimal debulking (logit p = 2.36 CA125 level +1.85 Liverinvolvement +1.68 presence of Ascites+ 2.28 Massive Ascites). Conclusion:The present study suggests that a serum CA125 level >420 U/ml, the presence of ascites or massive ascites and liver metastasis are strong predictors of suboptimal primary surgery in cases of EOC. Based on the constructed model, with any of these 4 factors, the probability of suboptimal debulking in EOC is more than 80%.
Collapse
Affiliation(s)
- Maliheh Arab
- Cancer Research Center, ShahidBeheshti University of Medical Science, Tehran, Iran.
| | | | | | | | | | | |
Collapse
|
15
|
El Bairi K, Amrani M, Kandhro AH, Afqir S. Prediction of therapy response in ovarian cancer: Where are we now? Crit Rev Clin Lab Sci 2017; 54:233-266. [PMID: 28443762 DOI: 10.1080/10408363.2017.1313190] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Therapy resistance is a major challenge in the management of ovarian cancer (OC). Advances in detection and new technology validation have led to the emergence of biomarkers that can predict responses to available therapies. It is important to identify predictive biomarkers to select resistant and sensitive patients in order to reduce important toxicities, to reduce costs and to increase survival. The discovery of predictive and prognostic biomarkers for monitoring therapy is a developing field and provides promising perspectives in the era of personalized medicine. This review article will discuss the biology of OC with a focus on targetable pathways; current therapies; mechanisms of resistance; predictive biomarkers for chemotherapy, antiangiogenic and DNA-targeted therapies, and optimal cytoreductive surgery; and the emergence of liquid biopsy using recent studies from the Medline database and ClinicalTrials.gov.
Collapse
Affiliation(s)
- Khalid El Bairi
- a Faculty of Medicine and Pharmacy , Mohamed Ist University , Oujda , Morocco
| | - Mariam Amrani
- b Equipe de Recherche ONCOGYMA, Faculty of Medicine, Pathology Department , National Institute of Oncology, Université Mohamed V , Rabat , Morocco
| | - Abdul Hafeez Kandhro
- c Department of Biochemistry , Healthcare Molecular and Diagnostic Laboratory , Hyderabad , Pakistan
| | - Said Afqir
- d Department of Medical Oncology , Mohamed VI University Hospital , Oujda , Morocco
| |
Collapse
|
16
|
Imaging diagnostics in ovarian cancer: magnetic resonance imaging and a scoring system guiding choice of primary treatment. Eur J Obstet Gynecol Reprod Biol 2017; 210:83-89. [DOI: 10.1016/j.ejogrb.2016.10.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 09/27/2016] [Accepted: 10/21/2016] [Indexed: 11/21/2022]
|
17
|
Zeng J, Yin J, Song X, Jin Y, Li Y, Pan L. Reduction of CA125 Levels During Neoadjuvant Chemotherapy Can Predict Cytoreduction to No Visible Residual Disease in Patients with Advanced Epithelial Ovarian Cancer, Primary Carcinoma of Fallopian tube and Peritoneal Carcinoma. J Cancer 2016; 7:2327-2332. [PMID: 27994671 PMCID: PMC5166544 DOI: 10.7150/jca.16761] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 09/30/2016] [Indexed: 02/06/2023] Open
Abstract
Background and aims. To determine whether reduction of CA125 levels is a predictive factor for cytoreduction to no visible residual disease (NVRD) and chemotherapeutic sensitivity in advanced epithelial ovarian carcinoma (EOC), primary carcinoma of fallopian tube and peritoneal carcinoma patients who received neoadjuvant chemotherapy followed by interval debulking surgery (NAC-IDS). Methods. This was a single-team-based study of advanced EOC, primary carcinoma of fallopian tube and peritoneal carcinoma patients diagnosed between 1996 and 2015 at Peking Union Medical College Hospital. Patients were treated with NAC-IDS by one gynecologic oncologist. Demographic data, CA125 levels, radiographic data, and chemotherapy and surgical-pathologic information were obtained. Univariate and multivariate analyses were performed to evaluate variables associated with optimal cytoreduction to NVRD and chemotherapy-sensitivity. Results. One hundred and eighteen patients met the study inclusion criteria. Thirty-seven (31.4%) patients underwent resection to NVRD. The median serum CA125 level at presentation and before IDS was 1814.5 U/ml and 205.9 U/ml, respectively. In the univariate analysis, histology, a preoperative CA125 of ≤200 U/ml and a >80% reduction of CA125 between presentation and IDS were significantly associated with the likelihood of NVRD (P=0.014, 0.000, 0.000, respectively). Multivariate analysis revealed that, of the various CA125 parameters tested, preoperative CA125 ≤200 U/ml was the only independent predictor of NVRD (odds ratio 3.667, 95% confidence interval 1.337-10.057; P=0.012). Preoperative CA125 ≤200 U/ml was also significantly associated with chemotherapy-sensitive disease in the univariate analysis (P=0.037). Conclusions. EOC patients who received NAC-IDS and had a preoperative CA125 level of ≤200 U/ml were highly likely to be cytoreduced to NVRD and to exhibit chemotherapeutic sensitivity.
