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Zhang Y, Tedja R, Millman M, Wong T, Fox A, Chehade H, Gershater M, Adzibolosu N, Gogoi R, Anderson M, Rutherford T, Zhang Z, Chopp M, Mor G, Alvero AB. Adipose-derived exosomal miR-421 targets CBX7 and promotes metastatic potential in ovarian cancer cells. J Ovarian Res 2023; 16:233. [PMID: 38037081 PMCID: PMC10688490 DOI: 10.1186/s13048-023-01312-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/09/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Chromobox protein homolog 7 (CBX7), a member of the Polycomb repressor complex, is a potent epigenetic regulator and gene silencer. Our group has previously reported that CBX7 functions as a tumor suppressor in ovarian cancer cells and its loss accelerated formation of carcinomatosis and drove tumor progression in an ovarian cancer mouse model. The goal of this study is to identify specific signaling pathways in the ovarian tumor microenvironment that down-regulate CBX7. Given that adipocytes are an integral component of the peritoneal cavity and the ovarian tumor microenvironment, we hypothesize that the adipose microenvironment is an important regulator of CBX7 expression. RESULTS Using conditioned media from human omental explants, we found that adipose-derived exosomes mediate CBX7 downregulation and enhance migratory potential of human ovarian cancer cells. Further, we identified adipose-derived exosomal miR-421 as a novel regulator of CBX7 expression and the main effector that downregulates CBX7. CONCLUSION In this study, we identified miR-421 as a specific signaling pathway in the ovarian tumor microenvironment that can downregulate CBX7 to induce epigenetic change in OC cells, which can drive disease progression. These findings suggest that targeting exosomal miR-421 may curtail ovarian cancer progression.
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Affiliation(s)
- Yi Zhang
- Neurology, Henry Ford Health System, 2799 W Grand Blvd., Detroit, MI, 48202, USA.
| | - Roslyn Tedja
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, 275 E. Hancock St., Detroit, MI, 48201, USA
| | - Michael Millman
- Neurology, Henry Ford Health System, 2799 W Grand Blvd., Detroit, MI, 48202, USA
| | - Terrence Wong
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, 275 E. Hancock St., Detroit, MI, 48201, USA
| | - Alexandra Fox
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, 275 E. Hancock St., Detroit, MI, 48201, USA
| | - Hussein Chehade
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, 275 E. Hancock St., Detroit, MI, 48201, USA
| | - Meyer Gershater
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, 275 E. Hancock St., Detroit, MI, 48201, USA
| | - Nicholas Adzibolosu
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, 275 E. Hancock St., Detroit, MI, 48201, USA
| | - Radhika Gogoi
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, 275 E. Hancock St., Detroit, MI, 48201, USA
| | - Matthew Anderson
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
| | - Thomas Rutherford
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
| | - Zhenggang Zhang
- Neurology, Henry Ford Health System, 2799 W Grand Blvd., Detroit, MI, 48202, USA
| | - Michael Chopp
- Neurology, Henry Ford Health System, 2799 W Grand Blvd., Detroit, MI, 48202, USA
- Department of Physics, Oakland University, Rochester, MI, USA
| | - Gil Mor
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, 275 E. Hancock St., Detroit, MI, 48201, USA
| | - Ayesha B Alvero
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, 275 E. Hancock St., Detroit, MI, 48201, USA.
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de Jong D, Thangavelu A, Broadhead T, Chen I, Burke D, Hutson R, Johnson R, Kaufmann A, Lodge P, Nugent D, Quyn A, Theophilou G, Laios A. Prerequisites to improve surgical cytoreduction in FIGO stage III/IV epithelial ovarian cancer and subsequent clinical ramifications. J Ovarian Res 2023; 16:214. [PMID: 37951927 PMCID: PMC10638711 DOI: 10.1186/s13048-023-01303-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 10/26/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND No residual disease (CC 0) following cytoreductive surgery is pivotal for the prognosis of women with advanced stage epithelial ovarian cancer (EOC). Improving CC 0 resection rates without increasing morbidity and no delay in subsequent chemotherapy favors a better outcome in these women. Prerequisites to facilitate this surgical paradigm shift and subsequent ramifications need to be addressed. This quality improvement study assessed 559 women with advanced EOC who had cytoreductive surgery between January 2014 and December 2019 in our tertiary referral centre. Following implementation of the Enhanced Recovery After Surgery (ERAS) pathway and prehabilitation protocols, the surgical management paradigm in advanced EOC patients shifted towards maximal surgical effort cytoreduction in 2016. Surgical outcome parameters before, during, and after this paradigm shift were compared. The primary outcome measure was residual disease (RD). The secondary outcome parameters were postoperative morbidity, operative time (OT), length of stay (LOS) and progression-free-survival (PFS). RESULTS R0 resection rate in patients with advanced EOC increased from 57.3% to 74.4% after the paradigm shift in surgical management whilst peri-operative morbidity and delays in adjuvant chemotherapy were unchanged. The mean OT increased from 133 + 55 min to 197 + 85 min, and postoperative high dependency/intensive care unit (HDU/ICU) admissions increased from 8.1% to 33.1%. The subsequent mean LOS increased from 7.0 + 2.6 to 8.4 + 4.9 days. The median PFS was 33 months. There was no difference for PFS in the three time frames but a trend towards improvement was observed. CONCLUSIONS Improved CC 0 surgical cytoreduction rates without compromising morbidity in advanced EOC is achievable owing to the right conditions. Maximal effort cytoreductive surgery should solely be carried out in high output tertiary referral centres due to the associated substantial prerequisites and ramifications.
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Affiliation(s)
- Diederick de Jong
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Amudha Thangavelu
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Timothy Broadhead
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Inga Chen
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Dermot Burke
- Department of Surgery, Colorectal Surgery Service, St. James's University Hospital LTHT, Leeds, UK
| | - Richard Hutson
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Racheal Johnson
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Angelika Kaufmann
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Peter Lodge
- Department of Surgery, Hepatobilliary Surgery and Liver Transplant Service, St. James's University Hospital LTHT, Leeds, UK
| | - David Nugent
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Aaron Quyn
- Department of Surgery, Hepatobilliary Surgery and Liver Transplant Service, St. James's University Hospital LTHT, Leeds, UK
| | - Georgios Theophilou
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Alexandros Laios
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK.
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Zhang Y, Tedja R, Millman M, Wong T, Fox A, Chehade H, Gershater M, Adzibolosu N, Gogoi R, Anderson M, Rutherford T, Zhang Z, Chopp M, Mor G, Alvero AB. Adipose-derived exosomal miR-421 targets CBX7 and promotes metastatic potential in ovarian cancer cells. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.11.07.566022. [PMID: 37986971 PMCID: PMC10659572 DOI: 10.1101/2023.11.07.566022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Background Chromobox protein homolog 7 (CBX7), a member of the Polycomb repressor complex, is a potent epigenetic regulator and gene silencer. Our group has previously reported that CBX7 functions as a tumor suppressor in ovarian cancer cells and its loss accelerated formation of carcinomatosis and drove tumor progression in an ovarian cancer mouse model. The goal of this study is to identify specific signaling pathways in the ovarian tumor microenvironment that down-regulate CBX7. Given that adipocytes are an integral component of the peritoneal cavity and the ovarian tumor microenvironment, we hypothesize that the adipose microenvironment is an important regulator of CBX7 expression. Results Using conditioned media from human omental explants, we found that adipose-derived exosomes mediate CBX7 downregulation and enhance migratory potential of human ovarian cancer cells. Further, we identified adipose-derived exosomal miR-421 as a novel regulator of CBX7 expression and the main effector that downregulates CBX7. Conclusion In this study, we identified miR-421 as a specific signaling pathway in the ovarian tumor microenvironment that can downregulate CBX7 to induce epigenetic change in OC cells, which can drive disease progression. These findings suggest that targeting exosomal miR-421 may curtail ovarian cancer progression.
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Affiliation(s)
- Yi Zhang
- Neurology, Henry Ford Health, Detroit, MI
| | - Roslyn Tedja
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | | | - Terrence Wong
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Alexandra Fox
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Hussein Chehade
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Meyer Gershater
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Nicholas Adzibolosu
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Radhika Gogoi
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Matthew Anderson
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL
| | - Thomas Rutherford
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL
| | | | - Michael Chopp
- Neurology, Henry Ford Health, Detroit, MI
- Department of Physics, Oakland University, Rochester, MI
| | - Gil Mor
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Ayesha B. Alvero
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
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De Jong D, Otify M, Chen I, Jackson D, Jayasinghe K, Nugent D, Thangavelu A, Theophilou G, Laios A. Survival and Chemosensitivity in Advanced High Grade Serous Epithelial Ovarian Cancer Patients with and without a BRCA Germline Mutation: More Evidence for Shifting the Paradigm towards Complete Surgical Cytoreduction. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111611. [PMID: 36363568 PMCID: PMC9699274 DOI: 10.3390/medicina58111611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022]
Abstract
Background and Objectives: Approximately 10−15% of high-grade serous ovarian cancer (HGSOC) cases are related to BRCA germline mutations. Better survival rates and increased chemosensitivity are reported in patients with a BRCA 1/2 germline mutation. However, the FIGO stage and histopathological entity may have been confounding factors. This study aimed to compare chemotherapy response and survival between patients with and without a BRCA 1/2 germline mutation in advanced HGSOC receiving neoadjuvant chemotherapy (NACT). Materials and Methods: A cohort of BRCA-tested advanced HGSOC patients undergoing cytoreductive surgery following NACT was analyzed for chemotherapy response and survival. Neoadjuvant chemotherapy served as a vehicle to assess chemotherapy response on biochemical (CA125), histopathological (CRS), biological (dissemination), and surgical (residual disease) levels. Univariate and multivariate analyses for chemotherapy response and survival were utilized. Results: Thirty-nine out of 168 patients had a BRCA ½ germline mutation. No differences in histopathological chemotherapy response between the patients with and without a BRCA ½ germline mutation were observed. Survival in the groups of patients was comparable Irrespective of the BRCA status, CRS 2 and 3 (HR 7.496, 95% CI 2.523−22.27, p < 0.001 & HR 4.069, 95% CI 1.388−11.93, p = 0.011), and complete surgical cytoreduction (p = 0.017) were independent parameters for a favored overall survival. Conclusions: HGSOC patients with or without BRCA ½ germline mutations, who had cytoreductive surgery, showed comparable chemotherapy responses and subsequent survival. Irrespective of BRCA status, advanced-stage HGSOC patients have a superior prognosis with complete surgical cytoreduction and good histopathological response to chemotherapy.
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Affiliation(s)
- Diederick De Jong
- ESGO Center of Excellence for Advanced Ovarian Cancer Surgery, Department of Gynaecological Oncology, St James’s University Hospital, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, UK
| | - Mohamed Otify
- ESGO Center of Excellence for Advanced Ovarian Cancer Surgery, Department of Gynaecological Oncology, St James’s University Hospital, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, UK
| | - Inga Chen
- Department of Obstetrics and Gynaecology, St James’s University Hospital, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, UK
| | - David Jackson
- Department of Medical Oncology, St James’s University Hospital, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, UK
| | - Kelum Jayasinghe
- ESGO Center of Excellence for Advanced Ovarian Cancer Surgery, Department of Gynaecological Oncology, St James’s University Hospital, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, UK
| | - David Nugent
- ESGO Center of Excellence for Advanced Ovarian Cancer Surgery, Department of Gynaecological Oncology, St James’s University Hospital, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, UK
| | - Amudha Thangavelu
- ESGO Center of Excellence for Advanced Ovarian Cancer Surgery, Department of Gynaecological Oncology, St James’s University Hospital, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, UK
| | - Georgios Theophilou
- ESGO Center of Excellence for Advanced Ovarian Cancer Surgery, Department of Gynaecological Oncology, St James’s University Hospital, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, UK
| | - Alexandros Laios
- ESGO Center of Excellence for Advanced Ovarian Cancer Surgery, Department of Gynaecological Oncology, St James’s University Hospital, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, UK
- Correspondence: ; Tel.: +44-(0)-1132068251
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Hiu S, Bryant A, Gajjar K, Kunonga PT, Naik R. Ultra-radical (extensive) surgery versus standard surgery for the primary cytoreduction of advanced epithelial ovarian cancer. Cochrane Database Syst Rev 2022; 8:CD007697. [PMID: 36041232 PMCID: PMC9427128 DOI: 10.1002/14651858.cd007697.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Ovarian cancer is the seventh most common cancer among women and the leading cause of death in women with gynaecological malignancies. Opinions differ regarding the role of ultra-radical (extensive) cytoreductive surgery in ovarian cancer treatment. OBJECTIVES To evaluate the effectiveness and morbidity associated with ultra-radical/extensive surgery in the management of advanced-stage epithelial ovarian cancer. SEARCH METHODS We searched CENTRAL (2021, Issue 11), MEDLINE Ovid and Embase Ovid up to November 2021. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. SELECTION CRITERIA Randomised controlled trials (RCTs) or non-randomised studies (NRS), analysed using multivariate methods, that compared ultra-radical/extensive and standard surgery in women with advanced primary epithelial ovarian cancer. DATA COLLECTION AND ANALYSIS Two review authors independently assessed whether potentially relevant studies met the inclusion criteria, abstracted data and assessed the risk of bias. We identified three NRS and conducted meta-analyses where possible. MAIN RESULTS We identified three retrospective observational studies for inclusion in the review. Two studies included women exclusively undergoing upfront primary debulking surgery (PDS) and the other study including both PDS and interval debulking surgical (IDS) procedures. All studies were at critical risk of bias due to retrospective and non-randomised study designs. Meta-analysis of two studies, assessing 397 participants, found that women who underwent radical procedures, as part of PDS, may have a lower risk of mortality compared to women who underwent standard surgery (adjusted HR 0.60, 95% CI 0.43 to 0.82; I2 = 0%; very low-certainty evidence), but the evidence is very uncertain. The results were robust to a sensitivity analysis including women with more-extensive disease (carcinomatosis) (adjusted HR 0.61, 95% CI 0.44 to 0.85; I2 = 0%; n = 283, very low-certainty evidence), but the evidence is very uncertain. One study reported a comparison of radical versus standard surgical procedures associated with both PDS and IDS procedures, but a multivariate analysis was only undertaken for disease-free survival (DFS) and therefore the certainty of the evidence was not assessable for overall survival (OS) and remains very low. The lack of reporting of OS meant the study was at high risk of bias for selective reporting of outcomes. One study, 203 participants, found that women who underwent radical procedures as part of PDS may have a lower risk of disease progression or death compared to women who underwent standard surgery (adjusted HR 0.62, 95% CI 0.42 to 0.92; very low-certainty evidence), but the evidence is very uncertain. The results were robust to a sensitivity analysis in one study including women with carcinomatosis (adjusted HR 0.52, 95% CI 0.33 to 0.82; n = 139; very low-certainty evidence), but the evidence is very uncertain. A combined analysis in one study found that women who underwent radical procedures (using both PDS and IDS) may have an increased chance of disease progression or death than those who received standard surgery (adjusted HR 1.60, 95% CI 1.11 to 2.31; I2 = 0%; n = 527; very low-certainty evidence), but the evidence is very uncertain. In absolute and unadjusted terms, the DFS was 19.3 months in the standard surgery group, 15.8 in the PDS group and 15.9 months in the IDS group. All studies were at critical risk of bias and we only identified very low-certainty evidence for all outcomes reported in the review. Perioperative mortality, adverse events and quality of life (QoL) outcomes were either not reported or inadequately reported in the included studies. Two studies reported perioperative mortality (death within 30 days of surgery), but they did not use any statistical adjustment. In total, there were only four deaths within 30 days of surgery in both studies. All were observed in the standard surgery group, but we did not report a risk ratio (RR) to avoid potentially misleading results with so few deaths and very low-certainty evidence. Similarly, one study reported postoperative morbidity, but the authors did not use any statistical adjustment. Postoperative morbidity occurred more commonly in women who received ultra-radical surgery compared to standard surgery, but the certainty of the evidence was very low. AUTHORS' CONCLUSIONS We found only very low-certainty evidence comparing ultra-radical surgery and standard surgery in women with advanced ovarian cancer. The evidence was limited to retrospective, NRSs and so is at critical risk of bias. The results may suggest that ultra-radical surgery could result in improved OS, but results are based on very few women who were chosen to undergo each intervention, rather than a randomised study and intention-to-treat analysis, and so the evidence is very uncertain. Results for progression/DFS were inconsistent and evidence was sparse. QoL and morbidity was incompletely or not reported in the three included studies. A separate prognostic review assessing residual disease as a prognostic factor in this area has been addressed elsewhere, which demonstrates the prognostic effect of macroscopic debulking to no macroscopic residual disease. In order to aid existing guidelines, the role of ultra-radical surgery in the management of advanced-stage ovarian cancer could be addressed through the conduct of a sufficiently powered, RCT comparing ultra-radical and standard surgery, or well-designed NRSs, if this is not possible.
