1
|
Sullivan SM, Stoneham S, Lockley M, Frazier AL, Billmire DF, Poynter JN. Comparison of overall and patterns of care in patients with a malignant ovarian germ cell tumor by age in the United States: a National Cancer Database (2004-2016) analysis. Int J Gynecol Cancer 2024:ijgc-2024-005280. [PMID: 38955375 DOI: 10.1136/ijgc-2024-005280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Women aged ≥40 years diagnosed with a malignant ovarian germ cell tumor are more likely to have poor outcomes than their younger counterparts (aged 15-39 years). OBJECTIVE We used the National Cancer Database (NCDB) to evaluate patterns of care and overall survival for individuals diagnosed with one of the four most common histologic subtypes of malignant ovarian germ cell tumor by age group. METHODS We identified women aged 15-90 diagnosed with ovarian germ cell tumors in the NCDB (2004-2016). Logistic regression was used to compare patterns of care, demographic, and disease characteristics by age group. Cox proportional hazards regression was used to evaluate associations between a range of demographic, clinical, and treatment characteristics with overall survival. RESULTS A total of n=2998 patients who were diagnosed with one of the four most common histologic subtypes (immature teratoma, dysgerminoma, yolk sac tumor, and mixed germ cell) of ovarian germ cell tumor were included in the analysis. Patients aged ≥40 years diagnosed with ovarian germ cell tumors were more likely to have co-morbidities, a bilateral tumor, higher stage of disease, receive chemotherapy only, and have a residual tumor after resection as compared with patients aged <40 years. Moreover, women aged ≥40 years had the highest risk of death (reference: 15-24 year olds; HR=5.37, 95% CI 3.76 to 7.66) after adjustment for demographic characteristics, tumor histology, and treatment received. In stratified analyses, women aged ≥40 years had significantly worse overall survival at each disease stage and histologic subtype. CONCLUSION Findings suggest that women aged ≥40 years who are diagnosed with ovarian germ cell tumors have worse overall survival than those aged <40, independent of stage, disease characteristics, and treatment. Our study highlights the need for future research to better understand reasons for poorer outcomes in women aged ≥40 years.
Collapse
Affiliation(s)
- Shannon M Sullivan
- Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
- Department of Laboratory Medicine and Pathology, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Sara Stoneham
- Department of Paediatric Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Michelle Lockley
- Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
- Department of Gynaecological Oncology, Cancer Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - A Lindsay Frazier
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Deborah F Billmire
- Department of Pediatric Surgery, Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Jenny N Poynter
- Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
- University of Minnesota Masonic Cancer Center, Minneapolis, Minnesota, USA
| |
Collapse
|
2
|
Chitoran E, Rotaru V, Mitroiu MN, Durdu CE, Bohiltea RE, Ionescu SO, Gelal A, Cirimbei C, Alecu M, Simion L. Navigating Fertility Preservation Options in Gynecological Cancers: A Comprehensive Review. Cancers (Basel) 2024; 16:2214. [PMID: 38927920 PMCID: PMC11201795 DOI: 10.3390/cancers16122214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 06/08/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
(1) Background: Currently, an increasing number of women postpone pregnancy beyond the age of 35. Gynecological cancers affect a significant proportion of women of reproductive age, necessitating the development of fertility preservation methods to fulfill family planning. Consequently, providing treatment options that preserve fertility in women diagnosed with gynecological cancers has become a crucial component of care for survivors. (2) Methods: We conducted an extensive search of relevant scientific publications in PubMed and Embase databases and performed a narrative review, including high-quality peer-reviewed research on fertility after being treated for gynecologic cancers, reporting pregnancy rates, birth rates, and pregnancy outcomes in cancer survivors as well as therapeutic options which partially preserve fertility and methods for obtaining a pregnancy in survivors. (3) Discussion: The medicine practiced today is focused on both treating the neoplasm and preserving the quality of life of the patients, with fertility preservation being an important element of this quality. This leads to an improved quality of life, allowing these women to become mothers even in the seemingly adverse circumstances posed by such a pathology. However, although there are guidelines on female fertility preservation in the context of neoplasms, an analysis shows that physicians do not routinely consider it and do not discuss these options with their patients. (4) Conclusions: Advancements in medicine have led to a better understanding and management of gynecological neoplasms, resulting in increased survival rates. Once the battle against these neoplasms is won, the issue of preserving the quality of life for these women arises, with fertility preservation being an important aspect for women who have not yet fulfilled their family planning desires at the time of diagnosis. It is important for patients to be informed about the available options for fertility preservation and to be encouraged to make informed decisions in collaboration with their medical team. Standardized recommendations for onco-fertility into guidelines should be taken into consideration in the future.