Collapse
Affiliation(s)
- Jing Zeng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jie Yin
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiao Song
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ying Jin
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yan Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lingya Pan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| |
Collapse
|
18
|
Tozzi R, Traill Z, Garruto Campanile R, Ferrari F, Soleymani Majd H, Nieuwstad J, Hardern K, Gubbala K. Porta hepatis peritonectomy and hepato-celiac lymphadenectomy in patients with stage IIIC-IV ovarian cancer: Diagnostic pathway, surgical technique and outcomes. Gynecol Oncol 2016; 143:35-39. [PMID: 27519966 DOI: 10.1016/j.ygyno.2016.08.232] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 07/31/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To report the surgical technique of ovarian cancer resection at the porta hepatis (PH) and hepato-celiac lymph nodes (HCL). To assess surgical and survival outcomes. Define the accuracy of an integrated diagnostic pathway. METHODS Patients with FIGO stage IIIC-IV ovarian cancer that underwent Visceral-Peritoneal Debulking (VPD). Data of patients with disease at the PH/HCL during VPD were extracted from our database. The CT scan findings were compared with the exploratory laparoscopy. Accuracy of CT scan, intra- and post-operative morbidity, rate of complete resection (CR), disease free and overall survival are reported. RESULTS Thirty one patients out of 216 (14.3%) had tumor at the PH and/or HCL. In 8 patients out of 31 (25.8%) it was only found with the aid of the exploratory laparoscopy. CR was achieved in 28 patients out of 31 (90.3%). Pathology confirmed disease in the PH/HCL specimens of all but one patient. Overall morbidity relating to the VPD was 29.2%. No complication was specifically related to the PH/HCL. Median disease free survival was 19months and median overall survival was 42months. CONCLUSION PH/HCL surgery was required in 15% of patients with FIGO stage IIIC-IV. The surgery was feasible, safe and significantly contributed to CR. CT scan failed to identify the disease in 31% of the patients. CT and laparoscopy correctly identified all patients.
Collapse
Affiliation(s)
- Roberto Tozzi
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK.
| | - Zoe Traill
- Department of Radiology, Oxford University Hospital, Oxford, UK
| | | | - Federico Ferrari
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK
| | | | - Joost Nieuwstad
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK
| | - Kieran Hardern
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK
| | - Kumar Gubbala
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK
| |
Collapse
|
19
|
Karlsen MA, Fagö-Olsen C, Høgdall E, Schnack TH, Christensen IJ, Nedergaard L, Lundvall L, Lydolph MC, Engelholm SA, Høgdall C. A novel index for preoperative, non-invasive prediction of macro-radical primary surgery in patients with stage IIIC-IV ovarian cancer-a part of the Danish prospective pelvic mass study. Tumour Biol 2016; 37:12619-12626. [PMID: 27440204 DOI: 10.1007/s13277-016-5166-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 07/12/2016] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study was to develop a novel index for preoperative, non-invasive prediction of complete primary cytoreduction in patients with FIGO stage IIIC-IV epithelial ovarian cancer. Prospectively collected clinical data was registered in the Danish Gynecologic Cancer Database. Blood samples were collected within 14 days of surgery and stored by the Danish CancerBiobank. Serum human epididymis protein 4 (HE4), serum cancer antigen 125 (CA125), age, performance status, and presence/absence of ascites at ultrasonography were evaluated individually and combined to predict complete tumor removal. One hundred fifty patients with advanced epithelial ovarian cancer were treated with primary debulking surgery (PDS). Complete PDS was achieved in 41 cases (27 %). The receiver operating characteristic curves demonstrated an area under the curve of 0.785 for HE4, 0.678 for CA125, and 0.688 for age. The multivariate model (Cancer Ovarii Non-invasive Assessment of Treatment Strategy (CONATS) index), consisting of HE4, age, and performance status, demonstrated an AUC of 0.853. According to the Danish indicator level, macro-radical PDS should be achieved in 60 % of patients admitted to primary surgery (positive predictive value of 60 %), resulting in a negative predictive value of 87.5 %, sensitivity of 68.3 %, specificity of 83.5 %, and cutoff of 0.63 for the CONATS index. Non-invasive prediction of complete PDS is possible with the CONATS index. The CONATS index is meant as a supplement to the standard preoperative evaluation of each patient. Evaluation of the CONATS index combined with radiological and/or laparoscopic findings may improve the assessment of the optimal treatment strategy in patients with advanced epithelial ovarian cancer.
Collapse
Affiliation(s)
- Mona Aarenstrup Karlsen
- Gynecologic Clinic, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark. .,Molecular Unit, Department of Pathology, Herlev University Hospital, Herlev Ringvej 75, DK-2730, Herlev, Denmark.
| | - Carsten Fagö-Olsen
- Gynecologic Clinic, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Estrid Høgdall
- Molecular Unit, Department of Pathology, Herlev University Hospital, Herlev Ringvej 75, DK-2730, Herlev, Denmark
| | - Tine Henrichsen Schnack
- Gynecologic Clinic, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Ib Jarle Christensen
- Molecular Unit, Department of Pathology, Herlev University Hospital, Herlev Ringvej 75, DK-2730, Herlev, Denmark
| | - Lotte Nedergaard
- Department of Pathology, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Lene Lundvall
- Gynecologic Clinic, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Magnus Christian Lydolph
- Department of Autoimmunology and Biomarkers, Statens Serum Institute, Artillerivej 5, DK-2300, Copenhagen, Denmark
| | - Svend Aage Engelholm
- Department of Radiation Oncology, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Claus Høgdall
- Gynecologic Clinic, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| |
Collapse
|
20
|
Tang Z, Chang X, Ye X, Li Y, Cheng H, Cui H. Usefulness of human epididymis protein 4 in predicting cytoreductive surgical outcomes for advanced ovarian tubal and peritoneal carcinoma. Chin J Cancer Res 2015; 27:309-17. [PMID: 26157328 DOI: 10.3978/j.issn.1000-9604.2015.06.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 04/05/2015] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Human epididymis protein 4 (HE4) is a promising biomarker of epithelial ovarian cancer (EOC). But its role in assessing the primary optimal debulking (OD) of EOC remains unknown. The purpose of this study is to elucidate the ability of preoperative HE4 in predicting the primary cytoreductive outcomes in advanced EOC, tubal or peritoneal carcinoma. METHODS We reviewed the records of 90 patients with advanced ovarian, tubal or peritoneal carcinoma who underwent primary cytoreduction at the Department of Obstetrics and Gynecology of Peking University People's Hospital between November 2005 and October 2010. Preoperative serum HE4 and CA125 levels were detected with EIA kit. A receiver operating characteristic (ROC) curve was used to determine the most useful HE4 cut-off value. Logistic regression analysis was performed to identify significant preoperative clinical characteristics to predict optimal primary cytoreduction. RESULTS OD was achieved in 47.7% (43/48) of patients. The median preoperative HE4 level for patients with OD vs. suboptimal debulking was 423 and 820 pmol/L, respectively (P<0.001). The areas under the ROC curve for HE4 and CA125 were 0.716 and 0.599, respectively (P=0.080). The most useful HE4 cut-off value was 473 pmol/L. Suboptimal cytoreduction was obtained in 66.7% (38/57) of cases with HE4 ≥473 pmol/L compared with only 27.3% (9/33) of cases with HE4 <473 pmol/L. At this threshold, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for diagnosing suboptimal debulking were 81%, 56%, 67%, and 73%, respectively. Logistic regression analysis showed that the patients with HE4 ≥473 pmol/L were less likely to achieve OD (odds ratio =5.044, P=0.002). CONCLUSIONS Preoperative serum HE4 may be helpful to predict whether optimal cytoreductive surgery could be obtained or whether extended cytoreduction would be needed by an interdisciplinary team.