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Affiliation(s)
- Shaun Hiu
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Bryant
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ketankumar Gajjar
- Department of Gynaecological Oncology, 1st Floor Maternity Unit, City Hospital Campus, Nottingham, UK
| | - Patience T Kunonga
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Raj Naik
- Queen Elizabeth Hospital, Northern Gynaecological Oncology Centre, Gateshead, UK
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6
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Norppa N, Staff S, Helminen M, Auranen A, Saarelainen S. Improved survival after implementation of ultra-radical surgery in advanced epithelial ovarian cancer: Results from a tertiary referral center. Gynecol Oncol 2022; 165:478-485. [DOI: 10.1016/j.ygyno.2022.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/26/2022] [Accepted: 03/27/2022] [Indexed: 11/04/2022]
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Eisenkop SM, Okabe H. Prognostic influence of an early time to chemotherapy following primary cytoreductive surgery for advanced epithelial ovarian cancer. J Gynecol Oncol 2022; 33:e80. [PMID: 36245229 PMCID: PMC9634102 DOI: 10.3802/jgo.2022.33.e80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 06/15/2022] [Accepted: 08/07/2022] [Indexed: 12/03/2022] Open
Abstract
Objective The current investigation analyzes the prognostic role of the time to chemotherapy (TTC) interval following primary cytoreductive surgery for patients with advanced epithelial ovarian cancer. Methods Characteristics and outcome data for 509 consecutive patients with stage IIIB–IVB ovarian, fallopian tube, and peritoneal cancer who had primary cytoreductive surgery between January 2000 and December 2019 are utilized. A univariate Cox regression determined the association of categorical variables with progression-free survival (PFS) and overall survival (OS). Significant variables (p≤0.05) on univariate analysis were applied to Cox proportional hazard regression. Results The median TTC was 19 days and overall follow-up was 62.2 months. The PFS and OS were 25.5 months and 78.4 months for the study cohort plus 28.4 months and OS 84.5 months for patients rendered grossly disease-free. An early TTC (7–14 vs. 15–21 vs. 22–28 vs. >28 days) was associated with an improved PFS (41.7 vs. 30.6 vs. 18.9 vs. 17.9 months; p<0.001) and OS (132.7 vs. 104.6 vs. 56.5 vs. 48.0 months; p<0.001). The performance status, histology, disease distribution, dimension of residual disease, and categorical plus continuous TTC were predictors of PFS and OS. The use of maintenance therapy was also a predictor of PFS, and the route of chemotherapy administration was a predictor of OS. Conclusions For advanced epithelial ovarian cancer, a TTC of less than 21-days was observed to independently improve the PFS and OS. A 7–14 days TTC trended towards a further extension of the OS. Chemotherapy was administered as early as possible after extensive primary cytoreductive surgery for patients with stage IIIB-IV epithelial ovarian cancer. Early time to chemotherapy improved survival. Complete recovery from surgery before chemotherapy is not essential.
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Affiliation(s)
| | - Hidefusa Okabe
- Math Question Center, Division of Continuing Education, Harvard University, Cambridge, MA, USA
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8
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Hunt AL, Bateman NW, Barakat W, Makohon-Moore S, Hood BL, Conrads KA, Zhou M, Calvert V, Pierobon M, Loffredo J, Litzi TJ, Oliver J, Mitchell D, Gist G, Rojas C, Blanton B, Robinson EL, Odunsi K, Sood AK, Casablanca Y, Darcy KM, Shriver CD, Petricoin EF, Rao UN, Maxwell GL, Conrads TP. Extensive three-dimensional intratumor proteomic heterogeneity revealed by multiregion sampling in high-grade serous ovarian tumor specimens. iScience 2021; 24:102757. [PMID: 34278265 PMCID: PMC8264160 DOI: 10.1016/j.isci.2021.102757] [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: 03/01/2021] [Revised: 04/19/2021] [Accepted: 06/17/2021] [Indexed: 12/15/2022] Open
Abstract
Enriched tumor epithelium, tumor-associated stroma, and whole tissue were collected by laser microdissection from thin sections across spatially separated levels of ten high-grade serous ovarian carcinomas (HGSOCs) and analyzed by mass spectrometry, reverse phase protein arrays, and RNA sequencing. Unsupervised analyses of protein abundance data revealed independent clustering of an enriched stroma and enriched tumor epithelium, with whole tumor tissue clustering driven by overall tumor "purity." Comparing these data to previously defined prognostic HGSOC molecular subtypes revealed protein and transcript expression from tumor epithelium correlated with the differentiated subtype, whereas stromal proteins (and transcripts) correlated with the mesenchymal subtype. Protein and transcript abundance in the tumor epithelium and stroma exhibited decreased correlation in samples collected just hundreds of microns apart. These data reveal substantial tumor microenvironment protein heterogeneity that directly bears on prognostic signatures, biomarker discovery, and cancer pathophysiology and underscore the need to enrich cellular subpopulations for expression profiling.
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Affiliation(s)
- Allison L. Hunt
- Women's Health Integrated Research Center, Inova Women's Service Line, Inova Health System, 3289 Woodburn Road, Annandale, VA 22042, USA
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University and Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
| | - Nicholas W. Bateman
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University and Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, MD 20817, USA
- The John P. Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
| | - Waleed Barakat
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University and Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, MD 20817, USA
| | - Sasha Makohon-Moore
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University and Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, MD 20817, USA
| | - Brian L. Hood
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University and Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, MD 20817, USA
| | - Kelly A. Conrads
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University and Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, MD 20817, USA
| | - Ming Zhou
- Women's Health Integrated Research Center, Inova Women's Service Line, Inova Health System, 3289 Woodburn Road, Annandale, VA 22042, USA
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University and Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
| | - Valerie Calvert
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA 20110, USA
| | - Mariaelena Pierobon
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA 20110, USA
| | - Jeremy Loffredo
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University and Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, MD 20817, USA
| | - Tracy J. Litzi
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University and Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, MD 20817, USA
| | - Julie Oliver
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University and Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, MD 20817, USA
| | - Dave Mitchell
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University and Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, MD 20817, USA
| | - Glenn Gist
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University and Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, MD 20817, USA
| | - Christine Rojas
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University and Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
| | - Brian Blanton
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University and Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
- The John P. Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
| | - Emma L. Robinson
- Women's Health Integrated Research Center, Inova Women's Service Line, Inova Health System, 3289 Woodburn Road, Annandale, VA 22042, USA
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University and Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
| | - Kunle Odunsi
- Department of Gynecologic Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Anil K. Sood
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA
| | - Yovanni Casablanca
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University and Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, MD 20817, USA
- The John P. Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
| | - Kathleen M. Darcy
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University and Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, MD 20817, USA
- The John P. Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
| | - Craig D. Shriver
- The John P. Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
| | - Emanuel F. Petricoin
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA 20110, USA
| | - Uma N.M. Rao
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University and Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, MD 20817, USA
| | - G. Larry Maxwell
- Women's Health Integrated Research Center, Inova Women's Service Line, Inova Health System, 3289 Woodburn Road, Annandale, VA 22042, USA
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University and Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
- The John P. Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
| | - Thomas P. Conrads
- Women's Health Integrated Research Center, Inova Women's Service Line, Inova Health System, 3289 Woodburn Road, Annandale, VA 22042, USA
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University and Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
- The John P. Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
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9
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Jiao Y, Xiong Y, He L, Yang Z, Yuan H, Liu D, Li R, Song R, Yin Y. Dioscorea deltoidea Leaf Extract (DDLE) Targets PI3K/AKT/mTOR Pathway and Inhibits Ovarian Cancer Cell Growth. DOKL BIOCHEM BIOPHYS 2021; 497:144-150. [PMID: 33895931 DOI: 10.1134/s1607672921020058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/05/2020] [Accepted: 12/06/2020] [Indexed: 12/24/2022]
Abstract
Ovarian cancer is the malignant tumour of the female reproductive organ with highest mortality rate among all the types of gynaecological tumours. This study investigated the effect of Dioscorea deltoidea leaf extract (DDLE) on OV-90 and CAOV4 ovarian cancer cells. The results demonstrated that DDLE suppresses OV-90 and CAOV3 cell viability significantly in dose dependent manner. The OV-90 and CAOV3 cell viability were reduced to 24 and 27% respectively with 20 mg/mL DDLE treatment. Five mg/mL DDLE treatment of OV-90 and CAOV4 cells raised percentage of cells in G2-phase to 55.9 and 51.2%, respectively. In 5 mg/mL DDLE -treated OV-90 and CAOV4 cells a prominent suppression in cyclin-D1 and cyclin B1 proteins was observed in 48 h. The DDLE treatment promoted OV-90 and CAOV3 cell apoptosis to 34.65 and 29.89%, respectively. The Fas, FasL, cleaved caspase-3, and Bax levels were up-regulated markedly in the cells after DDLE treatment. Moreover, DDLE treatment suppressed p-mTOR, p-AKT and p-PI3K expression in OV-90 and CAOV3 cells. Thus, DDLE suppressed ovary cancer cell viability and elevated cell apoptosis. Inhibitory effect of DDLE on ovarian cancer cells is associated with targeting PI3K/AKT/mTOR pathway.
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Affiliation(s)
- Ying Jiao
- Department of Gynecology, The No. 2 Hospital of Baoding, 071000, Baoding, Hebei, China
| | - Ying Xiong
- Department of Gynecology, The General Hospital of Ningxia Medical University, 750004, Yinchuan, Ningxia, China
| | - Lin He
- Department of Gynecology, The No. 2 Hospital of Baoding, 071000, Baoding, Hebei, China
| | - Zhifeng Yang
- Department of Gynecology, The No. 2 Hospital of Baoding, 071000, Baoding, Hebei, China
| | - Hong Yuan
- Department of Gynecology, The No. 2 Hospital of Baoding, 071000, Baoding, Hebei, China
| | - Dan Liu
- Department of Gynecology, The No. 2 Hospital of Baoding, 071000, Baoding, Hebei, China
| | - Runting Li
- Department of Gynecology, The No. 2 Hospital of Baoding, 071000, Baoding, Hebei, China
| | - Ran Song
- Department of Gynecology, The No. 2 Hospital of Baoding, 071000, Baoding, Hebei, China
| | - Yanru Yin
- Department of Gynecology, Traditional Chinese Medical Hospital of HuZhou, 313000, HuZhou, Zhejiang, China.
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10
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Aggressive surgery could overcome the extent of initial peritoneal dissemination for advanced ovarian, fallopian tube, and peritoneal carcinoma. Sci Rep 2020; 10:21307. [PMID: 33277564 PMCID: PMC7718231 DOI: 10.1038/s41598-020-78296-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/20/2020] [Indexed: 12/27/2022] Open
Abstract
We examined whether the extent of initial peritoneal dissemination affected the prognosis of patients with advanced ovarian, fallopian tube, and peritoneal carcinoma when initially disseminated lesions > 1 cm in diameter were removed, regardless of the timing of aggressive cytoreductive surgery. The extent of peritoneal dissemination was assessed by the peritoneal cancer index (PCI) at initial laparotomy in 186 consecutive patients with stage IIIC/IV. Sixty patients underwent primary debulking surgery and 109 patients underwent neoadjuvant chemotherapy followed by interval debulking surgery. Seventeen patients could not undergo debulking surgery because of disease progression during neoadjuvant chemotherapy. The median initial PCI were 17. Upper abdominal surgery and bowel resection were performed in 149 (80%) and 171 patients (92%), respectively. Residual disease ≤ 1 cm after surgery was achieved in 164 patients (89%). The initial PCI was not significantly associated with progression-free survival (PFS; p = 0.13) and overall survival (OS; p = 0.09). No residual disease and a high-complexity surgery significantly prolonged PFS (p < 0.01 and p = 0.02, respectively) and OS (p < 0.01 and p ≤ 0.01, respectively). The extent of initial peritoneal dissemination did not affect the prognosis when initially disseminated lesions > 1 cm were resected.