Collapse
Affiliation(s)
- Elena Chitoran
- School of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.C.); (S.-O.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Vlad Rotaru
- School of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.C.); (S.-O.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Al. Trestioreanu”, 022328 Bucharest, Romania
| | | | - Cristiana-Elena Durdu
- Obstetrics and Gynecology Department, “Filantropia” Clinical Hospital, 011132 Bucharest, Romania
| | - Roxana-Elena Bohiltea
- School of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.C.); (S.-O.I.)
- Obstetrics and Gynecology Department, “Filantropia” Clinical Hospital, 011132 Bucharest, Romania
| | - Sinziana-Octavia Ionescu
- School of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.C.); (S.-O.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Aisa Gelal
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Ciprian Cirimbei
- School of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.C.); (S.-O.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Mihnea Alecu
- School of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.C.); (S.-O.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Laurentiu Simion
- School of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.C.); (S.-O.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Al. Trestioreanu”, 022328 Bucharest, Romania
| |
Collapse
|
3
|
Marino G, Grassi T, De Ponti E, Negri S, Testa F, Giuliani D, Delle Marchette M, Dell’Oro C, Fumagalli D, Donatiello G, Besana G, Marchetta L, Bonazzi CM, Lissoni AA, Landoni F, Fruscio R. Outcome of patients with stage I immature teratoma after surveillance or adjuvant chemotherapy. Front Oncol 2024; 14:1330481. [PMID: 38371620 PMCID: PMC10869612 DOI: 10.3389/fonc.2024.1330481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/19/2024] [Indexed: 02/20/2024] Open
Abstract
Objective Immature teratomas are rare malignant ovarian germ cell tumours, typically diagnosed in young women, where fertility-sparing surgery is the treatment of choice. The role of adjuvant chemotherapy in stage I disease remains controversial. We evaluated the impact of surveillance versus chemotherapy on the recurrence rate in stage I immature teratomas. Methods We collected a single centre retrospective series of patients with stage I immature teratomas treated with fertility-sparing surgery at San Gerardo Hospital, Monza, Italy, between 1980 and 2019. Potential risk factors for recurrence were investigated by multivariate logistic regression. Results Of the 74 patients included, 12% (9/74) received chemotherapy, while 88% (65/74) underwent surveillance. Median follow-up was 188 months. No difference in recurrence was found in stage IA/IB and IC immature teratomas [10% (6/60) vs. 28.6% (4/14) (P=0.087)], grade 1, grade 2, and grade 3 [7.1% (2/28) vs. 14.3% (4/28) vs. 22.2% (4/18) (p=0.39)], and surveillance versus chemotherapy groups [13.9% (9/65) vs. 11.1% (1/9)) (p = 1.00)]. In univariate analysis, the postoperative approach had no impact on recurrence. The 5-year disease-free survival was 87% and 90% in the surveillance and chemotherapy groups, respectively; the overall survival was 100% in both cohorts. Conclusions Our results support the feasibility of surveillance in stage I immature teratomas. Adjuvant chemotherapy may be reserved for relapses. However, the potential benefit of chemotherapy should be discussed, especially for high-risk tumours. Prospective series are warranted to confirm our findings. What is already known on this topic To date, no consensus has been reached regarding the role of adjuvant chemotherapy in stage I immature teratomas of the ovary. Some studies suggest that only surveillance is an acceptable choice. However, guidelines are not conclusive on this topic. What this study adds No difference in terms of recurrence was observed between the surveillance and the adjuvant chemotherapy group. All patients who relapsed were successfully cured with no disease-related deaths. How this study might affect research practice or policy Adjuvant chemotherapy should be appropriately discussed with patients. However, it may be reserved for relapse according to our data.