Collapse
Affiliation(s)
- Zhijian Tang
- Gynecology Oncology Center, Peking University People's Hospital, Beijing 100044, China
| | - Xiaohong Chang
- Gynecology Oncology Center, Peking University People's Hospital, Beijing 100044, China
| | - Xue Ye
- Gynecology Oncology Center, Peking University People's Hospital, Beijing 100044, China
| | - Yi Li
- Gynecology Oncology Center, Peking University People's Hospital, Beijing 100044, China
| | - Hongyan Cheng
- Gynecology Oncology Center, Peking University People's Hospital, Beijing 100044, China
| | - Heng Cui
- Gynecology Oncology Center, Peking University People's Hospital, Beijing 100044, China
| |
Collapse
|
21
|
Heudel PE, Selle F, Morice P, Rouzier R, Taieb S, Devouassoux-Shisheboran M, Genestie C, Balleyguier C, Ray-Coquard I. [Initial management of advanced ovarian cancer: What radiological, pathological and surgical information are important for optimal therapeutic strategy?]. Bull Cancer 2015; 102:772-9. [PMID: 26028492 DOI: 10.1016/j.bulcan.2015.04.011] [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: 04/09/2015] [Accepted: 04/10/2015] [Indexed: 11/18/2022]
Abstract
Because the majority of patients present advanced disease at diagnosis, the management of epithelial ovarian cancer needs specialist multidisciplinary teamwork. Expertise in surgery, chemotherapy, imaging and histopathology is essential to achieve optimum outcomes. Computed tomography scans are routinely used to determine the extent of disease and to aid in surgical planning. The histologic classification is crucial to plan the best therapeutic strategy and to define the prognosis of disease. Pathological prognostic factors, such as degree of differentiation, FIGO-stage, and histological type have to be described. This report is fundamental to assessing prognosis and selection of appropriate treatment strategy. An adequate staging procedure is an extensive staging by an experienced gynecological oncologist, exploring the entire upper abdomen, and the pelvic and para-aortic lymph node regions to define the Peritoneal Cancer Index (PCI). The final assessment is the completeness of cytoreduction (CC) score, which is an assessment of residual disease after a maximal surgical effort. Initial management of advanced ovarian cancer is best provided by a specialist multidisciplinary team, including a radiologist, a pathologist, a gynecologic oncologist and a medical oncologist.
Collapse
Affiliation(s)
| | - Frédéric Selle
- Hôpital Tenon, service d'oncologie médicale, 75020 Paris, France
| | - Philippe Morice
- Institut Gustave-Roussy, département de chirurgie, 94800 Villejuif, France
| | - Roman Rouzier
- Institut Curie, département de chirurgie, 75005 Paris, France
| | - Sophie Taieb
- Centre Oscar-Lambret, département d'imagerie médicale, 59000 Lille, France
| | | | - Catherine Genestie
- Institut Gustave-Roussy, service d'anatomo-pathologie, 94800 Villejuif, France
| | - Corinne Balleyguier
- Institut Gustave-Roussy, département d'imagerie médicale, 94800 Villejuif, France
| | | |
Collapse
|
22
|
Borley J, Wilhelm-Benartzi C, Yazbek J, Williamson R, Bharwani N, Stewart V, Carson I, Hird E, McIndoe A, Farthing A, Blagden S, Ghaem-Maghami S. Radiological predictors of cytoreductive outcomes in patients with advanced ovarian cancer. BJOG 2015; 122:843-849. [PMID: 25132394 DOI: 10.1111/1471-0528.12992] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess site of disease on preoperative computed tomography (CT) to predict surgical debulking in patients with ovarian cancer. DESIGN Two-phase retrospective cohort study. SETTING West London Gynaecological Cancer Centre, UK. POPULATION Women with stage 3 or 4, ovarian, fallopian or primary peritoneal cancer undergoing cytoreductive surgery. METHODS Preoperative CT images were reviewed by experienced radiologists to assess the presence or absence of disease at predetermined sites. Multivariable stepwise logistic regression models determined sites of disease which were significantly associated with surgical outcomes in the test (n = 111) and validation (n = 70) sets. MAIN OUTCOME MEASURES Sensitivity and specificity of CT in predicting surgical outcome. RESULTS Stepwise logistic regression identified that the presence of lung metastasis, pleural effusion, deposits on the large-bowel mesentery and small-bowel mesentery, and infrarenal para-aortic nodes were associated with debulking status. Logistic regression determined a surgical predictive score which was able to significantly predict suboptimal debulking (n = 94, P = 0.0001) with an area under the curve (AUC) of 0.749 (95% confidence interval [95% CI]: 0.652, 0.846) and a sensitivity of 69.2%, specificity of 71.4%, positive predictive value of 75.0% and negative predictive value of 65.2%. These results remained significant in a recent validation set. There was a significant difference in residual disease volume in the test and validation sets (P < 0.001) in keeping with improved optimal debulking rates. CONCLUSIONS The presence of disease at some sites on preoperative CT scan is significantly associated with suboptimal debulking and may be an indication for a change in surgical planning.