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11
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Saeedi N, Ghorbian S. Analysis of clinical important of LncRNA-HOTAIR gene variations and ovarian cancer susceptibility. Mol Biol Rep 2020; 47:7421-7427. [PMID: 32901358 DOI: 10.1007/s11033-020-05797-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/29/2020] [Indexed: 10/23/2022]
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12
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Hunsicker O, Gericke S, Graw JA, Krannich A, Boemke W, Meyer O, Braicu I, Spies C, Sehouli J, Pruß A, Feldheiser A. Transfusion of red blood cells does not impact progression-free and overall survival after surgery for ovarian cancer. Transfusion 2019; 59:3589-3600. [PMID: 31633819 DOI: 10.1111/trf.15552] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/11/2019] [Accepted: 09/15/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Allogeneic red blood cells (RBCs) have the potential to impact the immunosurveillance of the recipient and may therefore increase the risk of recurrence after cancer surgery. In this article the relationship between perioperative RBC transfusion and the risk of recurrence after ovarian cancer surgery is examined. STUDY DESIGN AND METHODS This is a retrospective cohort analysis of a prospective database of patients who underwent surgery due to primary ovarian cancer between 2006 and 2014 and who had no residual disease after surgery. Patients who did and did not receive perioperative RBC transfusion were compared. The primary endpoint was progression-free survival (PFS). Propensity score matching (PSM) and Cox proportional hazards regression (CPH) was used to control for between-group differences of prognostic determinants. RESULTS A total of 529 patients with a median follow-up of 51.4 months (95% CI, 46.1-56.5) were eligible for analysis. Of those, 408 patients (77.1%) received allogeneic, leukoreduced RBCs with a median of 4 units (IQR, 2-6) per patient. There was a strong selection bias of prognostic determinants between patients with and without transfusion. In unadjusted analysis, transfusion of RBCs was associated with an increased risk of cancer recurrence (hazard ratio [HR] of PFS 2.71 [95% CI, 1.94-3.77], p < 0.001). After bias reduction, transfusion of RBCs was no longer associated with an increased risk of cancer recurrence, neither in PSM-adjusted (HR 1.03 [95% CI, 0.59-1.80], p = 0.91), nor in multivariable CPH-adjusted analysis (HR 1.26 [95% CI, 0.85-1.86], p = 0.23). CONCLUSION Perioperative transfusion of RBCs did not increase the risk of recurrence after ovarian cancer surgery.
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Affiliation(s)
- Oliver Hunsicker
- Department of Anesthesiology and Operative Intensive Care Medicine CCM/CVK, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sara Gericke
- Department of Anesthesiology and Operative Intensive Care Medicine CCM/CVK, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jan Adriaan Graw
- Department of Anesthesiology and Operative Intensive Care Medicine CCM/CVK, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alexander Krannich
- Clinical Trial Office, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Willehad Boemke
- Department of Anesthesiology and Operative Intensive Care Medicine CCM/CVK, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Oliver Meyer
- Institute of Transfusion Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ioana Braicu
- Department of Gynecology, European Competence Center for Ovarian Cancer, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Operative Intensive Care Medicine CCM/CVK, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology, European Competence Center for Ovarian Cancer, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Axel Pruß
- Institute of Transfusion Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Aarne Feldheiser
- Department of Anesthesiology and Operative Intensive Care Medicine CCM/CVK, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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13
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González Martín A, Oza AM, Embleton AC, Pfisterer J, Ledermann JA, Pujade-Lauraine E, Kristensen G, Bertrand MA, Beale P, Cervantes A, Kent E, Kaplan RS, Parmar MKB, Scotto N, Perren TJ. Exploratory outcome analyses according to stage and/or residual disease in the ICON7 trial of carboplatin and paclitaxel with or without bevacizumab for newly diagnosed ovarian cancer. Gynecol Oncol 2019; 152:53-60. [PMID: 30449719 PMCID: PMC6338677 DOI: 10.1016/j.ygyno.2018.08.036] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/22/2018] [Accepted: 08/26/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVE In the randomized phase 3 ICON7 trial (ISRCTN91273375), adding bevacizumab to chemotherapy for newly diagnosed ovarian cancer significantly improved progression-free survival (PFS; primary endpoint) but not overall survival (OS; secondary endpoint) in the intent-to-treat (ITT) population. We explored treatment effect according to stage and extent of residual disease. METHODS Patients with stage IIB-IV or high-risk (grade 3/clear-cell) stage I-IIA ovarian cancer were randomized to receive six cycles of carboplatin and paclitaxel either alone or with bevacizumab 7.5 mg/kg every 3 weeks followed by single-agent bevacizumab for 12 further cycles (total duration 12 months). Post hoc exploratory analyses of subgroups defined by stage and extent of residual disease at diagnosis within the stage IIIB-IV population (European indication) was performed. RESULTS The PFS benefit from bevacizumab was seen consistently in all subgroups explored. The PFS hazard ratio was 0.77 (95% confidence interval [CI], 0.59-0.99) in 411 patients with stage IIIB-IV ovarian cancer with no visible residuum and 0.81 (95% CI, 0.69-0.95) in 749 patients with stage IIIB-IV disease and visible residuum. As in the ITT population, no OS difference was detected in any subgroup except the previously described 'high-risk' subgroup. Safety results in analyzed subgroups were consistent with the overall population. CONCLUSIONS Adding bevacizumab to front-line chemotherapy improves PFS irrespective of stage/residual disease. In patients with stage III with >1 cm residuum, stage IV or inoperable disease, this translates into an OS benefit. No OS benefit or detriment was seen in other subgroups explored.
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Affiliation(s)
| | - Amit M Oza
- Princess Margaret Cancer Centre, University Health Network Toronto, 610 University Avenue, Toronto, ON M5G 2M9, Canada.
| | - Andrew C Embleton
- Medical Research Council Clinical Trials Unit at University College London (UCL), 90 High Holborn, London WC1V 6LJ, UK.
| | - Jacobus Pfisterer
- Gynecologic Oncology Center, Herzog-Friedrich-Str. 21, 24103 Kiel, Germany.
| | | | - Eric Pujade-Lauraine
- Hôpital Hôtel-Dieu, Assistance Publique - Hôpitaux de Paris, 1, Parvis Notre-Dame - Place Jean-Paul II, 75181 Paris CEDEX 04, France.
| | - Gunnar Kristensen
- Department of Gynecologic Oncology and Institute for Cancer Genetics and Informatics, Radiumhospital, Oslo University Hospital, PO Box 4950, Nydalen, N-0424 Oslo, Norway.
| | - Monique A Bertrand
- Western University and London Health Sciences Centre, 800 Commissioners Road East, PO Box 5010, Stn B, London, ON N6A 5W9, Canada.
| | - Philip Beale
- University of Sydney and Royal Prince Alfred Hospital, Level 6, Gloucester House, RPAH, Missenden Road, Camperdown, NSW 2050, Australia.
| | - Andrés Cervantes
- CIBERONC, Biomedical Research Institute INCLIVA, University of Valencia and Hospital Clínico de Valencia, Servicio de Hematología y Oncología Médica, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.
| | - Emma Kent
- Medical Research Council Clinical Trials Unit at University College London (UCL), 90 High Holborn, London WC1V 6LJ, UK.
| | - Richard S Kaplan
- Medical Research Council Clinical Trials Unit at University College London (UCL), 90 High Holborn, London WC1V 6LJ, UK.
| | - Mahesh K B Parmar
- Medical Research Council Clinical Trials Unit at University College London (UCL), 90 High Holborn, London WC1V 6LJ, UK.
| | - Nana Scotto
- F. Hoffmann-La Roche Ltd, Building 1, Grenzacherstrasse 124, CH-4070 Basel, Switzerland.
| | - Timothy J Perren
- Leeds Institute for Cancer Medicine and Pathology, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
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14
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Sebastian A, Thomas A, Varghese G, Yadav B, Chandy R, Peedicayil A. Outcome of Bowel Resection in Women with Advanced Ovarian Carcinoma. Indian J Surg Oncol 2018; 9:511-518. [PMID: 30538381 DOI: 10.1007/s13193-018-0790-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 07/13/2018] [Indexed: 12/20/2022] Open
Abstract
To evaluate the mortality and morbidity related to bowel resection in women with advanced ovarian carcinoma. Retrospective case series of 47 women with stage III and IV carcinoma ovary who underwent bowel resection, over the period of 5 years from Jan 2011 to Dec 2015. The risk factors for perioperative morbidity and death were determined by regression analysis. The disease free and overall survival were determined by Kaplan-Meier plots. In this cohort, 64% (30/47) had primary debulking, 21% (10/47) had interval debulking, and 15% (7/47) had secondary debulking. The mean period of follow-up was 23 months (1 to 45 months). There were no anastomotic leaks. The commonest morbidities were relaparotomy (8.5%), surgical site infection (12%), and paralytic ileus (19%). The overall morbidity was 42.6% (20/47). The 30-day mortality was 4.2% (2/47). The recurrence rate was 51% (20/47). The overall mortality from ovarian cancer in this cohort was 40% (19/47) during the follow-up period. Stage and histology seemed to be important risk factors for morbidity. Low BMI and sub-optimal debulking were significant risk factors for recurrence and death in univariate analysis. Bowel resection, in optimally selected cases of advanced carcinoma ovary, is often required for optimal cytoreduction. It carries a reasonable peri-operative mortality and morbidity and improves overall survival.
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Affiliation(s)
- Ajit Sebastian
- 1Department of Gynaecologic Oncology, CMC Hospital, Vellore, 632004 India
| | - Anitha Thomas
- 1Department of Gynaecologic Oncology, CMC Hospital, Vellore, 632004 India
| | - Gigi Varghese
- 2Department of Colorectal Surgery, CMC Hospital, Vellore, 632004 India
| | - Bijesh Yadav
- 3Department of Biostatistics, CMC Hospital, Vellore, 632004 India
| | - Rachel Chandy
- 1Department of Gynaecologic Oncology, CMC Hospital, Vellore, 632004 India
| | - Abraham Peedicayil
- 1Department of Gynaecologic Oncology, CMC Hospital, Vellore, 632004 India
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15
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Javellana M, Hoppenot C, Lengyel E. The road to long-term survival: Surgical approach and longitudinal treatments of long-term survivors of advanced-stage serous ovarian cancer. Gynecol Oncol 2018; 152:228-234. [PMID: 30471899 DOI: 10.1016/j.ygyno.2018.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 10/30/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE It is unclear if the types of surgical procedures performed on long-term survivors (LTS) of high-grade serous ovarian carcinoma (HGSOC) contribute to prolonged survival. In this case-control study we review the surgical procedures performed on LTS and describe their individual longitudinal disease courses. METHODS Women with FIGO stage III-IV high-grade serous cancer of the ovary, fallopian tube or peritoneum were selected from the University of Chicago ovarian cancer database. LTS were those surviving >7 years and controls were short-term survivors (STS) living 1-2 years. Patients with non-serous histology, low grade, and low malignant potential tumors were excluded. RESULTS We identified 450 women with stage III/IV HGSOC including 45 LTS and 78 STS. LTS showed a trend towards lower disease burden, yet underwent more aggressive surgical treatment. Interestingly, only 15 LTS (34%) were debulked to microscopic disease and 9 LTS (21%) underwent suboptimal debulking. Two LTS (5%) recurred within 12 months. LTS had heterogeneous clinical courses with 13 (29%) never experiencing a recurrence with 143 months median follow-up and 32 (71%) experiencing a recurrence with 115 months median follow-up. Of the women who recurred, 19 (59%) underwent at least one surgery for recurrence. CONCLUSIONS Aggressive surgical treatment intended to achieve microscopic disease, primary debulking surgery, preservation of sensitivity to chemotherapy, and recurrence amenable to secondary debulking are associated with long-term survival. However, clinicopathologic data are insufficient to predict long-term survival of HGSOC. Biologic characterization of these patient's tumors likely holds the key to understanding their unusually favorable courses.
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Affiliation(s)
- Melissa Javellana
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology/Center for Integrated Science, University of Chicago, Chicago, IL 60637, United States of America
| | - Claire Hoppenot
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology/Center for Integrated Science, University of Chicago, Chicago, IL 60637, United States of America
| | - Ernst Lengyel
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology/Center for Integrated Science, University of Chicago, Chicago, IL 60637, United States of America.
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16
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González Martín A, Oza AM, Embleton AC, Pfisterer J, Ledermann JA, Pujade-Lauraine E, Kristensen G, Bertrand MA, Beale P, Cervantes A, Kent E, Kaplan RS, Parmar MKB, Scotto N, Perren TJ. Exploratory outcome analyses according to stage and/or residual disease in the ICON7 trial of carboplatin and paclitaxel with or without bevacizumab for newly diagnosed ovarian cancer. Gynecol Oncol 2018. [PMID: 30449719 DOI: 10.1016/j.ygyno.2018.08.036] [] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In the randomized phase 3 ICON7 trial (ISRCTN91273375), adding bevacizumab to chemotherapy for newly diagnosed ovarian cancer significantly improved progression-free survival (PFS; primary endpoint) but not overall survival (OS; secondary endpoint) in the intent-to-treat (ITT) population. We explored treatment effect according to stage and extent of residual disease. METHODS Patients with stage IIB-IV or high-risk (grade 3/clear-cell) stage I-IIA ovarian cancer were randomized to receive six cycles of carboplatin and paclitaxel either alone or with bevacizumab 7.5 mg/kg every 3 weeks followed by single-agent bevacizumab for 12 further cycles (total duration 12 months). Post hoc exploratory analyses of subgroups defined by stage and extent of residual disease at diagnosis within the stage IIIB-IV population (European indication) was performed. RESULTS The PFS benefit from bevacizumab was seen consistently in all subgroups explored. The PFS hazard ratio was 0.77 (95% confidence interval [CI], 0.59-0.99) in 411 patients with stage IIIB-IV ovarian cancer with no visible residuum and 0.81 (95% CI, 0.69-0.95) in 749 patients with stage IIIB-IV disease and visible residuum. As in the ITT population, no OS difference was detected in any subgroup except the previously described 'high-risk' subgroup. Safety results in analyzed subgroups were consistent with the overall population. CONCLUSIONS Adding bevacizumab to front-line chemotherapy improves PFS irrespective of stage/residual disease. In patients with stage III with >1 cm residuum, stage IV or inoperable disease, this translates into an OS benefit. No OS benefit or detriment was seen in other subgroups explored.