Collapse
Affiliation(s)
- Giuseppe Marino
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Tommaso Grassi
- Unit of Gynecology, Woman and Child Department, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) San Gerardo, Monza, Italy
| | - Elena De Ponti
- Unit of Gynecology, Woman and Child Department, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) San Gerardo, Monza, Italy
| | - Serena Negri
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Filippo Testa
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Daniela Giuliani
- Unit of Gynecology, Woman and Child Department, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) San Gerardo, Monza, Italy
| | | | - Cristina Dell’Oro
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Diletta Fumagalli
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Gianluca Donatiello
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Giulia Besana
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Liliana Marchetta
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Cristina Maria Bonazzi
- Unit of Gynecology, Woman and Child Department, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) San Gerardo, Monza, Italy
| | - Andrea Alberto Lissoni
- Unit of Gynecology, Woman and Child Department, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) San Gerardo, Monza, Italy
| | - Fabio Landoni
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- Unit of Gynecology, Woman and Child Department, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) San Gerardo, Monza, Italy
| | - Robert Fruscio
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- Unit of Gynecology, Woman and Child Department, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) San Gerardo, Monza, Italy
| |
Collapse
|
4
|
Li S, Zhang X, Zhang T, Yin M, Cao D, Xiang Y, Yang J. Prognostic factors for pure ovarian immature teratoma and the role of adjuvant chemotherapy in stage I diseases. Ann Med 2023; 55:2273984. [PMID: 37909181 PMCID: PMC10836279 DOI: 10.1080/07853890.2023.2273984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/18/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND The prognostic factors for patients with pure ovarian immature teratoma (POIT) and the role of adjuvant chemotherapy in stage IA G2-G3 and IB-IC POIT remains controversial. METHODS We conducted a retrospective study of 155 POIT patients treated in our hospital between 2000 and 2022. The recurrence-free survival (RFS), disease-specific survival (DSS), and potential prognostic factors of POIT patients were evaluated. Subgroup analysis was conducted in stage I other than stage IA G1 POIT. RESULTS The median age at diagnosis was 23.0 years (range: 4.0 - 39.0), and 126 (81.3%), 2 (1.3%), 26 (16.8%), and 1 (0.6%) patients had FIGO stage I, stage II, stage III, and stage IV disease, respectively. Twenty-three patients relapsed and five died of the diseases after a median follow-up of 7.6 years, with a 5-year RFS and DSS rate of 86.0% and 97.0%, respectively. Multivariate analysis showed that positive postoperative tumour markers (TM) were the risk factor for recurrence in the overall cohort (hazard ratio [HR] 4.058, 95% CI 1.175 - 14.019, p = 0.027) and subgroup (HR 10.237, 95% CI 2.175 - 48.179, p = 0.003), and FIGO stage II-IV was the only factor for DSS in overall cohort (HR 7.751, 95% CI 1.281 - 46.895, p = 0.026). In 110 patients subjected to subgroup analysis, 29 patients received surveillance without chemotherapy and 81 patients were administered adjuvant chemotherapy. Multivariate analysis revealed active surveillance significantly increased the recurrence rate (5-year RFS of 75.7% vs. 93.6%, HR 7.562, 95% CI 2.441 - 23.424, p < 0.001) but not the death related to POIT (p = 0.338). CONCLUSION Positive postoperative TM and FIGO stage II-IV were the prognostic factors for POIT. Active surveillance in stage I POIT of any grade may be practical for those with negative postoperative TM.
Collapse
Affiliation(s)
- Sijian Li
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Xinyue Zhang
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Tianyu Zhang
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Min Yin
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
- Department of Gynecology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, People’s Republic of China
| | - Dongyan Cao
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Yang Xiang
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Jiaxin Yang
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| |
Collapse
|
5
|
Role of Adjuvant Chemotherapy in Stage I Pure Ovarian Immature Teratoma: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15061741. [PMID: 36980627 PMCID: PMC10046473 DOI: 10.3390/cancers15061741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/15/2023] Open
Abstract
To determine the role of adjuvant chemotherapy in stage IA G2-3 and stage IB-IC pure ovarian immature teratoma (POIT), we performed a systematic review and meta-analysis by searching PubMed, Embase, Cochrane library, Web of Science, and ClinicalTrials.gov. Randomized controlled trials or cohort studies on stage IA G2-G3 or stage IB-IC POIT between 1 January 1970 and 15 December 2022 were enrolled. The recurrence rate and mortality rate were the primary outcomes, and subgroup analysis based on the tumor stage and grade was also conducted. In total, 15 studies with 707 patients were included. Compared with surveillance, adjuvant chemotherapy significantly decreased the mortality rate (RR 0.31, 95% CI 0.11–0.88, p = 0.03), but not recurrence (RR 0.74, 95% CI 0.39–1.42, p = 0.37), in the overall population. Subgroup analysis showed no statistical difference in the recurrence rate and mortality rate between patients who received adjuvant chemotherapy and surveillance in pediatric POIT, stage IA G2-3 POIT, stage IB-IC POIT, and stage IA-IC G3 POIT (all with p > 0.05). However, patients who underwent adjuvant chemotherapy appeared to have a lower risk of both recurrence (RR 0.17, 95% CI 0.03–0.83, p = 0.03) and death (RR 0.04, 95% CI 0.00–1.00, p = 0.05) in adult POIT. Adjuvant chemotherapy significantly decreased the mortality rate in patients with stage I POIT and lowered the risk of recurrence in the adult subgroup. Surveillance administered in stage I POIT over IA G1 should be cautious, especially in adult patients.