Collapse
Affiliation(s)
- J Borley
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - J Yazbek
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
| | - R Williamson
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - N Bharwani
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - V Stewart
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - I Carson
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
| | - E Hird
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
| | - A McIndoe
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
| | - A Farthing
- Department of Surgery and Cancer, Imperial College London, London, UK
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
| | - S Blagden
- Department of Surgery and Cancer, Imperial College London, London, UK
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
| | - S Ghaem-Maghami
- Department of Surgery and Cancer, Imperial College London, London, UK
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
| |
Collapse
|
23
|
Enshaei A, Robson CN, Edmondson RJ. Artificial Intelligence Systems as Prognostic and Predictive Tools in Ovarian Cancer. Ann Surg Oncol 2015; 22:3970-5. [DOI: 10.1245/s10434-015-4475-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Indexed: 11/18/2022]
|
24
|
Tangjitgamol S, Hanprasertpong J, Cubelli M, Zamagni C. Neoadjuvant chemotherapy and cytoreductive surgery in epithelial ovarian cancer. World J Obstet Gynecol 2013; 2:153-166. [DOI: 10.5317/wjog.v2.i4.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 02/06/2013] [Indexed: 02/05/2023] Open
Abstract
Ovarian cancer is one of the leading causes of death among gynecological cancers. This is because the majority of patients present with advanced stage disease. Primary debulking surgery (PDS) followed by adjuvant chemotherapy is still a mainstay of treatment. An optimal surgery, which is currently defined by leaving no gross residual tumor, is the goal of PDS. The extent of disease as well as the operative setting, including the surgeon’s skill, influences the likelihood of successful debulking. With extensive disease and a poor chance of optimal surgery or high morbidity anticipated, neoadjuvant chemotherapy (NACT) prior to primary surgery is an option. Secondary surgery after induction chemotherapy is termed interval debulking surgery (IDS). Delayed PDS or IDS is offered to patients who show some clinical response and are without progressive disease. NACT or IDS has become more established in clinical practice and there are numerous publications regarding its advantages and disadvantages. However, data on survival are limited and inconsistent. Only one large randomized trial could demonstrate that NACT was not inferior to PDS while the few randomized trials on IDS had inconsistent results. Without a definite benefit of NACT prior to surgery over PDS, one must carefully weigh the chances of safe and successful PDS against the morbidity and risks of suboptimal surgery. Appropriate selection of a patient to undergo PDS followed by chemotherapy or, preferably, to have NACT prior to surgery is very important. Some clinical characteristics from physical examination, serum tumor markers and/or findings from imaging studies may be predictive of resectability. However, no specific features have been consistently identified in the literature. This article will address the clinical data on prediction of surgical outcomes, the role of NACT, and the role of IDS.
Collapse
|
25
|
Mangili G, Scambia G, Ottolina J, Fanfani F, Viganò R, Costantini B, Candiani M, Fagotti A. Comparison of optimal cytoreduction rates in emergency versus non-emergency admissions for advanced ovarian cancer: A multi-institutional study. Eur J Surg Oncol 2013; 39:906-11. [DOI: 10.1016/j.ejso.2013.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 03/26/2013] [Accepted: 05/08/2013] [Indexed: 12/01/2022] Open
|
26
|
Raspagliesi F, Ditto A, Martinelli F, Haeusler E, Lorusso D. Advanced ovarian cancer: omental bursa, lesser omentum, celiac, portal and triad nodes spread as cause of inaccurate evaluation of residual tumor. Gynecol Oncol 2013; 129:92-6. [PMID: 23385151 DOI: 10.1016/j.ygyno.2013.01.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 01/12/2013] [Accepted: 01/27/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We evaluated the role of omental bursa (OB), surface of the pancreas, lesser omentum, caudate lobe, celiac nodes (CNs), portal nodes and triad nodes spread in advanced ovarian cancer (AOC). We investigated if the exploration and cleaning up of these areas can lead to a more complete cytoreduction and to a more realistic assessment of residual tumor in AOC. METHODS We prospectively recruited patients diagnosed with AOC, who underwent a complete cytoreduction. Demographics, surgical procedures, morbidities, pathologic findings and correlations with OB spread were assessed. RESULTS A total of 37 patients had an optimal debulking including OB evaluation and peritonectomy. The OB area procedure required in mean 65 min with an estimated blood loss of 250 ml. OB involvement was found in 67% (25/37) of cases. Peritoneal disease was found in 22 cases including 18 supragastric lesser sac and 4 porta hepatis peritoneum. CNs metastases were found in 5 cases, of which 3 cases are with bulky nodes, all presented also bulky nodes in the para-aortic area. Only in the case of a macroscopic involvement of the diaphragm OB was positive for disease. When adhesions occluding the Winslow foramen were present, no OB peritoneum involvement was found. OB resection related complications were low (2 out 25). CONCLUSIONS The data of this prospective study demonstrate the high rate of OB, surface of the pancreas, lesser omentum, caudate lobe, CNs, portal and triad nodes involvement and the value of investigating the dissemination and cytoreduction in these sites to obtain a real optimal debulking.
Collapse
|
27
|
Abstract
Ovarian cancer affects approximately 21,880 women and accounts for over 13,000 deaths annually in the United States. Although survival rates have improved over the past several decades, directly as a result of advances in chemotherapy and surgery, ovarian cancer continues to have high mortality rates. Understanding the multiple roles of surgery throughout the disease course is the focus of this review.