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Affiliation(s)
| | - Amit M Oza
- Princess Margaret Cancer Centre, University Health Network Toronto, 610 University Avenue, Toronto, ON M5G 2M9, Canada.
| | - Andrew C Embleton
- Medical Research Council Clinical Trials Unit at University College London (UCL), 90 High Holborn, London WC1V 6LJ, UK.
| | - Jacobus Pfisterer
- Gynecologic Oncology Center, Herzog-Friedrich-Str. 21, 24103 Kiel, Germany.
| | | | - Eric Pujade-Lauraine
- Hôpital Hôtel-Dieu, Assistance Publique - Hôpitaux de Paris, 1, Parvis Notre-Dame - Place Jean-Paul II, 75181 Paris CEDEX 04, France.
| | - Gunnar Kristensen
- Department of Gynecologic Oncology and Institute for Cancer Genetics and Informatics, Radiumhospital, Oslo University Hospital, PO Box 4950, Nydalen, N-0424 Oslo, Norway.
| | - Monique A Bertrand
- Western University and London Health Sciences Centre, 800 Commissioners Road East, PO Box 5010, Stn B, London, ON N6A 5W9, Canada.
| | - Philip Beale
- University of Sydney and Royal Prince Alfred Hospital, Level 6, Gloucester House, RPAH, Missenden Road, Camperdown, NSW 2050, Australia.
| | - Andrés Cervantes
- CIBERONC, Biomedical Research Institute INCLIVA, University of Valencia and Hospital Clínico de Valencia, Servicio de Hematología y Oncología Médica, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.
| | - Emma Kent
- Medical Research Council Clinical Trials Unit at University College London (UCL), 90 High Holborn, London WC1V 6LJ, UK.
| | - Richard S Kaplan
- Medical Research Council Clinical Trials Unit at University College London (UCL), 90 High Holborn, London WC1V 6LJ, UK.
| | - Mahesh K B Parmar
- Medical Research Council Clinical Trials Unit at University College London (UCL), 90 High Holborn, London WC1V 6LJ, UK.
| | - Nana Scotto
- F. Hoffmann-La Roche Ltd, Building 1, Grenzacherstrasse 124, CH-4070 Basel, Switzerland.
| | - Timothy J Perren
- Leeds Institute for Cancer Medicine and Pathology, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
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17
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González Martín A, Oza AM, Embleton AC, Pfisterer J, Ledermann JA, Pujade-Lauraine E, Kristensen G, Bertrand MA, Beale P, Cervantes A, Kent E, Kaplan RS, Parmar MKB, Scotto N, Perren TJ. Exploratory outcome analyses according to stage and/or residual disease in the ICON7 trial of carboplatin and paclitaxel with or without bevacizumab for newly diagnosed ovarian cancer. Gynecol Oncol 2018. [PMID: 30449719 DOI: 10.1016/j.ygyno.2018.08.036]+[] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
OBJECTIVE In the randomized phase 3 ICON7 trial (ISRCTN91273375), adding bevacizumab to chemotherapy for newly diagnosed ovarian cancer significantly improved progression-free survival (PFS; primary endpoint) but not overall survival (OS; secondary endpoint) in the intent-to-treat (ITT) population. We explored treatment effect according to stage and extent of residual disease. METHODS Patients with stage IIB-IV or high-risk (grade 3/clear-cell) stage I-IIA ovarian cancer were randomized to receive six cycles of carboplatin and paclitaxel either alone or with bevacizumab 7.5 mg/kg every 3 weeks followed by single-agent bevacizumab for 12 further cycles (total duration 12 months). Post hoc exploratory analyses of subgroups defined by stage and extent of residual disease at diagnosis within the stage IIIB-IV population (European indication) was performed. RESULTS The PFS benefit from bevacizumab was seen consistently in all subgroups explored. The PFS hazard ratio was 0.77 (95% confidence interval [CI], 0.59-0.99) in 411 patients with stage IIIB-IV ovarian cancer with no visible residuum and 0.81 (95% CI, 0.69-0.95) in 749 patients with stage IIIB-IV disease and visible residuum. As in the ITT population, no OS difference was detected in any subgroup except the previously described 'high-risk' subgroup. Safety results in analyzed subgroups were consistent with the overall population. CONCLUSIONS Adding bevacizumab to front-line chemotherapy improves PFS irrespective of stage/residual disease. In patients with stage III with >1 cm residuum, stage IV or inoperable disease, this translates into an OS benefit. No OS benefit or detriment was seen in other subgroups explored.
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Affiliation(s)
| | - Amit M Oza
- Princess Margaret Cancer Centre, University Health Network Toronto, 610 University Avenue, Toronto, ON M5G 2M9, Canada.
| | - Andrew C Embleton
- Medical Research Council Clinical Trials Unit at University College London (UCL), 90 High Holborn, London WC1V 6LJ, UK.
| | - Jacobus Pfisterer
- Gynecologic Oncology Center, Herzog-Friedrich-Str. 21, 24103 Kiel, Germany.
| | | | - Eric Pujade-Lauraine
- Hôpital Hôtel-Dieu, Assistance Publique - Hôpitaux de Paris, 1, Parvis Notre-Dame - Place Jean-Paul II, 75181 Paris CEDEX 04, France.
| | - Gunnar Kristensen
- Department of Gynecologic Oncology and Institute for Cancer Genetics and Informatics, Radiumhospital, Oslo University Hospital, PO Box 4950, Nydalen, N-0424 Oslo, Norway.
| | - Monique A Bertrand
- Western University and London Health Sciences Centre, 800 Commissioners Road East, PO Box 5010, Stn B, London, ON N6A 5W9, Canada.
| | - Philip Beale
- University of Sydney and Royal Prince Alfred Hospital, Level 6, Gloucester House, RPAH, Missenden Road, Camperdown, NSW 2050, Australia.
| | - Andrés Cervantes
- CIBERONC, Biomedical Research Institute INCLIVA, University of Valencia and Hospital Clínico de Valencia, Servicio de Hematología y Oncología Médica, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.
| | - Emma Kent
- Medical Research Council Clinical Trials Unit at University College London (UCL), 90 High Holborn, London WC1V 6LJ, UK.
| | - Richard S Kaplan
- Medical Research Council Clinical Trials Unit at University College London (UCL), 90 High Holborn, London WC1V 6LJ, UK.
| | - Mahesh K B Parmar
- Medical Research Council Clinical Trials Unit at University College London (UCL), 90 High Holborn, London WC1V 6LJ, UK.
| | - Nana Scotto
- F. Hoffmann-La Roche Ltd, Building 1, Grenzacherstrasse 124, CH-4070 Basel, Switzerland.
| | - Timothy J Perren
- Leeds Institute for Cancer Medicine and Pathology, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
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18
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Guo W, Zhu L, Yu M, Zhu R, Chen Q, Wang Q. A five-DNA methylation signature act as a novel prognostic biomarker in patients with ovarian serous cystadenocarcinoma. Clin Epigenetics 2018; 10:142. [PMID: 30446011 PMCID: PMC6240326 DOI: 10.1186/s13148-018-0574-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 10/28/2018] [Indexed: 12/25/2022] Open
Abstract
Background Ovarian cancer is the most fatal tumor of the female reproductive system and the fifth leading cause of cancer death among women in the USA. The prognosis is poor due to the lack of biomarkers for treatment options. Results The methylation array data of 551 patients with ovarian serous cystadenocarcinoma (OSC) in The Cancer Genome Atlas (TCGA) database were assessed in this study to explore the methylation biomarkers associated with prognosis and improve the prognosis of patients. These patients were divided into training (first two thirds) and validation datasets (remaining one third). A five-DNA methylation signature was found to be significantly associated with the overall survival of patients with OSC using the Cox regression analysis in the training dataset. The Kaplan–Meier analysis showed that the five-DNA methylation signature could significantly distinguish the high- and low-risk patients in both training and validation sets. The receiver operating characteristic (ROC) analysis further confirmed that the five-DNA methylation signature exhibited high sensitivity and specificity to predict the prognostic survival of patients. Also, the five-DNA methylation signature was not only applicable in patients of different ages, stages, histologic grade, and size of residual tumor after surgery but also more accurate in predicting OSC prognosis compared with known biomarkers. Conclusions This five-DNA methylation signature demonstrated the potential of being a novel independent prognostic indicator and served as an important tool for guiding the clinical treatment of OSC to improve outcome prediction and management for patients. Hence, the findings of this study might have potential clinical significance. Electronic supplementary material The online version of this article (10.1186/s13148-018-0574-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wenna Guo
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China
| | - Liucun Zhu
- School of Life Sciences, Shanghai University, Shanghai, China
| | - Minghao Yu
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China
| | - Rui Zhu
- School of Life Sciences, Shanghai University, Shanghai, China
| | - Qihan Chen
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China.
| | - Qiang Wang
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China.
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19
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Long H, Li G, Wen X, Lv Y, Zhang M, Wei Y, Xie W, Zhong P, Pang L. Prognostic significance of β-catenin expression in patients with ovarian cancer: A meta-analysis. Gene 2018; 678:270-279. [PMID: 30103006 DOI: 10.1016/j.gene.2018.08.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/06/2018] [Accepted: 08/09/2018] [Indexed: 11/18/2022]
Abstract
AIM The purpose of this study was to evaluate the impact of β-catenin immunohistochemical expression on the prognostic of ovarian cancer (OC) for that β-catenin could be responsible for the development and progress of OC. METHODS We searched various databases to identify eligible studies, and Review Managers 5.2 software was fulfilled in the meta-analysis. RESULTS A total of 11 studies were defined and composed in 1858 cases. β-catenin expression was significantly correlated with poor overall survival (OS) in OC patients (HR: 2.48, 95% CI: 1.38-4.47, P = 0.003), and showed a significant degree of heterogeneity (I2 = 83%, P < 0.00001). Subgroup analysis indicated that accumulation in the nucleus and/or cytoplasm, rather than membrane, considerably influences the survival of OC patients independently. CONCLUSION Nucleus and/or cytoplasma of β-catenin expression might be associated with tumor progression and could be a possible potential predictive factor of poor prognosis in OC patients.
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Affiliation(s)
- Huideng Long
- Department of Pathology and Key Laboratory for Xinjiang Endemic and Ethnic Diseases (Ministry of Education), Shihezi University School of Medicine, North 2nd Road, Shihezi 832002, Xinjiang, China; Department of Pathology, First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, China
| | - Ganxiong Li
- Department of Pathology and Key Laboratory for Xinjiang Endemic and Ethnic Diseases (Ministry of Education), Shihezi University School of Medicine, North 2nd Road, Shihezi 832002, Xinjiang, China; Department of Pathology, First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, China
| | - Xiaoman Wen
- Department of Public Health and Key Laboratory of Shanghai Endemic and Ethnic Diseases, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Yanmin Lv
- Department of Pathology and Key Laboratory for Xinjiang Endemic and Ethnic Diseases (Ministry of Education), Shihezi University School of Medicine, North 2nd Road, Shihezi 832002, Xinjiang, China; Department of Pathology, First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, China
| | - Min Zhang
- Department of Pathology and Key Laboratory for Xinjiang Endemic and Ethnic Diseases (Ministry of Education), Shihezi University School of Medicine, North 2nd Road, Shihezi 832002, Xinjiang, China; Department of Pathology, First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, China
| | - Yuanfeng Wei
- Department of Pathology and Key Laboratory for Xinjiang Endemic and Ethnic Diseases (Ministry of Education), Shihezi University School of Medicine, North 2nd Road, Shihezi 832002, Xinjiang, China; Department of Pathology, First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, China
| | - Wenting Xie
- Department of Nuclear Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Peng Zhong
- Department of Nuclear Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lijuan Pang
- Department of Pathology and Key Laboratory for Xinjiang Endemic and Ethnic Diseases (Ministry of Education), Shihezi University School of Medicine, North 2nd Road, Shihezi 832002, Xinjiang, China; Department of Pathology, First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, China.
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20
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Gharpure KM, Pradeep S, Sans M, Rupaimoole R, Ivan C, Wu SY, Bayraktar E, Nagaraja AS, Mangala LS, Zhang X, Haemmerle M, Hu W, Rodriguez-Aguayo C, McGuire M, Mak CSL, Chen X, Tran MA, Villar-Prados A, Pena GA, Kondetimmanahalli R, Nini R, Koppula P, Ram P, Liu J, Lopez-Berestein G, Baggerly K, S Eberlin L, Sood AK. FABP4 as a key determinant of metastatic potential of ovarian cancer. Nat Commun 2018; 9:2923. [PMID: 30050129 PMCID: PMC6062524 DOI: 10.1038/s41467-018-04987-y] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/06/2018] [Indexed: 12/30/2022] Open
Abstract
The standard treatment for high-grade serous ovarian cancer is primary debulking surgery followed by chemotherapy. The extent of metastasis and invasive potential of lesions can influence the outcome of these primary surgeries. Here, we explored the underlying mechanisms that could increase metastatic potential in ovarian cancer. We discovered that FABP4 (fatty acid binding protein) can substantially increase the metastatic potential of cancer cells. We also found that miR-409-3p regulates FABP4 in ovarian cancer cells and that hypoxia decreases miR-409-3p levels. Treatment with DOPC nanoliposomes containing either miR-409-3p mimic or FABP4 siRNA inhibited tumor progression in mouse models. With RPPA and metabolite arrays, we found that FABP4 regulates pathways associated with metastasis and affects metabolic pathways in ovarian cancer cells. Collectively, these findings demonstrate that FABP4 is functionally responsible for aggressive patterns of disease that likely contribute to poor prognosis in ovarian cancer.
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Affiliation(s)
- Kshipra M Gharpure
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Sunila Pradeep
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Marta Sans
- Department of Chemistry, The University of Texas at Austin, Austin, TX, 78712, USA
| | - Rajesha Rupaimoole
- Department of Pathology and Institute of RNA Medicine, Beth Israel Deaconess Medical Center Cancer Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Cristina Ivan
- Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, 77030, Texas, USA
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Sherry Y Wu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Emine Bayraktar
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Archana S Nagaraja
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Lingegowda S Mangala
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
- Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, 77030, Texas, USA
| | - Xinna Zhang
- Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, 77030, Texas, USA
| | - Monika Haemmerle
- Martin-Luther-University Halle-Wittenberg, Institute of Pathology, 06112, Halle (Saale), Germany
| | - Wei Hu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Cristian Rodriguez-Aguayo
- Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, 77030, Texas, USA
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Michael McGuire
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Celia Sze Ling Mak
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Xiuhui Chen
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Michelle A Tran
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Alejandro Villar-Prados
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Guillermo Armaiz Pena
- Department of Pharmacology, Ponce Health Sciences University, Ponce, 00716, Puerto Rico
| | | | - Ryan Nini
- Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Pranavi Koppula
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Prahlad Ram
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Jinsong Liu
- Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Gabriel Lopez-Berestein
- Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, 77030, Texas, USA
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Keith Baggerly
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Livia S Eberlin
- Department of Chemistry, The University of Texas at Austin, Austin, TX, 78712, USA
| | - Anil K Sood
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA.
- Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, 77030, Texas, USA.
- Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
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21
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Ruscito I, Darb-Esfahani S, Kulbe H, Bellati F, Zizzari IG, Rahimi Koshkaki H, Napoletano C, Caserta D, Rughetti A, Kessler M, Sehouli J, Nuti M, Braicu EI. The prognostic impact of cancer stem-like cell biomarker aldehyde dehydrogenase-1 (ALDH1) in ovarian cancer: A meta-analysis. Gynecol Oncol 2018; 150:151-157. [DOI: 10.1016/j.ygyno.2018.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/28/2018] [Accepted: 05/04/2018] [Indexed: 12/19/2022]
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22
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Torres D, Wang C, Kumar A, Bakkum-Gamez JN, Weaver AL, McGree ME, Konecny GE, Goode EL, Cliby WA. Factors that influence survival in high-grade serous ovarian cancer: A complex relationship between molecular subtype, disease dissemination, and operability. Gynecol Oncol 2018; 150:227-232. [PMID: 29925470 DOI: 10.1016/j.ygyno.2018.06.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/01/2018] [Accepted: 06/02/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To investigate the relationship between molecular subtype, intraperitoneal (IP) disease dissemination patterns, resectability, and overall survival (OS) in advanced high-grade serous ovarian cancer (HGSOC). METHODS Patients undergoing primary surgery for stage III-IV HGSOC at Mayo Clinic from 1994 to 2011 were categorized into three IP disease dissemination patterns: upper abdominal or miliary; lower abdominal; and pelvic. Residual disease was defined as 0 (RD0), 0.1-0.5, 0.6-1.0, or >1 cm. Molecular subtypes were derived from Agilent 4x44k tumor mRNA expression profiles and categorized as mesenchymal (MES) or non-mesenchymal (non-MES). RESULTS Operative and molecular data was available for 334 patients. Median OS was shorter in patients with MES compared to non-MES subtypes (34.2 vs 44.6 months; P = 0.009). Patients with MES subtype were more likely to have upper abdominal/miliary disease compared to non-MES subtype (90% vs. 72%, P < 0.001). For patients with upper abdominal/miliary disease, complete resection (RD0) was less common in MES compared to non-MES subtypes (11% vs. 27%, P = 0.004). On multivariable analysis, RD was the only factor associated with OS (P < 0.001). In patients with upper abdominal/miliary disease, though less commonly achieved, RD0 improved survival irrespective of molecular subtype (median OS of 69.2 and 57.9 months for MES and non-MES subtype). CONCLUSIONS Our results support a paradigm in which molecular subtype is an important driver of dissemination pattern; this in turn impacts resectability and ultimately survival. Consequently mesenchymal subtype is associated with much lower rates of complete resection, though RD0 remains the most important independent predictor of survival.
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Affiliation(s)
- Diogo Torres
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Chen Wang
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States; Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, MN, United States
| | - Amanika Kumar
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Jamie N Bakkum-Gamez
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Amy L Weaver
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Michaela E McGree
- Department of Medicine, Division of Hematology/Oncology, University of California Los Angeles, Los Angeles, CA, United States
| | - Gottfried E Konecny
- Department of Medicine, Division of Hematology/Oncology, University of California Los Angeles, Los Angeles, CA, United States
| | - Ellen L Goode
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - William A Cliby
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States.
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23
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Kulkarni Y, Kalyan P. There is Currently no Role of HIPEC in Epithelial Ovarian Cancer in Routine Clinical Practice. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2017. [DOI: 10.1007/s40944-017-0166-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Hamilton CA, Miller A, Casablanca Y, Horowitz NS, Rungruang B, Krivak TC, Richard SD, Rodriguez N, Birrer MJ, Backes FJ, Geller MA, Quinn M, Goodheart MJ, Mutch DG, Kavanagh JJ, Maxwell GL, Bookman MA. Clinicopathologic characteristics associated with long-term survival in advanced epithelial ovarian cancer: an NRG Oncology/Gynecologic Oncology Group ancillary data study. Gynecol Oncol 2017; 148:275-280. [PMID: 29195926 DOI: 10.1016/j.ygyno.2017.11.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/14/2017] [Accepted: 11/15/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To identify clinicopathologic factors associated with 10-year overall survival in epithelial ovarian cancer (EOC) and primary peritoneal cancer (PPC), and to develop a predictive model identifying long-term survivors. METHODS Demographic, surgical, and clinicopathologic data were abstracted from GOG 182 records. The association between clinical variables and long-term survival (LTS) (>10years) was assessed using multivariable regression analysis. Bootstrap methods were used to develop predictive models from known prognostic clinical factors and predictive accuracy was quantified using optimism-adjusted area under the receiver operating characteristic curve (AUC). RESULTS The analysis dataset included 3010 evaluable patients, of whom 195 survived greater than ten years. These patients were more likely to have better performance status, endometrioid histology, stage III (rather than stage IV) disease, absence of ascites, less extensive preoperative disease distribution, microscopic disease residual following cyoreduction (R0), and decreased complexity of surgery (p<0.01). Multivariable regression analysis revealed that lower CA-125 levels, absence of ascites, stage, and R0 were significant independent predictors of LTS. A predictive model created using these variables had an AUC=0.729, which outperformed any of the individual predictors. CONCLUSIONS The absence of ascites, a low CA-125, stage, and R0 at the time of cytoreduction are factors associated with LTS when controlling for other confounders. An extensively annotated clinicopathologic prediction model for LTS fell short of clinical utility suggesting that prognostic molecular profiles are needed to better predict which patients are likely to be long-term survivors.
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Affiliation(s)
- C A Hamilton
- Gynecologic Cancer Center of Excellence, John P. Murtha Cancer Center, Walter Reed National Military Medical Center and Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
| | - A Miller
- NRG Oncology Statistics and Data Management Center/Gynecologic Oncology Group, Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY, United States
| | - Y Casablanca
- Gynecologic Cancer Center of Excellence, John P. Murtha Cancer Center, Walter Reed National Military Medical Center and Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - N S Horowitz
- Division of Gynecologic Oncology, Brigham & Women's Hospital, Boston, MA, United States
| | - B Rungruang
- Division of Gynecologic Oncology, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - T C Krivak
- Division of Gynecologic Oncology, Western Pennsylvania Hospital, Pittsburgh, PA, United States
| | - S D Richard
- Division of Gynecologic Oncology, Hahnemann University Hospital/Drexel University College of Medicine, Philadelphia, PA, United States
| | - N Rodriguez
- Division of Gynecologic Oncology, Loma Linda University Medical Center, Loma Linda, CA, United States
| | - M J Birrer
- Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Boston, MA, United States
| | - F J Backes
- Division of Gynecologic Oncology, Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, United States
| | - M A Geller
- Gynecology and Women's Health, University of Minnesota, Minneapolis, MN, United States
| | - M Quinn
- Gynaecological Oncology, ANZGOG, Royal Women's Hospital and University of Melbourne, Australia
| | - M J Goodheart
- Gynecologic Oncology, University of Iowa, Iowa City, IA, United States
| | - D G Mutch
- Gynecologic Oncology, Washington University, St. Louis, MO, United States
| | - J J Kavanagh
- MD Anderson Cancer Center, Houston, TX, United States
| | - G L Maxwell
- Inova Fairfax Hospital Department of Obstetrics and Gynecology, Inova Schar Cancer Institute, Falls Church, VA, United States
| | - M A Bookman
- US Oncology Research and Arizona Oncology, Tucson, AZ, United States
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25
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Moore KN, Tritchler D, Kaufman KM, Lankes H, Quinn MCJ, Van Le L, Berchuck A, Backes FJ, Tewari KS, Lee RB, Kesterson JP, Wenham RM, Armstrong DK, Krivak TC, Bookman MA, Birrer MJ. Genome-wide association study evaluating single-nucleotide polymorphisms and outcomes in patients with advanced stage serous ovarian or primary peritoneal cancer: An NRG Oncology/Gynecologic Oncology Group study. Gynecol Oncol 2017; 147:396-401. [PMID: 28935272 PMCID: PMC5706110 DOI: 10.1016/j.ygyno.2017.08.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/17/2017] [Accepted: 08/21/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study evaluated single nucleotide polymorphisms (SNPs) associated with progression free (PFS) and overall survival (OS) in patients with advanced stage serous EOC. METHODS Patients enrolled in GOG-172 and 182 who provided specimens for translational research and consent were included. Germline DNA was evaluated with the Illumina's HumanOMNI1-Quad beadchips and scanned using Illumina's iScan optical imaging system. SNPs with allele frequency>0.05 and genotyping rate>0.98 were included. Analysis of SNPs for PFS and OS was done using Cox regression. Statistical significance was determined using Bonferroni corrected p-values with genomic control adjustment. RESULTS The initial GWAS analysis included 1,124,677 markers in 396 patients. To obtain the final data set, quality control checks were performed and limited to serous tumors and self-identified Caucasian race. In total 636,555 SNPs and 289 patients passed all the filters. The pre-specified statistical level of significance was 7.855e-08. No SNPs met this criteria for PFS or OS, however, two SNPs were close to significance (rs10899426 p-2.144e-08) (rs6256 p-9.774e-07) for PFS and 2 different SNPs were identified (rs295315 p-7.536e-07; rs17693104 p-7.734e-07) which were close to significance for OS. CONCLUSIONS Using the pre-specified level of significance of 1×10-08, we did not identify any SNPs of statistical significance for OS or PFS, however several were close. The SNP's identified in this GWAS study will require validation and these preliminary findings may lead to identification of novel pathways and biomarkers.
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Affiliation(s)
- Kathleen N Moore
- Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK, USA.
| | - David Tritchler
- The Gynecologic Oncology Group Biostatistics Office, Buffalo, NY, USA
| | - Kenneth M Kaufman
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; US Department of Veterans Affairs Medical Center, Cincinnati, OH, USA.
| | - Heather Lankes
- Statistics and Data Management Center, NRG Oncology, Buffalo, NY, USA.
| | - Michael C J Quinn
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
| | - Linda Van Le
- UNC, Chapel Hill, Department of OB/GYN, Chapel Hill, NC 27599, USA.
| | - Andrew Berchuck
- Duke University Medical Center, Room 25172, Durham, NC 27710, USA.
| | - Floor J Backes
- Ohio State University, Wexner Medical Center, Hilliard, OH 43026, USA.
| | | | | | | | | | - Deborah K Armstrong
- Sidney Kimmel Cancer Center, Division of Medical Oncology, John Hopkins, Baltimore, MD, USA.
| | - Thomas C Krivak
- Western Pennsylvania Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Pittsburgh, PA, USA.
| | - Michael A Bookman
- Gynecologic Oncology Research, US Oncology Research Arizona Oncology, Tucson, AZ 85711, USA.
| | - Michael J Birrer
- Gynecological Oncology, Massachusetts General Hospital, Department of Medicine, Boston, MA, USA.
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Torres D, Kumar A, Wallace SK, Bakkum-Gamez JN, Konecny GE, Weaver AL, McGree ME, Goode EL, Cliby WA, Wang C. Intraperitoneal disease dissemination patterns are associated with residual disease, extent of surgery, and molecular subtypes in advanced ovarian cancer. Gynecol Oncol 2017; 147:503-508. [PMID: 28964622 DOI: 10.1016/j.ygyno.2017.09.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/14/2017] [Accepted: 09/18/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the association between intraperitoneal (IP) disease dissemination patterns, residual disease (RD), surgical complexity, and molecular subtypes in advanced high-grade serous ovarian cancer (HGSOC). METHODS 741 patients with operable stage III-IV HGSOC undergoing primary debulking surgery at Mayo Clinic from 1994 to 2011 were categorized into four mutually exclusive IP disease dissemination patterns: upper abdominal (60%), miliary (16%), lower abdominal (15%), and pelvic (9%). Surgical complexity was classified as high, intermediate, or low; RD status was defined as 0, 0.1-0.5, 0.6-1.0, or >1cm; molecular subtype assignments were derived from expression profiling of tumors from 334 patients. RESULTS Patients with either miliary or upper abdominal dissemination patterns were less likely to achieve RD0 compared to patients with pelvic and lower abdominal dissemination patterns (25% vs. 9% and 62%, each P<0.001) despite higher surgical complexity (39% vs. 6% and 20%, each P<0.001). Among the subset with molecular subtype data, patients with mesenchymal subtype of tumors were more likely to have upper abdominal or miliary dissemination patterns compared to patients with differentiated, proliferative, or immunoreactive subtypes (90% vs. 77%, 70%, 69%, respectively, P<0.05). CONCLUSIONS IP disease dissemination patterns are associated with RD, surgical complexity, and tumor molecular subtypes. Patients with upper abdominal or miliary dissemination patterns are more likely to have mesenchymal HGSOC and in turn achieve lower rates of complete resection. This provides a plausible model for how the biologic behavior of molecular subtypes is manifest in disease and oncologic outcomes.
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Affiliation(s)
- Diogo Torres
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Amanika Kumar
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Sumer K Wallace
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Jamie N Bakkum-Gamez
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Gottfried E Konecny
- Department of Medicine, Division of Hematology/Oncology, University of California Los Angeles, Los Angeles, CA, United States
| | - Amy L Weaver
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Michaela E McGree
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Ellen L Goode
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, MN, United States
| | - William A Cliby
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Chen Wang
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States; Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States.
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McGee J, Bookman M, Harter P, Marth C, McNeish I, Moore K, Poveda A, Hilpert F, Hasegawa K, Bacon M, Gatsonis C, Brand A, Kridelka F, Berek J, Ottevanger N, Levy T, Silverberg S, Kim BG, Hirte H, Okamoto A, Stuart G, Ochiai K. Fifth Ovarian Cancer Consensus Conference: individualized therapy and patient factors. Ann Oncol 2017; 28:702-710. [DOI: 10.1093/annonc/mdx010] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Indexed: 12/13/2022] Open
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Salomon-Perzyński A, Salomon-Perzyńska M, Michalski B, Skrzypulec-Plinta V. High-grade serous ovarian cancer: the clone wars. Arch Gynecol Obstet 2017; 295:569-576. [PMID: 28154920 PMCID: PMC5315707 DOI: 10.1007/s00404-017-4292-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/04/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND The last 5 years' studies using next-generation sequencing provided evidences that many types of solid tumors present spatial and temporal genetic heterogeneity and are composed of multiple populations of genetically distinct subclones that evolve over time following a pattern of branched evolution. The evolutionary nature of cancer has been proposed as the major contributor to drug resistance and treatment failure. In this review, we present the current state of knowledge about the clonal evolution of high-grade serous ovarian cancer and discuss the challenge that clonal evolution poses for efforts to achieve an optimal cancer control. METHODS A systemic search of peer-reviewed articles published between August 2007 and October 2016 was performed using PUBMED and Google Scholar database. RESULTS AND CONCLUSIONS Recent studies using next-generation sequencing have allowed us to look inside the evolutionary nature of high-grade serous ovarian cancer, which in the light of current evidence can explain the relapsing course of the disease frequently observed in the clinical practice. Since only minimal improvement in the survival of patients treated with standard therapy has been observed in the last decade, novel molecular targeted therapies are of great interest in high-grade serous ovarian cancer. However, both spatial and temporal intratumoral genetic heterogeneity is a major challenge for personalized medicine, and greater knowledge of the molecular rules that drive tumor evolution through space and time is required to achieve a long-term clinical benefit from personalized therapy.