Collapse
|
6
|
Xie S, Jia X, Li T, Xu Y, Wu W, Qiu Y, Yuan S, Peng X, Wang H. Pelvic masses after surgery for immature ovarian teratoma: A 10-year experience of Western China. Medicine (Baltimore) 2022; 101:e29727. [PMID: 35945757 PMCID: PMC9351857 DOI: 10.1097/md.0000000000029727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
There are debates on the management of immature ovarian teratoma and its recurrence. This study aimed to report the incidence of pelvic masses after surgery for immature ovarian teratoma and to identify prognostic factors of disease-free survival after surgery, discussing aspects of primary treatment and postoperative management. Data on the diagnosis and treatment of patients with immature teratomas were collected. Follow-up data were acquired from clinic visits and telephone interviews. Disease-free survival was defined as the time interval between the initial surgery for immature ovarian teratoma and the diagnosis of a new pelvic mass. Survival curves were drawn using the Kaplan-Meire method, and multivariate analysis was performed using the Cox proportional hazard regression model using PASW statistics software. The estimated 5-year disease-free survival and overall survival were 74.3% (95%CI 63.9%-84.7%) and 96.5% (95%CI 91.6%-100.0%), respectively. The incidence of growing teratoma syndrome and immature teratoma relapse at a median follow-up of 46 months were 20.0% and 7.7%, respectively. Two patients died of repeated relapses or repeated growing teratoma syndrome. Rupture of initial lesions (RR 4.010, 95%CI 1.035-5.531), lymph node dissection (RR 0.212, 95%CI 0.051-0.887) and adjuvant chemotherapy (RR 0.143, 95%CI 0.024-0.845) were independent prognostic factors for disease-free survival. The development of growing teratoma syndrome is more prevalent than relapse after treatment of immature ovarian teratomas. Lymph node dissection and chemotherapy are recommended to reduce recurrence. Close surveillance and active surgical intervention are important for the diagnosis and appropriate management of new pelvic masses.
Collapse
Affiliation(s)
- Sixia Xie
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Xibiao Jia
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
| | - Tingting Li
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Yuanyuan Xu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Weiwei Wu
- Department of Pathology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Yichao Qiu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Shuang Yuan
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Xue Peng
- Department of Obstetrics and Gynecology, People’s Hospital of Deyang City, Deyang, People’s Republic of China
| | - Hongjing Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
- *Correspondence: Hongjing Wang, West China Second University Hospital, No. 20, Section 3, South Renmin Road, Chengdu, Sichuan Province, People’s Republic of China (e-mail: )
| |
Collapse
|
7
|
Yao G, Jin X. Impact of Lymphadenectomy on Outcomes of Early-Stage Ovarian Cancer: A Systematic Review and Meta-Analysis. Front Surg 2021; 8:682348. [PMID: 34169090 PMCID: PMC8218907 DOI: 10.3389/fsurg.2021.682348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/29/2021] [Indexed: 12/22/2022] Open
Abstract
Objective: The study aimed to assess if additional lymphadenectomy with primary staging surgery improves overall survival (OS) and disease-free survival (DFS) of early-stage ovarian cancer (ESOC). Methods: PubMed and Embase databases were searched for any type of study comparing OS or DFS between lymphadenectomy and control groups for any type of ESOC. Adjusted hazard ratios (HR) were pooled in a random-effects model. Results: Twelve studies were included. Meta-analysis indicated that lymphadenectomy is associated with significantly improved OS only for epithelial tumors (HR 0.75 95% CI 0.68, 0.82 I2 = 0% p < 0.00001) but not for malignant germ cell tumors (HR 1.31 95% CI 0.88, 1.94 I2 = 0% p = 0.18). Single studies indicated a tendency of improved OS with lymphadenectomy which was significant for ovarian carcinosarcoma but not for sex cord-stromal tumors. On meta-regression of all histological types, the percentage of patients with lymph node metastasis in the lymphadenectomy group was not found to influence the effect size. Meta-analysis also indicated that lymphadenectomy is associated with significantly improved DFS for epithelial tumors (HR 0.59 95% CI 0.45, 0.77 I2 = 0% p < 0.0001). Single studies on malignant germ cell and sex cord-stromal tumors failed to demonstrate any significant beneficial effect of lymphadenectomy on DFS. Conclusions: Within the limitations of the review, lymphadenectomy may improve OS and DFS for epithelial ESOC. Scarce data suggest that lymphadenectomy is not associated with improved outcomes for malignant germ cell and sex cord-stromal tumors but may benefit ovarian carcinosarcoma. Large-scale RCTs and robust observational studies shall improve current evidence.