Collapse
|
28
|
Rutten MJ, Gaarenstroom KN, Van Gorp T, van Meurs HS, Arts HJ, Bossuyt PM, Ter Brugge HG, Hermans RH, Opmeer BC, Pijnenborg JM, Schreuder HW, Schutter EM, Spijkerboer AM, Wensveen CW, Zusterzeel P, Mol BWJ, Kenter GG, Buist MR. Laparoscopy to predict the result of primary cytoreductive surgery in advanced ovarian cancer patients (LapOvCa-trial): a multicentre randomized controlled study. BMC Cancer 2012; 12:31. [PMID: 22264278 PMCID: PMC3292486 DOI: 10.1186/1471-2407-12-31] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 01/20/2012] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Standard treatment of advanced ovarian cancer is surgery and chemotherapy. The goal of surgery is to remove all macroscopic tumour, as the amount of residual tumour is the most important prognostic factor for survival. When removal off all tumour is considered not feasible, neoadjuvant chemotherapy (NACT) in combination with interval debulking surgery (IDS) is performed. Current methods of staging are not always accurate in predicting surgical outcome, since approximately 40% of patients will have more than 1 cm residual tumour after primary debulking surgery (PDS). In this study we aim to assess whether adding laparoscopy to the diagnostic work-up of patients suspected of advanced ovarian carcinoma may prevent unsuccessful primary debulking surgery for ovarian cancer. METHODS Multicentre randomized controlled trial, including all gynaecologic oncologic centres in the Netherlands and their affiliated hospitals. Patients are eligible when they are planned for PDS after conventional staging. Participants are randomized between direct PDS or additional diagnostic laparoscopy. Depending on the result of laparoscopy patients are treated by PDS within three weeks, followed by six courses of platinum based chemotherapy or with NACT and IDS 3-4 weeks after three courses of chemotherapy, followed by another three courses of chemotherapy. Primary outcome measure is the proportion of PDS's leaving more than one centimetre tumour residual in each arm. In total 200 patients will be randomized. Data will be analysed according to intention to treat. DISCUSSION Patients who have disease considered to be resectable to less than one centimetre should undergo PDS to improve prognosis. However, there is a need for better diagnostic procedures because the current number of debulking surgeries leaving more than one centimetre residual tumour is still high. Laparoscopy before starting treatment for ovarian cancer can be an additional diagnostic tool to predict the outcome of PDS. Despite the absence of strong evidence and despite the possible complications, laparoscopy is already implemented in many countries. We propose a randomized multicentre trial to provide evidence on the effectiveness of laparoscopy before primary surgery for advanced stage ovarian cancer patients. TRIAL REGISTRATION Netherlands Trial Register number NTR2644.
Collapse
Affiliation(s)
- Marianne J Rutten
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Burges A, Schmalfeldt B. Ovarian cancer: diagnosis and treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:635-41. [PMID: 22025930 DOI: 10.3238/arztebl.2011.0635] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 11/11/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients with ovarian cancer usually present to a family physician with nonspecific symptoms, most often abdominal pain. The outcome depends above all on the stage of the disease when it is diagnosed and on the quality of treatment. METHODS This article is based on a review of selected publications from 2000 to 2010 that were retrieved by an automated search in Medline on the terms "ovarian cancer," "screening," "diagnosis," "treatment," and "prognosis," as well as the interdisciplinary S2k guideline Diagnostik und Therapie maligner Ovarialtumoren (the diagnosis and treatment of malignant ovarian tumors) issued in 2007 by the Ovarian Tumor Committee of the German Consortium of Gynecologic Oncology (AGO) and the Committee's updated recommendations of 2009. RESULTS The proper treatment of early ovarian cancer involves resection of the primary tumor and all macroscopically visible tumor mass as well as meticulous inspection of the entire abdominal cavity for staging. Platinum-based chemotherapy is indicated for women with ovarian cancer in FIGO stage I to IIA (except stage IA, G1). For women with advanced ovarian cancer, the prognosis largely depends on the extent of tumor mass reduction on initial surgery. Complete resection confers significantly longer survival (median 5 years) than incomplete resection. After surgery, the standard adjuvant chemotherapy consists of a combination of carboplatin and paclitaxel. Treatment that conforms to published guidelines significantly improves survival (60% versus 25% at 3 years). CONCLUSION The possibility of ovarian cancer must be considered for any woman who presents with new, persistent, nonspecific abdominal pain. Ovarian cancer should always be treated in accordance with published guidelines.
Collapse
Affiliation(s)
- Alexander Burges
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe-Großhadern.
| | | |
Collapse
|
30
|
Ovarian Cancer Management: The role of imaging and diagnostic challenges. Eur J Radiol 2011; 78:41-51. [DOI: 10.1016/j.ejrad.2010.11.039] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 05/05/2010] [Accepted: 11/30/2010] [Indexed: 11/18/2022]
|
31
|
Usefulness of computed tomography in predicting cytoreductive surgical outcomes for ovarian cancer. Arch Gynecol Obstet 2011; 284:1501-7. [PMID: 21347681 DOI: 10.1007/s00404-011-1864-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 02/09/2011] [Indexed: 01/08/2023]
Abstract
PURPOSE The objective of this study was to identify features of preoperative computed tomography (CT) scans that can best predict outcomes of primary cytoreductive surgery in ovarian cancer patients. METHODS Preoperative CT scans of 98 patients were evaluated retrospectively. Multiple logistic regression analysis was used to develop two models. RESULTS Although optimal surgical reduction was attempted in 98 patients, 12 had suboptimal results. Having tumor implants on the small or large bowel mesenteries (any size) or at other sites (cutoff index: ≥ 1 cm) was found to be significant (p < 0.001) for predicting a suboptimal cytoreduction outcome. Two predictive models were created using multiple logistic regression analysis; both consider diffuse peritoneal thickening (DPT), infrarenal para-aortic or pelvic lymph node involvement, a bowel encasement tumor (≥ 2 cm), and any tumor implants in the cul-de-sac as significant. Model 1 adds consideration to any tumors in the pelvic or retroperitoneum and has an accuracy of 90.8% for predicting a suboptimal surgery. Model 2 (accuracy of 93.9%) adds to the core of predictors the presence of tumor implants on the bowel mesenteries (≥ 2 cm), omental caking (≥ 2 cm), and ascites fluid. CONCLUSION Using specific CT findings from patients with ovarian cancer, we have devised two predictive models that have an accuracy of greater than 90% for predicting whether cytoreductive surgery will completely remove all tumor tissue, which should greatly aid in the differential decision-making as to whether to attempt cytoreductive surgery first, or to advance directly to neoadjuvant chemotherapy.