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Affiliation(s)
- Aleksander Salomon-Perzyński
- Department of Internal Medicine and Oncological Chemotherapy, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Magdalena Salomon-Perzyńska
- Department of Gynaecology Oncological, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
| | - Bogdan Michalski
- Department of Gynaecology Oncological, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
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Correlation of Pattern of Spread and Outcomes in Advanced Epithelial Ovarian Cancers. Indian J Surg Oncol 2017; 9:126-132. [PMID: 29887688 DOI: 10.1007/s13193-017-0618-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/24/2017] [Indexed: 01/16/2023] Open
Abstract
The purpose of this study was to correlate the pattern of spread with oncological outcomes in advanced ovarian cancer patients. This is a retrospective analysis of 55 consecutive patients who had advanced epithelial ovarian cancer or primary peritoneal carcinomatosis (stages 3C and 4) with primary surgical intervention as the initial modality of treatment. Based on the spread of disease, they were further classified into class A: disease confined to the pelvis (excluded); class B: disease extending to the lower abdomen and omentum; class C: diffuse small-bowel disease with or without A, B, or D; and class D: disease in the upper abdomen. There were 17 patients (30.9%) in class B, 17 (30.9%) in class C, and 21 (38.2%) in class D. The number of patients with suboptimal cytoreduction was highest in class C (six patients). At the end of follow-up (median 38.6 months), 16 patients had no evidence of disease and 26 patients were alive with disease. The 3-year overall survival rates in classes B, C, and D were 94.1, 52.5, and 93.3%, respectively. The 3-year progression-free survival rates were 55.8, 11.8, and 41.9%, respectively. The rates were lowest for class C. The differences in the overall survival rate (p < 0.001) and progression-free survival rate (p = 0.001) were statistically significant. In advanced ovarian cancer patients, the presence of disease in the small-bowel serosa and mesentery results in poorer outcomes in terms of overall and progression-free survival. The number of patients with suboptimal cytoreduction was also highest in this group.
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Melamed A, Hinchcliff EM, Clemmer JT, Bregar AJ, Uppal S, Bostock I, Schorge JO, Del Carmen MG, Rauh-Hain JA. Trends in the use of neoadjuvant chemotherapy for advanced ovarian cancer in the United States. Gynecol Oncol 2016; 143:236-240. [PMID: 27612977 DOI: 10.1016/j.ygyno.2016.09.002] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 08/28/2016] [Accepted: 09/01/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Neoadjuvant chemotherapy and interval debulking surgery for the treatment of advanced ovarian cancer has remained controversial, despite the publication of two randomized trials comparing this modality with primary cytoreductive surgery. This study describes temporal trends in the utilization of neoadjuvant chemotherapy and interval debulking surgery in clinical practice in the United States. METHODS We completed a time trend analysis of the National Cancer Data Base. We identified women with stage IIIC and IV epithelial ovarian cancer diagnosed between 2004 and 2013. We categorized subjects as having undergone one of four treatment modalities: primary cytoreductive surgery followed by adjuvant chemotherapy, neoadjuvant chemotherapy followed by interval debulking surgery, surgery only, and chemotherapy only. Temporal trends in the frequency of treatment modalities were evaluated using Joinpoint regression, and χ2 tests. RESULTS We identified 40,694 women meeting inclusion criteria, of whom 27,032 (66.4%) underwent primary cytoreductive surgery and adjuvant chemotherapy, 5429 (13.3%) received neoadjuvant chemotherapy and interval surgery, 5844 (15.4%) had surgery only, and 2389 (5.9%) received chemotherapy only. The proportion of women receiving neoadjuvant chemotherapy and surgery increased from 8.6% to 22.6% between 2004 and 2013 (p<0.001), and adoption of this treatment modality occurred primarily after 2007 (95%CI 2006-2009; p=0.001). During this period, the proportion of women who received primary cytoreductive surgery and chemotherapy declined from 68.1% to 60.8% (p<0.001), and the proportion who underwent surgery only declined from 17.8% to 9.9% (p<0.001). CONCLUSION Between 2004 and 2013 the frequency of neoadjuvant chemotherapy and interval surgery increased significantly in the United States.
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Affiliation(s)
- Alexander Melamed
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
| | - Emily M Hinchcliff
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Joel T Clemmer
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Amy J Bregar
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Shitanshu Uppal
- Division of Gynecologic Oncology, Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States
| | - Ian Bostock
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - John O Schorge
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Marcela G Del Carmen
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - J Alejandro Rauh-Hain
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Impact of Extended Primary Surgery on Suboptimally Operable Patients With Advanced Ovarian Cancer. Int J Gynecol Cancer 2016; 26:873-83. [DOI: 10.1097/igc.0000000000000707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectivesExtensive surgical efforts to achieve an optimal debulking (no residual tumor) in primary surgery of ovarian cancer are today’s criterion standard in gyneco-oncologic surgery. However, it is controversial whether extensive surgery, including resections of metastases in the upper abdomen and bowel resections, is justifiable in patients with not completely operable lesions.MethodsAll patients who had undergone surgery for ovarian cancer in the years 2002 to 2013 at our institution were viewed (n = 472). We retrospectively identified 278 operations for primary ovarian cancer. Ninety-six (35%) of the 278 patients showed postoperative tumor residuals and were included in this study.ResultsFifty-five (57%) of 96 patients underwent bowel resection, showing significantly higher complication rates (64% vs 39% minor complications, P = 0.017; 31% vs 9.8% severe complications, P = 0.013) compared with patients without bowel resections as well as no improvement in progression-free or overall survival (median overall survival, 19.5 vs 32.9; P = 0.382). Multiple anastomoses (≥2) were associated with higher rates for anastomotic leakage (16.7% vs 2.6%, P = 0.02) and a higher mortality (16.7% vs 0%, P = 0.04) compared with patients with only 1 anastomosis. Extensive surgery of the upper abdomen was not associated with a significant increase in complication rates.ConclusionsBecause of the increased morbidity of bowel resections without any evidence for improvement of survival, we suggest to restrain from further resection of intestines if an optimal debulking seems not feasible after removal of the major tumor bulk.
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Martinez A, Ngo C, Leblanc E, Gouy S, Luyckx M, Darai E, Classe JM, Guyon F, Pomel C, Ferron G, Filleron T, Querleu D. Surgical Complexity Impact on Survival After Complete Cytoreductive Surgery for Advanced Ovarian Cancer. Ann Surg Oncol 2016; 23:2515-21. [DOI: 10.1245/s10434-015-5069-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Indexed: 01/07/2023]
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Fagotti A, Ferrandina G, Vizzielli G, Fanfani F, Gallotta V, Chiantera V, Costantini B, Margariti PA, Gueli Alletti S, Cosentino F, Tortorella L, Scambia G. Phase III randomised clinical trial comparing primary surgery versus neoadjuvant chemotherapy in advanced epithelial ovarian cancer with high tumour load (SCORPION trial): Final analysis of peri-operative outcome. Eur J Cancer 2016; 59:22-33. [PMID: 26998845 DOI: 10.1016/j.ejca.2016.01.017] [Citation(s) in RCA: 252] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 01/11/2016] [Accepted: 01/24/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To establishing whether neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is superior primary debulking surgery (PDS) in terms of clinical outcome as well as peri-operative morbidity in advanced epithelial ovarian cancer (AEOC) endowed with high tumour load (HTL). MATERIAL AND METHODS This is a single-Institution, superiority, randomised phase III trial enrolling supposed AEOC women. Patients considered pre-operatively eligible were triaged to staging laparoscopy to assess the predictive index (PI) of tumour load. All AEOC women with PI≥8 or≤12 (considered as HTL) were included. They were randomly assigned (1:1 ratio) to undergo either PDS followed by systemic adjuvant chemotherapy (arm A, standard), or NACT followed by IDS (NACT/IDS) (arm B, experimental). Co-primary outcome measures were postoperative complications (graded according to the Memorial Sloan Kettering Cancer Center surgical secondary events grading system) and progression free survival (PFS); secondary outcomes were overall survival, and quality of life (QoL). QoL was assessed using the EORTC QoL questionnaires. A sample size of 110 patients was required for the analysis of the first co-primary end-point (major peri-operative morbidity) whereas recruitment is still on-going to achieve the statistical power on PFS. RESULTS Between October 2011 and November 2014, we registered 280 AEOC. Of the 110 eligible women, 55 were assigned to arm A and 55 to arm B. Despite different extension of surgery, rates of complete residual disease (residual tumour=0 cm) were superimposable between the groups (45.5% versus 57.7%; p=0.206). Twenty-nine patients (52.7%) in arm A experienced early grade III-IV complications versus three patients (5.7%) in IDS (p=0.0001). The most common complication was grade III and consisted of symptomatic pleural effusion requiring thoracic drainage (17/55 women (30.9%) in arm A versus 1/52 (1.9%) in arm B, p=0.0001). Three grade IV (5.4%) (i.e., two re-operations for postoperative haemorrhage and one septic multi-organ failure), and two grade V (3.6%) (two deaths for acute cardiopulmonary failure) early complications were observed in arm A only. Mean QoL scores of several scales/items were shown to ameliorate over time in both arms. Emotional functioning, cognitive functioning, nausea/vomiting, dyspnoea, insomnia and hair loss were statistically and clinically better in NACT/IDS compared to PDS arm. CONCLUSIONS Perioperative moderate/severe morbidity as well as QoL scores were shown to be more favourable in NACT/IDS arm than PDS in AEOC patients with very HTL. Completion of patient enrolment and analysis of survival data will clarify whether PDS with such a high rate of severe complications is an acceptable treatment in AEOC women with HTL.
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Affiliation(s)
- Anna Fagotti
- Division of Minimally Invasive Gynecological Surgery, St. Maria Hospital, University of Perugia, Terni, Italy.
| | - Gabriella Ferrandina
- Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Vizzielli
- Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Fanfani
- Department of Medicine and Aging Sciences, University "G. d'Annunzio" of Chieti-Pescara, Italy
| | - Valerio Gallotta
- Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Vito Chiantera
- Division of Gynecologic Oncology, Foundation for Research and Care "Giovanni Paolo II", Catholic University of the Sacred Heart and University of Molise, Campobasso, Italy
| | - Barbara Costantini
- Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - Francesco Cosentino
- Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Lucia Tortorella
- Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy
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Chiva L, Lapuente F, Castellanos T, Alonso S, Gonzalez-Martin A. What Should We Expect After a Complete Cytoreduction at the Time of Interval or Primary Debulking Surgery in Advanced Ovarian Cancer? Ann Surg Oncol 2015; 23:1666-73. [DOI: 10.1245/s10434-015-5051-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Indexed: 11/18/2022]
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Abstract
While there is an ongoing debate regarding the timing of the maximal surgical effort in epithelial ovarian cancer, it is well established that patients with suboptimal tumor debulking derive no benefit from the surgical procedure. The amount of residual disease after cytoreductive surgery has been repeatedly identified as a strong predictor of survival, and accordingly, the surgical effort to achieve the goal of complete gross tumor resection has been constantly evolving. Centers that have adopted the concept of radical surgery in patients with advanced ovarian cancer have reported improvements in their patients' survival. In addition to the expected improvements in the pharmacologic treatment of this disease, some of the next challenges in the surgical management of ovarian cancer include the preoperative prediction of suboptimal debulking, improving the drug delivery to the tumor, and increasing access to centers of excellence in ovarian cancer regardless of geographical, financial, or other social barriers. This review will discuss an update on the role of surgery in the treatment of primary epithelial ovarian cancer as it has evolved since the emergence of the concept of surgical cytoreduction.
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Ren Y, Jiang R, Yin S, You C, Liu D, Cheng X, Tang J, Zang R. Radical surgery versus standard surgery for primary cytoreduction of bulky stage IIIC and IV ovarian cancer: an observational study. BMC Cancer 2015; 15:583. [PMID: 26268818 PMCID: PMC4535562 DOI: 10.1186/s12885-015-1525-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 06/26/2015] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to evaluate the survival benefit of radical surgery with additional extensive upper abdominal procedures (EUAS) for the treatment of stage IIIC and IV ovarian cancer with bulky upper abdominal disease (UAD). Methods An observational study was conducted between 2009 and 2012 involving two different surgical teams. Team A was composed of the “believers” in EUAS and Team B the “non-believers” in EUAS. Patients were divided into a radical surgery group (EUAS group) or a standard surgery group (non-EUAS group) according to whether or not they had received EUAS. All patients underwent primary cytoreductive surgery with the goal of optimal debulking (≤1 cm); this was reviewed in the pelvis, middle abdomen, and upper abdomen. The baseline for the two groups was optimal cytoreduction in both the pelvis and middle abdomen. Progression-free survival (PFS) was evaluated. Results Radical surgery was performed in 70.7 % (82/116) and 12.7 % (30/237) of the patients by Teams A and B, respectively. The study groups had similar clinicopathologic characteristics. The median PFS and OS were significantly improved in the radical surgery group, compared with standard surgery groups (PFS: 19.5 vs. 13.3 months, HR: 0.61; 95 % CI: 0.46–0.80, P < 0.001; OS: not reached vs. 39.3 months, HR: 0.47; 95 % CI: 0.30–0.72, P < 0.001). Positive predictors of complete cytoreduction were treatment with neoadjuvant chemotherapy, improved American Society of Anesthesiologists performance status, and the absence of bowel mesenteric carcinomatosis. Conclusions Radical surgery lengthens the PFS and overall survival times of ovarian cancer patients with bulky UAD. However, a well-designed randomized trial is needed to confirm the present results.