Collapse
|
32
|
Martinez A, Pomel C, Mery E, Querleu D, Gladieff L, Ferron G. Celiac lymph node resection and porta hepatis disease resection in advanced or recurrent epithelial ovarian, fallopian tube, and primary peritoneal cancer. Gynecol Oncol 2011; 121:258-63. [PMID: 21295334 DOI: 10.1016/j.ygyno.2010.12.328] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 12/06/2010] [Accepted: 12/07/2010] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Prognostic value of complete macroscopic resection of primary disease has been reported and confirmed in several publications. Published data indicate that extensive upper abdominal disease involving the hepatic pedicle and celiac trunk is associated with an abortion of the surgical procedure or with suboptimal residual disease. METHODS All patients who had disease at the porta hepatis or celiac lymph node resection as part of cytoreductive surgery were included. Medical and operative records with particular emphasis on extent and distribution of disease spread, number of peritonectomy procedures, visceral resections, and lymphadenectomy procedures were examined. RESULTS A total of 28 patients who underwent some kind of celiac lymph node resection or resection of metastatic involvement of the porta hepatis were included. Median preoperative serum Ca-125 level was 78U/ml (range, 30-2950U/ml), and median ascites volume was 1900ml (range, 0-10,000ml). Of the 28 patients, 23 underwent supra-radical surgery for diffuse peritoneal carcinomatosis. Median operative time was 252minutes (range, 100-540minutes). Complete cytoreduction to CCO was achieved in all except one case, who was cytoreduced to millimetric residue. Fifteen patients had positive celiac nodes and nineteen patients had peritoneal disease in the porta hepatis region. DISCUSSION Resection of enlarged nodes and metastatic disease to the porta hepatis is feasible with an acceptable morbidity. The decision to undergo an aggressive cytoreductive surgery is based on appropriate patient selection depending on the extension of surgical procedure, on medical comorbidities, and on the potential to tolerate an extensive procedure, rather than on specific anatomic locations.
Collapse
Affiliation(s)
- A Martinez
- Claudius Regaud Comprehensive Cancer Center, Department of Surgical Oncology, Toulouse, France.
| | | | | | | | | | | |
Collapse
|
33
|
|
34
|
Song YJ, Lim MC, Kang S, Seo SS, Kim SH, Han SS, Park SY. Extended cytoreduction of tumor at the porta hepatis by an interdisciplinary team approach in patients with epithelial ovarian cancer. Gynecol Oncol 2011; 121:253-7. [PMID: 21277009 DOI: 10.1016/j.ygyno.2010.12.350] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Revised: 12/14/2010] [Accepted: 12/17/2010] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective of this study was to describe the development and experience in resection of tumor at the porta hepatis in patients with ovarian cancer by an interdisciplinary team approach. METHODS From August 2007 to June 2009, 11 women (2 primary and 9 recurrent ovarian cancers) underwent extended cytoreductive surgery including resection of tumor at the porta hepatis by hepatobiliary surgeons. RESULTS Tumor resection at the porta hepatis was required in 7.1% of the patients (11/155) during the study period. The median tumor size of the porta hepatis was 2.0cm (range, 0.7-4cm). All visible tumors at the porta hepatis were completely resected with co-operation of hepatobiliary surgeons. Optimal cytoreduction was achieved in all patients. There was no significant morbidity related to tumor resection of the porta hepatis and mortality associated with surgery. Five of 11 patients had recurrent disease at median 8months (range, 1-13) after the surgery with a median follow-up of 8months (range, 3-21months). CONCLUSION Tumor resection at the porta hepatis is feasible with acceptable morbidities in patients with ovarian cancer by an interdisciplinary team approach with hepatobiliary surgeons. Long term follow up is needed to know the impact on survival.
Collapse
Affiliation(s)
- Yong Jung Song
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Republic of Korea.
| | | | | | | | | | | | | |
Collapse
|
35
|
Ramirez I, Chon HS, Apte SM. The Role of Surgery in the Management of Epithelial Ovarian Cancer. Cancer Control 2011; 18:22-30. [DOI: 10.1177/107327481101800104] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Epithelial ovarian cancer is the most deadly gynecologic cancer in the United States. Multiple modalities of therapy are utilized in the management of the disease. The role of surgery remains important in the treatment of this disease and is described herein. Methods Medline and PubMed were utilized to search the English language medical literature up to March 2010. A broad range of studies and quality of data were analyzed, including prospective studies, case control analyses, and meta-analyses. When possible, the highest level of evidence was reviewed and presented. Results For the medically fit patient, optimal cytoreductive surgery positively impacts survival. For some highly selected patients, there is a role for a minimally invasive approach. In the recurrent setting, factors such as interval to recurrence and the distribution of disease will determine the utility of secondary cytoreductive surgery. A subgroup of patients may benefit from palliative surgical procedures in the recurrent setting. Conclusions Despite advances in the use of chemotherapy and biologic agents, surgery remains an important modality in the diagnosis and treatment of ovarian cancer.
Collapse
Affiliation(s)
- Ingrid Ramirez
- Department of Obstetrics and Gynecology at the University of South Florida, Tampa, Florida
| | - Hye Sook Chon
- Department of Women's Oncology at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Sachin M. Apte
- Department of Women's Oncology at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| |
Collapse
|
36
|
Fotopoulou C, Richter R, Braicu E, Schmidt SC, Lichtenegger W, Sehouli J. Can complete tumor resection be predicted in advanced primary epithelial ovarian cancer? A systematic evaluation of 360 consecutive patients. Eur J Surg Oncol 2010; 36:1202-10. [DOI: 10.1016/j.ejso.2010.09.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Revised: 07/16/2010] [Accepted: 09/06/2010] [Indexed: 01/08/2023] Open
|
37
|
Kyriazi S, Kaye SB, deSouza NM. Imaging ovarian cancer and peritoneal metastases—current and emerging techniques. Nat Rev Clin Oncol 2010; 7:381-93. [DOI: 10.1038/nrclinonc.2010.47] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
38
|
Weinberg LE, Rodriguez G, Hurteau JA. The role of neoadjuvant chemotherapy in treating advanced epithelial ovarian cancer. J Surg Oncol 2010; 101:334-43. [PMID: 20187069 DOI: 10.1002/jso.21482] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The current management of advanced ovarian cancer consists of aggressive primary cytoreductive surgery (PCS) followed by combination platinum based chemotherapy. Recent studies have suggested that platinum-based chemotherapy may be of benefit in patients with advanced ovarian cancer prior to cytoreductive surgery (neoadjuvant chemotherapy, NACT). The concept of NACT has not been completely validated in the treatment of ovarian cancer. This review will discuss the role of NACT in patients with advanced epithelial ovarian cancer.
Collapse
Affiliation(s)
- Lori E Weinberg
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | | |
Collapse
|
39
|
Ibeanu OA, Bristow RE. Predicting the Outcome of Cytoreductive Surgery for Advanced Ovarian Cancer. Int J Gynecol Cancer 2010; 20 Suppl 1:S1-11. [DOI: 10.1111/igc.0b013e3181cff38b] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
|
40
|
Risum S, Høgdall E, Engelholm SA, Fung E, Lomas L, Yip C, Petri AL, Nedergaard L, Lundvall L, Høgdall C. A Proteomics Panel for Predicting Optimal Primary Cytoreduction in Stage III/IV Ovarian Cancer. Int J Gynecol Cancer 2009; 19:1535-8. [DOI: 10.1111/igc.0b013e3181a840f5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The objective of this prospective study was to evaluate CA-125 and a 7-marker panel as predictors of incomplete primary cytoreduction in patients with stage III/IV ovarian cancer (OC). From September 2004 to January 2008, serum from 201 patients referred to surgery for a pelvic tumor was analyzed for CA-125. In addition, serum was analyzed for 7 biomarkers using surface-enhanced laser desorption/ionization time-of-flight mass spectrometry. These biomarkers were combined into a single-valued ovarian-cancer-risk index (OvaRI). CA-125 and OvaRI were evaluated as predictors of cytoreduction in 75 stage III/IV patients using receiver operating characteristic curves.Complete primary cytoreduction (no macroscopic residual disease) was achieved in 31% (23/75) of the patients. The area under the receiver operating characteristic curve was 0.66 for CA-125 and 0.75 for OvaRI.The sensitivity and specificity of CA-125 for predicting incomplete cytoreduction were 71% (37/52) and 57% (13/23), respectively (P = 0.04). The sensitivity and specificity of OvaRI for predicting incomplete cytoreduction were 73% (38/52) and 70% (16/23), respectively (P = 0.001). In conclusion, CA-125 and an index of 7 biomarkers were found to be predictors of cytoreduction. However, future studies of biomarkers are anticipated to promote early diagnosis and provide prognostic information to guide treatment of OC patients. In addition, new biomarkers might also play a role in predicting outcome from primary surgery in OC patients.
Collapse
|
41
|
A multicenter validation of computerized tomography models as predictors of non- optimal primary cytoreduction of advanced epithelial ovarian cancer. Eur J Surg Oncol 2009; 35:1109-12. [DOI: 10.1016/j.ejso.2009.03.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2008] [Revised: 11/27/2008] [Accepted: 03/05/2009] [Indexed: 11/30/2022] Open
|
42
|
Harter P, Hilpert F, Mahner S, Kommoss S, Heitz F, du Bois A. Role of cytoreductive surgery in recurrent ovarian cancer. Expert Rev Anticancer Ther 2009; 9:917-22. [PMID: 19589031 DOI: 10.1586/era.09.49] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cytoreductive surgery is well established in patients with primary ovarian cancer. The benefit of surgery in patients with recurrent ovarian cancer remains a controversial matter. There is a large heterogeneity in surgical results published in the literature, possibly caused by infrastructure, surgeons' philosophy and belief in adding various surgical skills. This might also be a result of different preoperative selection procedures. Further questions to be addressed are the definition of surgical end points and whether there are predictive factors for a successful surgery. The surgical end point in recurrent ovarian cancer should be complete resection. Predictive factors could help identify patients in whom complete resection is possible.
Collapse
Affiliation(s)
- Philipp Harter
- Department of Gynecology and Gynecologic Oncology, HSK, Dr Horst Schmidt Klinik, Ludwig-Erhard-Str. 100, D-65199 Wiesbaden, Germany.
| | | | | | | | | | | |
Collapse
|
43
|
Multidetector CT predictors of incomplete resection in primary cytoreduction of patients with advanced ovarian cancer. Eur Radiol 2009; 20:100-7. [PMID: 19657649 DOI: 10.1007/s00330-009-1533-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 05/27/2009] [Accepted: 06/07/2009] [Indexed: 10/20/2022]
Abstract
This study was designed to develop a preoperative predictor model using multidetector CT (MDCT) imaging findings for the prediction of surgical outcome in patients with advanced epithelial ovarian cancer (EOC). Seventy-seven patients with advanced EOC who had preoperative MDCT and who had undergone primary cytoreductive surgery between January 1999 and June 2008 were enrolled in the study. All MDCT examinations were analysed retrospectively, assessing nine imaging features without knowledge of the operative findings. The complete debulking rate and optimal debulking rate were 42.5% and 93.2%, respectively. Based on the use of univariate and multivariate analysis, one imaging feature that showed the presence of upper abdominal ascites was significantly associated with incomplete tumour resection (P = 0.019 on univariate analysis, P = 0.04 on multivariate analysis). The combination of the MDCT findings that showed the presence of upper abdominal ascites and diffuse subdiaphragmatic peritoneal nodularity was associated with an incomplete resection of a tumour (P = 0.04; specificity 80.0%; positive predictive value 76.9%). It is important that emphasis on the upper abdominal sites of the tumour is helpful when reporting preoperative MDCT results.