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Affiliation(s)
- Yulan Ren
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
| | - Rong Jiang
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China. .,Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
| | - Sheng Yin
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
| | - Chao You
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
| | - Dongli Liu
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
| | - Xi Cheng
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
| | - Jie Tang
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
| | - Rongyu Zang
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China. .,Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
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Zhou Q, Chen A, Song H, Tao J, Yang H, Zuo M. Prognostic value of cancer stem cell marker CD133 in ovarian cancer: a meta-analysis. Int J Clin Exp Med 2015; 8:3080-3088. [PMID: 26064196 PMCID: PMC4443030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/02/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the association between CD133 expression and prognosis and clinicopathological features of ovarian cancer. METHODS The electronic and manual searches were performed through the database of PubMed Chinese Wanfang databases (up to September 15, 2014) was performed using the following keywords ovarian cancer, CD133, AC133, prominin-1. Meta-analysis was performed by using Review Manager 5.2 and the outcomes included the overall survival and various clinicopathological features. RESULTS A total of 1051 ovarian cancer patients from 8 studies were included. Meta-analysis showed that overexpression of CD133 was highly correlated with reduced 2-year overall survival (OR = 1.67, 95% CI: 1.06-2.63, P = 0.03, fixed-effect). With respect to clinicopathological features, CD133 level was positively correlated with tumor stage (OR = 0.26, 95% CI: 0.12-0.58, P = 0.001 random-effect). But not correlated with patients' age (OR = 1.12, 95% CI: 0.68-1.86, P = 0.65 fixed-effect), tumor grade (OR = 1.20, 95% CI: 0.06-1.62, P = 0.17 random-effect), histological type (OR = 1.10, 95% CI: 0.82-1.47, P = 0.54 fixed-effect) and response to treatment (OR = 0.84, 95% CI: 0.61-1.16, P = 0.29 fixed-effect). CONCLUSION On the basis of current retrospective evidence, the present meta-analysis indicated that high level of CD133 expression trends to correlate with a worse prognosis in patients with ovarian cancer.
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Affiliation(s)
- Quan Zhou
- Department of Gynecology and Obstetrics, The People's Hospital of Three Gorges University/The First People's Hospital of Yichang Yichang 443000, China
| | - Aihua Chen
- Department of Gynecology and Obstetrics, The People's Hospital of Three Gorges University/The First People's Hospital of Yichang Yichang 443000, China
| | - Huamei Song
- Department of Gynecology and Obstetrics, The People's Hospital of Three Gorges University/The First People's Hospital of Yichang Yichang 443000, China
| | - Jing Tao
- Department of Gynecology and Obstetrics, The People's Hospital of Three Gorges University/The First People's Hospital of Yichang Yichang 443000, China
| | - Huaijie Yang
- Department of Gynecology and Obstetrics, The People's Hospital of Three Gorges University/The First People's Hospital of Yichang Yichang 443000, China
| | - Manzhen Zuo
- Department of Gynecology and Obstetrics, The People's Hospital of Three Gorges University/The First People's Hospital of Yichang Yichang 443000, China
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Horowitz NS, Miller A, Rungruang B, Richard SD, Rodriguez N, Bookman MA, Hamilton CA, Krivak TC, Maxwell GL. Does aggressive surgery improve outcomes? Interaction between preoperative disease burden and complex surgery in patients with advanced-stage ovarian cancer: an analysis of GOG 182. J Clin Oncol 2015; 33:937-43. [PMID: 25667285 DOI: 10.1200/jco.2014.56.3106] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To examine the effects of disease burden, complex surgery, and residual disease (RD) status on progression-free (PFS) and overall survival (OS) in patients with advanced epithelial ovarian cancer (EOC) or primary peritoneal cancer (PPC) and complete surgical resection (R0) or < 1 cm of RD (MR) after surgical cytoreduction. PATIENTS AND METHODS Demographic, pathologic, surgical, and outcome data were collected from 2,655 patients with EOC or PPC enrolled onto the Gynecologic Oncology Group 182 study. The effects of disease distribution (disease score [DS]) and complexity of surgery (complexity score [CS]) on PFS and OS were assessed using the Kaplan-Meier method and multivariable regression analysis. RESULTS Consistent with existing literature, patients with MR had worse prognosis than R0 patients (PFS, 15 v 29 months; P < .01; OS, 41 v 77 months; P < .01). Patients with the highest preoperative disease burden (DS high) had shorter PFS (15 v 23 or 34 months; P < .01) and OS (40 v 71 or 86 months; P < .01) compared with those with DS moderate or low, respectively. This relationship was maintained in the subset of R0 patients with PFS (18.3 v 33.2 months; DS moderate or low: P < .001) and OS (50.1 v 82.8 months; DS moderate or low: P < .001). After controlling for DS, RD, an interaction term for DS/CS, performance status, age, and cell type, CS was not an independent predictor of either PFS or OS. CONCLUSION In this large multi-institutional sample, initial disease burden remained a significant prognostic indicator despite R0. Complex surgery does not seem to affect survival when accounting for other confounding influences, particularly RD.
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Affiliation(s)
- Neil S Horowitz
- Neil S. Horowitz, Brigham and Women's Hospital, Boston, MA; Austin Miller, Roswell Park Cancer Institute, Buffalo, NY; Bunja Rungruang, Georgia Regents University, Augusta, GA; Scott D. Richard, Hahnemann University Hospital, Philadelphia; Thomas C. Krivak, Western Pennsylvania Hospital, Pittsburgh, PA; Noah Rodriguez, Kaiser Permanente Irvine Medical Center, Irvine, CA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; and G. Larry Maxwell, Inova Fairfax Women's Hospital, Falls Church, VA
| | - Austin Miller
- Neil S. Horowitz, Brigham and Women's Hospital, Boston, MA; Austin Miller, Roswell Park Cancer Institute, Buffalo, NY; Bunja Rungruang, Georgia Regents University, Augusta, GA; Scott D. Richard, Hahnemann University Hospital, Philadelphia; Thomas C. Krivak, Western Pennsylvania Hospital, Pittsburgh, PA; Noah Rodriguez, Kaiser Permanente Irvine Medical Center, Irvine, CA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; and G. Larry Maxwell, Inova Fairfax Women's Hospital, Falls Church, VA
| | - Bunja Rungruang
- Neil S. Horowitz, Brigham and Women's Hospital, Boston, MA; Austin Miller, Roswell Park Cancer Institute, Buffalo, NY; Bunja Rungruang, Georgia Regents University, Augusta, GA; Scott D. Richard, Hahnemann University Hospital, Philadelphia; Thomas C. Krivak, Western Pennsylvania Hospital, Pittsburgh, PA; Noah Rodriguez, Kaiser Permanente Irvine Medical Center, Irvine, CA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; and G. Larry Maxwell, Inova Fairfax Women's Hospital, Falls Church, VA
| | - Scott D Richard
- Neil S. Horowitz, Brigham and Women's Hospital, Boston, MA; Austin Miller, Roswell Park Cancer Institute, Buffalo, NY; Bunja Rungruang, Georgia Regents University, Augusta, GA; Scott D. Richard, Hahnemann University Hospital, Philadelphia; Thomas C. Krivak, Western Pennsylvania Hospital, Pittsburgh, PA; Noah Rodriguez, Kaiser Permanente Irvine Medical Center, Irvine, CA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; and G. Larry Maxwell, Inova Fairfax Women's Hospital, Falls Church, VA
| | - Noah Rodriguez
- Neil S. Horowitz, Brigham and Women's Hospital, Boston, MA; Austin Miller, Roswell Park Cancer Institute, Buffalo, NY; Bunja Rungruang, Georgia Regents University, Augusta, GA; Scott D. Richard, Hahnemann University Hospital, Philadelphia; Thomas C. Krivak, Western Pennsylvania Hospital, Pittsburgh, PA; Noah Rodriguez, Kaiser Permanente Irvine Medical Center, Irvine, CA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; and G. Larry Maxwell, Inova Fairfax Women's Hospital, Falls Church, VA
| | - Michael A Bookman
- Neil S. Horowitz, Brigham and Women's Hospital, Boston, MA; Austin Miller, Roswell Park Cancer Institute, Buffalo, NY; Bunja Rungruang, Georgia Regents University, Augusta, GA; Scott D. Richard, Hahnemann University Hospital, Philadelphia; Thomas C. Krivak, Western Pennsylvania Hospital, Pittsburgh, PA; Noah Rodriguez, Kaiser Permanente Irvine Medical Center, Irvine, CA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; and G. Larry Maxwell, Inova Fairfax Women's Hospital, Falls Church, VA
| | - Chad A Hamilton
- Neil S. Horowitz, Brigham and Women's Hospital, Boston, MA; Austin Miller, Roswell Park Cancer Institute, Buffalo, NY; Bunja Rungruang, Georgia Regents University, Augusta, GA; Scott D. Richard, Hahnemann University Hospital, Philadelphia; Thomas C. Krivak, Western Pennsylvania Hospital, Pittsburgh, PA; Noah Rodriguez, Kaiser Permanente Irvine Medical Center, Irvine, CA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; and G. Larry Maxwell, Inova Fairfax Women's Hospital, Falls Church, VA
| | - Thomas C Krivak
- Neil S. Horowitz, Brigham and Women's Hospital, Boston, MA; Austin Miller, Roswell Park Cancer Institute, Buffalo, NY; Bunja Rungruang, Georgia Regents University, Augusta, GA; Scott D. Richard, Hahnemann University Hospital, Philadelphia; Thomas C. Krivak, Western Pennsylvania Hospital, Pittsburgh, PA; Noah Rodriguez, Kaiser Permanente Irvine Medical Center, Irvine, CA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; and G. Larry Maxwell, Inova Fairfax Women's Hospital, Falls Church, VA
| | - G Larry Maxwell
- Neil S. Horowitz, Brigham and Women's Hospital, Boston, MA; Austin Miller, Roswell Park Cancer Institute, Buffalo, NY; Bunja Rungruang, Georgia Regents University, Augusta, GA; Scott D. Richard, Hahnemann University Hospital, Philadelphia; Thomas C. Krivak, Western Pennsylvania Hospital, Pittsburgh, PA; Noah Rodriguez, Kaiser Permanente Irvine Medical Center, Irvine, CA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; and G. Larry Maxwell, Inova Fairfax Women's Hospital, Falls Church, VA.
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International Federation of Gynecology and Obstetrics Staging Classification for Cancer of the Ovary, Fallopian Tube, and Peritoneum: Estimation of Survival in Patients With Node-Positive Epithelial Ovarian Cancer. Int J Gynecol Cancer 2015; 25:49-54. [DOI: 10.1097/igc.0000000000000316] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
ObjectiveThe objective of this study was to determine the survival of patients with node-positive epithelial ovarian cancer according to the 2014 International Federation of Gynecology and Obstetrics (FIGO) staging system.Materials and MethodsWe performed a retrospective chart review. Data from all consecutive patients with node-positive epithelial ovarian cancer (stages IIIC and IV) who underwent cytoreductive surgery at the Mayo Clinic from 1996 to 2000 were reassessed to evaluate the prognostic significance of the new FIGO stages. Multivariate Cox regression was performed, and Kaplan-Meier survival curves constructed.ResultsThe distribution of the restaged patients was as follows: IIIA1, 23 patients (IIIA1i, 9 patients; and IIIA1ii, 14 patients); IIIA2, 3 patients; IIIB, 4; IIIC, 67 patients; IVA, 4 patients; and IVB, 15 patients. In the univariate analysis, the relative risk for positive nodes greater than 10 mm on the longer axis was 2.57 and 3.00 for patients with microscopic peritoneal disease, compared with patients with microscopic positive nodes. However, the difference was not statistically significant. Moreover, the univariate analyses revealed statistically significant differences for 2014 FIGO stages (IIIA, IIIB, IIIC, and IVA-B), anatomical sites of peritoneal metastases, and disease staged at IIIC because of the presence of omental metastases. Multivariate analysis showed that survival was higher in patients restaged to IIIA-B than in those restaged to IIIC and IV (hazard ratios, 2.75 and 3.16, respectively; P = 0.002). The hazard ratio for patients with abdominal peritoneal metastases was 2.76 compared with patients with pelvic peritoneal metastases (P = 0.001).ConclusionsThe current 2014 FIGO staging system for ovarian cancer successfully correlates survival, anatomical location of peritoneal metastases, and extra-abdominal lymph node metastases.
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A critical appraisal of hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of advanced and recurrent ovarian cancer. Gynecol Oncol 2014; 136:130-5. [PMID: 25434634 DOI: 10.1016/j.ygyno.2014.11.072] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 11/13/2014] [Accepted: 11/20/2014] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Our objective was to review the published experiences of the use of hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of advanced and recurrent ovarian cancer with a focus on survival outcomes. METHODS A search of the PubMed database (2008-2014) for articles specifically addressing the topic "HIPEC and ovarian cancer" was performed. We found a total of 22 publications that included 1450 patients. A final group of eleven studies (248 patients with advanced ovarian cancer) and eight publications (499 patients with recurrent sensitive ovarian cancer) that included information about survival were reviewed. RESULTS Among patients with primary ovarian cancer who were treated with primary debulking and HIPEC, the weighted median overall survival was 37.3 months (range 27-78), the median disease-free survival was 14.4 months (range 12-30), and the 5-yr-survival rate was 40% (range 28-72). In the recurrent cohort, the overall survival after HIPEC was 36.5 months (range 23-62), and the median disease-free survival was 20.2 months (range 11-29). The rates of severe morbidity were 25 and 19% in the primary and recurrent groups, respectively. CONCLUSION Although randomized trials are ongoing, the recently published retrospective data regarding the use of HIPEC for primary advanced and for recurrent ovarian cancer do not indicate any apparent advantage of this treatment in terms of the survival outcomes in these patients. Therefore, HIPEC cannot be considered a standard treatment and should not be offered outside of clinical trials.
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Abstract
OBJECTIVE The aim of the study was to report on the oncologic outcome of the disease spread to celiac lymph nodes (CLNs) in advanced-stage ovarian cancer patients. METHODS All patients who had CLN resection as part of their cytoreductive surgery for epithelial ovarian, fallopian, or primary peritoneal cancer were identified. Patient demographic data with particular emphasis on operative records to detail the extent and distribution of the disease spread, lymphadenectomy procedures, pathologic data, and follow-up data were included. RESULTS The median follow-up was 26.3 months. The median overall survival values in the group with positive CLNs and in the group with negative CLNs were 26.9 months and 40.04 months, respectively. The median progression-free survival values in the group with metastatic CLNs and in the group with negative CLNs were 8.8 months and 20.24 months, respectively (P = 0.053). Positive CLNs were associated with progression during or within 6 months after the completion of chemotherapy (P = 0.0044). Tumor burden and extensive disease distribution were significantly associated with poor progression-free survival, short-term progression, and overall survival. In multivariate analysis, only the CLN status was independently associated with short-term progression. CONCLUSIONS Disease in the CLN is a marker of disease severity, which is associated to a high-risk group of patients with presumed adverse tumor biology, increased risk of lymph node progression, and worst oncologic outcome.