Collapse
|
44
|
Abstract
Ovarian cancer is the leading cause of death from gynecologic cancers in the United States. Initial management is reviewed here and is best provided by a multidisciplinary team, including a gynecologic oncologist and a medical oncologist. Typically these patients are first treated with aggressive surgical debulking, followed by chemotherapy. Exceptions to this strategy, including those for patients adequately treated with surgery alone and those better served by neoadjuvant chemotherapy (NAC), are discussed. The history and rationale of current chemotherapy regimens, both intravenous (IV) and intraperitoneal (IP), are reviewed. Given the chemo-sensitive nature of this disease, as well as the fact that it remains largely incurable in advanced stages, efforts continue to be made to improve initial therapy. This disease represents an excellent target for new drug development, and some of the newer agents in trials for ovarian cancer are discussed.
Collapse
Affiliation(s)
- Carolyn Krasner
- Division of Medical Oncology, Massachusetts General Hospital, Boston, MA 02114, USA.
| | | |
Collapse
|
45
|
Tiersten AD, Liu PY, Smith HO, Wilczynski SP, Robinson WR, Markman M, Alberts DS. Phase II evaluation of neoadjuvant chemotherapy and debulking followed by intraperitoneal chemotherapy in women with stage III and IV epithelial ovarian, fallopian tube or primary peritoneal cancer: Southwest Oncology Group Study S0009. Gynecol Oncol 2009; 112:444-9. [PMID: 19138791 PMCID: PMC3513943 DOI: 10.1016/j.ygyno.2008.10.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Revised: 10/30/2008] [Accepted: 10/31/2008] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Intraperitoneal (IP) chemotherapy prolongs survival in optimally reduced ovarian cancer patients. For patients in whom optimal debulking cannot be achieved, one could incorporate IP therapy post-operatively if the cancer was optimally debulked following neoadjuvant chemotherapy. We sought to evaluate overall survival (OS), progression-free survival (PFS), percent of patients optimally debulked and toxicity in patients treated with this strategy. METHODS Women with adenocarcinoma by biopsy or cytology with stage III/IV (pleural effusions only) epithelial ovarian, fallopian tube or primary peritoneal carcinoma that presented with bulky disease were treated with neoadjuvant intravenous (IV) paclitaxel 175 mg/m2 and carboplatin AUC 6 q 21 daysx3 cycles followed by surgery (if >/=50% decrease in CA125). If optimally debulked they received IV paclitaxel 175 mg/m2 and IP carboplatin AUC 5 (day 1) and IP paclitaxel 60 mg/m2 (day 8) q 28 daysx6 cycles. RESULTS Sixty-two patients were registered. Four were ineligible. Fifty-six were evaluated for neoadjuvant chemotherapy toxicities. One patient died of pneumonia. Five patients had grade 4 toxicity, including neutropenia (3), anemia, leukopenia, anorexia, fatigue, muscle weakness, respiratory infection, and cardiac ischemia. Thirty-six patients had debulking surgery. Two had grade 4 hemorrhage. Twenty-six patients received post-cytoreduction chemotherapy. Four had grade 4 neutropenia. At a median follow-up of 21 months, median PFS is 21 months and median OS is 32 months for all 58 patients. PFS and OS for the 26 patients who received IV/IP chemotherapy is 29 and 34 months respectively. CONCLUSIONS These results compare favorably with other studies of sub-optimally debulked patients.
Collapse
Affiliation(s)
- Amy D Tiersten
- New York University Cancer Center, 160 E. 34 St., New York, NY 10016, USA.
| | | | | | | | | | | | | |
Collapse
|
46
|
A contemporary analysis of the ability of preoperative serum CA-125 to predict primary cytoreductive outcome in patients with advanced ovarian, tubal and peritoneal carcinoma. Gynecol Oncol 2009; 112:6-10. [PMID: 19100916 DOI: 10.1016/j.ygyno.2008.10.010] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 10/07/2008] [Accepted: 10/12/2008] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We previously reported that preoperative CA-125 may predict primary cytoreductive outcome in patients with stage III ovarian carcinoma (OC). The objective of this study was to perform a contemporary analysis of the ability of CA-125 to predict cytoreductive outcome in advanced OC since our programmatic change in surgical approach that currently incorporates the utilization of extensive upper abdominal procedures, as needed, to achieve maximal cytoreduction. METHODS We reviewed the records of all patients with advanced ovarian, tubal or peritoneal carcinoma who underwent primary cytoreduction at our institution between 1/01 and 4/05. RESULTS The study cohort included 277 patients. Primary disease sites were: ovary, 232 (84%); tubal, 9 (3%); and peritoneum, 36 (13%). Stages were: IIIA, 6 (2%); IIIB, 12 (4%); IIIC, 215 (78%); and IV, 44 (16%). Tumor grades were: grade 1, 6 (2%); grade 2, 30 (11%); grade 3, 233 (84%), and undifferentiated, 8 (3%). Cytoreductive outcomes were: no gross residual disease (RD), 68 (25%); <or=1 cm RD, 153 (55%); and >cm RD, 56 (20%). There was no threshold CA-125 level that accurately predicted cytoreductive outcome. However, with CA-125 values >500 U/mL, 50% (57/113) of patients required extensive upper abdominal surgery to achieve RD <or=1 cm, compared to 27% (25/93) for those with CA-125 <500 U/mL (P=0.001). CONCLUSION Following our change in surgical paradigm that the incorporated extensive upper abdominal procedures to attain optimal debulking, preoperative CA-125 did not predict the primary cytoreductive outcome of patients with advanced ovarian, tubal, or peritoneal carcinoma. However, with a preoperative CA-125 >500 U/mL, extensive upper abdominal procedures were necessary in 50% of cases to achieve residual disease <or=1 cm. These data may be useful as part of preoperative surgical counseling and planning.
Collapse
|
47
|
Chi DS, Schwartz PE. Cytoreduction vs. neoadjuvant chemotherapy for ovarian cancer. Gynecol Oncol 2008; 111:391-9. [PMID: 19041036 DOI: 10.1016/j.ygyno.2008.07.058] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Accepted: 07/31/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Dennis S Chi
- Department of Surgery, Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
| | | |
Collapse
|