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Preoperative fluorine 18 fluorodeoxyglucose tumoral uptake ratio between upper and lower abdomen in primary advanced-stage ovarian cancer. Int J Gynecol Cancer 2014; 23:1383-92. [PMID: 24257552 DOI: 10.1097/igc.0b013e3182a58992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The objective of this study was to assess whether the ratio of upper abdomen (UA) to lower abdomen (LA) (relative to the umbilicus) standardized fluorine 18 fluorodeoxyglucose uptake, as measured by preoperative positron emission tomography and computed tomography, is predictive of recurrence, survival, and suboptimal cytoreduction (residual tumor >1.0 cm) in advanced-stage ovarian cancer (AOC). METHODS Positron emission tomography/computed tomography before surgical staging was performed in 159 AOC patients. The ratio between the highest maximum standardized uptake value (SUV(max)) in the UA and the LA was expressed as UA/LA SUV(max). Clinicopathological characteristics and follow-up information were collected retrospectively. Cox proportional hazards analysis was used to identify prognostic factors for recurrence and survival. Logistic regression analysis was used to identify predictors of suboptimal cytoreduction. RESULTS The median age and follow-up period were 55 years (range, 27-80 years) and 32 months (range, 1-92 months), respectively; 133 and 26 patients had stage III and IV disease, respectively. There were 120 and 54 cases of recurrence and disease-specific death, respectively. Multivariate analysis showed that recurrence was associated significantly with high UA/LA SUV(max) (P < 0.05; hazard ratio [HR], 4.902; 95% confidence interval [CI], 2.521-9.531) and suboptimal cytoreduction (P < 0.05; HR, 2.431; 95% CI, 1.561-3.788), and that disease-specific death was significantly associated with high UA/LA SUV(max) (P < 0.05; HR, 2.777; 95% CI, 1.270-6.075), suboptimal cytoreduction (P < 0.05; HR, 1.951; 95% CI, 1.080-3.524), and histology (P < 0.05; HR, 4.134; 95% CI, 1.676-10.196). Upper abdomen/lower abdomen SUV(max) was the only independent predictor of suboptimal cytoreduction (P < 0.05; odds ratio, 4.644; 95% CI, 1.676-12.862). CONCLUSIONS High preoperative UA/LA SUV(max) was significantly associated with poor prognosis and may be predictive of suboptimal cytoreduction in AOC. This parameter may be considered in the treatment of AOC patients.
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Vizzielli G, Costantini B, Tortorella L, Petrillo M, Fanfani F, Chiantera V, Ercoli A, Iodice R, Scambia G, Fagotti A. Influence of Intraperitoneal Dissemination Assessed by Laparoscopy on Prognosis of Advanced Ovarian Cancer: An Exploratory Analysis of a Single-Institution Experience. Ann Surg Oncol 2014; 21:3970-7. [DOI: 10.1245/s10434-014-3783-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Indexed: 11/18/2022]
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Stone RL, Baggerly KA, Armaiz-Pena GN, Kang Y, Sanguino AM, Thanapprapasr D, Dalton HJ, Bottsford-Miller J, Zand B, Akbani R, Diao L, Nick AM, DeGeest K, Lopez-Berestein G, Coleman RL, Lutgendorf S, Sood AK. Focal adhesion kinase: an alternative focus for anti-angiogenesis therapy in ovarian cancer. Cancer Biol Ther 2014; 15:919-29. [PMID: 24755674 DOI: 10.4161/cbt.28882] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
This investigation describes the clinical significance of phosphorylated focal adhesion kinase (FAK) at the major activating tyrosine site (Y397) in epithelial ovarian cancer (EOC) cells and tumor-associated endothelial cells. FAK gene amplification as a mechanism for FAK overexpression and the effects of FAK tyrosine kinase inhibitor VS-6062 on tumor growth, metastasis, and angiogenesis were examined. FAK and phospho-FAK(Y397) were quantified in tumor (FAK-T; pFAK-T) and tumor-associated endothelial (FAK-endo; pFAK-endo) cell compartments of EOCs using immunostaining and qRT-PCR. Associations between expression levels and clinical variables were evaluated. Data from The Cancer Genome Atlas were used to correlate FAK gene copy number and expression levels in EOC specimens. The in vitro and in vivo effects of VS-6062 were assayed in preclinical models. FAK-T and pFAK-T overexpression was significantly associated with advanced stage disease and increased microvessel density (MVD). High MVD was observed in tumors with elevated endothelial cell FAK (59%) and pFAK (44%). Survival was adversely affected by FAK-T overexpression (3.03 vs 2.06 y, P = 0.004), pFAK-T (2.83 vs 1.78 y, P<0.001), and pFAK-endo (2.33 vs 2.17 y, P = 0.005). FAK gene copy number was increased in 34% of tumors and correlated with expression levels (P<0.001). VS-6062 significantly blocked EOC and endothelial cell migration as well as endothelial cell tube formation in vitro. VS-6062 reduced mean tumor weight by 56% (P = 0.005), tumor MVD by 40% (P = 0.0001), and extraovarian metastasis (P<0.01) in orthotopic EOC mouse models. FAK may be a unique therapeutic target in EOC given the dual anti-angiogenic and anti-metastatic potential of FAK inhibitors.
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Affiliation(s)
- Rebecca L Stone
- Department of Gynecologic Oncology; The University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Keith A Baggerly
- Department of Bioinformatics and Computational Biology; The University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Guillermo N Armaiz-Pena
- Department of Gynecologic Oncology; The University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Yu Kang
- Department of Obstetrics and Gynecology; Hospital of Fudan University; Shanghai, PR China
| | - Angela M Sanguino
- Department of Gynecologic Oncology; The University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Duangmani Thanapprapasr
- Department of Gynecologic Oncology; The University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Heather J Dalton
- Department of Gynecologic Oncology; The University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Justin Bottsford-Miller
- Department of Gynecologic Oncology; The University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Behrouz Zand
- Department of Gynecologic Oncology; The University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Rehan Akbani
- Department of Bioinformatics and Computational Biology; The University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Lixia Diao
- Department of Bioinformatics and Computational Biology; The University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Alpa M Nick
- Department of Gynecologic Oncology; The University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Koen DeGeest
- Department of Obstetrics and Gynecology; The University of Iowa; Iowa City, IA USA
| | - Gabriel Lopez-Berestein
- Department of Experimental Therapeutics; The University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Robert L Coleman
- Department of Gynecologic Oncology; The University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Susan Lutgendorf
- Department of Psychology; The University of Iowa; Iowa City, IA USA
| | - Anil K Sood
- Department of Gynecologic Oncology; The University of Texas M.D. Anderson Cancer Center; Houston, TX USA; Department of Cancer Biology; The University of Texas M.D. Anderson Cancer Center; Houston, TX USA
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Xu YS, Feng JG, Zhang D, Zhang B, Luo M, Su D, Lin NM. S-allylcysteine, a garlic derivative, suppresses proliferation and induces apoptosis in human ovarian cancer cells in vitro. Acta Pharmacol Sin 2014; 35:267-74. [PMID: 24362328 DOI: 10.1038/aps.2013.176] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 10/16/2013] [Indexed: 01/29/2023] Open
Abstract
AIM To investigate the effects of S-allylcysteine (SAC), a water-soluble garlic derivative, on human ovarian cancer cells in vitro. METHODS Human epithelial ovarian cancer cell line A2780 was tested. Cell proliferation was examined with CCK-8 and colony formation assays. Cell cycle was analyzed with flow cytometry. Cell apoptosis was studied using Hoechst 33258 staining and Annexin V/PI staining with flow cytometry. The migration and invasion of A2780 cells were examined with transwell and wound healing assays. The expression of relevant proteins was detected with Western blot assays. RESULTS SAC (1-100 mmol/L) inhibited the proliferation of A2780 cells in dose- and time-dependent manners (the IC50 value was approximately 25 mmol/L at 48 h, and less than 6.25 mmol/L at 96 h). Furthermore, SAC dose-dependently inhibited the colony formation of A2780 cells. Treatment of A2780 cells with SAC resulted in G1/S phase arrest and induced apoptosis, accompanied by decreased expression of pro-caspase-3, Parp-1 and Bcl-2, and increased expression of active caspase-3 and Bax. SAC treatment significantly reduced the migration of A2780 cells, and markedly decreased the protein expression of Wnt5a, p-AKT and c-Jun, which were the key proteins involved in proliferation and metastasis. CONCLUSION SAC suppresses proliferation and induces apoptosis in A2780 ovarian cancer cells in vitro.
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Iaco PD, Perrone AM, Procaccini M, Pellegrini A, Morice P. Natural history of epithelial ovarian cancer and its relation to surgical and medical treatment. World J Obstet Gynecol 2013; 2:137-142. [DOI: 10.5317/wjog.v2.i4.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 03/12/2013] [Accepted: 04/16/2013] [Indexed: 02/05/2023] Open
Abstract
Epithelial ovarian cancer (EOC) represents approximately 90% of primary malignant ovarian tumors, the sixth most common cancer in women and the second most common gynecologic cancer. Approximately 80%-85% of all ovarian carcinomas in Western society are serous and up to 95% of patients are in advanced stages (FIGO stage III-IV) at diagnosis. Treatment of ovarian cancer is mainly based on three key approaches: surgical removal of neoplasia; chemotherapy to kill cancer cells; direct chemotherapy on peritoneal surfaces. The application of hyperthermic chemotherapy to the peritoneal cavity (HIPEC) after radical surgery may also be an attractive option. We analyzed the natural history of EOC in the literature and identified various time-points where sensitivity to chemotherapy, freedom from disease and overall survival are different. We propose eight time-points in EOC history with homogeneous oncological findings. The effectiveness of HIPEC in EOC treatment should be evaluated based on these eight time-points and we believe that retrospective and prospective studies of HIPEC should be evaluated according to these time-points.
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Abstract
IntroductionImproved knowledge of recurrence sites after contemporary surgical management of ovarian cancer is needed.Material and MethodsWe retrospectively reviewed consecutive patients managed for epithelial ovarian or tubal cancer with surgery and platinum-based chemotherapy between January 1, 2005, and December 31, 2009, in a tertiary teaching hospital. The site of first recurrence was recorded. Univariate analysis was performed to identify factors associated with site-specific recurrence. Overall survival and progression-free survival were computed using the Kaplan-Meier method, and log-rank tests were performed to assess the impact on survival of the variables of interest.ResultsRecurrences were noted in 3 (20%) of 15 International Federation of Gynecologists and Obstetricians stage I to IIa patients and 36 (62.1%) of 58 International Federation of Gynecologists and Obstetricians IIb to IV patients, and the median progression-free survival was 21.6 (2.5–71) and 19.3 (1.8–67.6) months, respectively. In the advanced-disease group, 75% of recurrences involved the peritoneum and 40% were confined to the peritoneum; peritoneal recurrences developed at both treated and untreated sites. Peritoneal recurrence was associated with greater initial peritoneal involvement (Sugarbaker score, 12.1 ± 8.2 vs 7.1 ± 7.4; P = 0.01) and residual postoperative tumor. Nodal recurrences were noted in 38% of all recurrences, usually in combination with peritoneal recurrence and in the abdominal territories. Isolated distant metastasis was a rare mode of recurrence (8%).ConclusionsThe peritoneum is the main recurrence site in both early and advanced ovarian cancer. Initial disease spread and extent of surgery are associated with the recurrence risk. This article supports the view that more attention should be directed toward extensive treatment of the peritoneum.
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Optimal (≤1cm) but visible residual disease: Is extensive debulking warranted? Gynecol Oncol 2013; 130:284-8. [DOI: 10.1016/j.ygyno.2013.05.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/02/2013] [Accepted: 05/05/2013] [Indexed: 11/19/2022]
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Surgical outcomes and national comprehensive cancer network compliance in advanced ovarian cancer surgery in a low volume military treatment facility. Gynecol Oncol 2013; 131:158-62. [PMID: 23872110 DOI: 10.1016/j.ygyno.2013.07.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/02/2013] [Accepted: 07/03/2013] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To evaluate the optimal cytoreduction (OPT) rate, National Comprehensive Cancer Network (NCCN) treatment guideline compliance rate and patient outcomes for advanced stage epithelial ovarian cancer (EOC) patients at our low volume institution. METHODS Following IRB approval, records of patients with Stage III-IV EOC, primary peritoneal, or fallopian tube carcinoma completing both primary surgery and adjuvant chemotherapy were reviewed. Patient demographics, clinicopathologic variables, cytoreduction status (optimal or suboptimal), NCCN treatment guideline compliance, and survival were reviewed. Standard statistical tests including the t-test, Chi-square or Fisher's exact test and Kaplan-Meier Survival curves were utilized. RESULTS Overall, 48 patients met all inclusion criteria. 35(73%) and 13 (27%) achieved optimal and suboptimal cytoreduction, respectively. Median overall survival (OS) for all patients was 37.1 months (95% CI 23.2 - 51.1 months) and NCCN treatment guideline compliance was 85.4%. Compared to sub-optimally cytoreduced patients the optimally cytoreduced patients were significantly older (62.2 vs. 53.5 yrs; p=0.015); no other significant clinicopathologic differences were observed between the two groups. 19 of 48 (39.6%) patients enrolled in an upfront cooperative group trial. Median OS was 43.4 months for optimally compared to 15.6 months in sub-optimally cytoreduced patients (p=0.012). CONCLUSIONS NCCN treatment guideline compliance, OPT, and median OS rates in our low volume institution are similar to those reported nationally, and argue against using volume alone as a rationale for centralization of care.
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Mahner S, Eulenburg C, Staehle A, Wegscheider K, Reuss A, Pujade-Lauraine E, Harter P, Ray-Coquard I, Pfisterer J, du Bois A. Prognostic impact of the time interval between surgery and chemotherapy in advanced ovarian cancer: Analysis of prospective randomised phase III trials. Eur J Cancer 2013; 49:142-9. [DOI: 10.1016/j.ejca.2012.07.023] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 07/09/2012] [Accepted: 07/26/2012] [Indexed: 01/22/2023]
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