Collapse
Affiliation(s)
- Guorong Yao
- Department of Obstetrics and Gynaecology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
| | - Xiaotian Jin
- Gynecology Clinic, Huzhou Maternity & Child Health Care Hospital, Huzhou, China
| |
Collapse
|
8
|
Wang D, Zhu S, Jia C, Cao D, Yang J, Xiang Y. Oncological and Reproductive Outcomes of Cystectomy Compared with Unilateral Salpingo-Oophorectomy as Fertility-Sparing Surgery in Patients with Apparent Early Stage Pure Immature Ovarian Teratomas. Ann Surg Oncol 2021; 28:6684-6693. [PMID: 33772392 DOI: 10.1245/s10434-021-09719-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/28/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare the oncological and reproductive outcomes of patients with apparent early stage pure ovarian immature teratomas (IMTs) treated with unilateral salpingo-oophorectomy (USO) or cystectomy. PATIENTS AND METHODS We retrospectively reviewed the medical records of patients with apparent early stage pure ovarian IMTs who received fertility-sparing surgery (FSS) between 1984 and 2019. FSS was defined as preservation of the uterus and at least one adnexa. Recurrence rates were compared between patients receiving USO and cystectomy. Reproductive outcomes and menstrual histories were assessed by telephone interview. RESULTS A total of 124 patients were included, of whom 83 underwent USO and 41 underwent cystectomy. After a median follow-up of 70.6 months (range: 6.2-410.6 months), eight patients suffered recurrences (5 in the USO group and 3 in the cystectomy group). The median times to recurrence were 5.0 and 5.1 months in the USO and cystectomy groups, respectively (P = 0.764). All patients with recurrence were successfully salvaged by surgery, except for one death. Univariate analysis showed no difference in disease-free survival and overall survival between the groups (P = 0.781, 0.155). Of the 111 patients contacted by telephone, 97 resumed menstruation following the surgery. Of the 31 patients desiring pregnancy, 26 achieved 28 pregnancies. USO (83.3%), like cystectomy (85.7%), resulted in excellent pregnancy rates. CONCLUSIONS A USO is the standard treatment for women with early stage pure IMTs who want to preserve fertility. However, a cystectomy with adjuvant chemotherapy may be a suitable fertility-sparing therapy when a cystectomy is the only surgical option.
Collapse
Affiliation(s)
- Dan Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Shan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Congwei Jia
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Yang Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China.
| |
Collapse
|
9
|
Bercow A, Nitecki R, Brady PC, Rauh-Hain JA. Outcomes after Fertility-sparing Surgery for Women with Ovarian Cancer: A Systematic Review of the Literature. J Minim Invasive Gynecol 2021; 28:527-536.e1. [PMID: 32861046 DOI: 10.1016/j.jmig.2020.08.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To compare reproductive and oncologic outcomes of patients diagnosed with early-stage epithelial ovarian carcinoma, borderline ovarian tumors, or nonepithelial ovarian carcinoma according to receipt of fertility-sparing surgery or conventional surgery. DATA SOURCES PubMed was searched from January 1, 1995, to May 29, 2020. METHODS OF STUDY SELECTION Studies were included if they (1) enrolled women of childbearing age diagnosed with ovarian cancer between the ages of 18 years and 50 years, (2) reported on oncologic and/or reproductive outcomes after fertility-sparing surgery for ovarian cancer, and (3) included at least 20 patients. TABULATION, INTEGRATION, AND RESULTS The initial search identified 995 studies. After duplicates were removed, we abstracted 980 unique citations. Of those screened, 167 publications were identified as potentially relevant, and evaluated for inclusion and exclusion criteria. The final review included 44 studies in epithelial ovarian cancer, 42 in borderline ovarian tumors, and 31 in nonepithelial ovarian carcinoma. The narrative synthesis demonstrated that overall survival does not seem to be compromised in patients undergoing fertility-sparing surgery compared with those undergoing conventional surgery, although long-term data are limited. Areas of controversy include safety of fertility-sparing surgery in the setting of high-risk factors (stage IC, grade 3, and clear cell histology), as well as type of surgery (salpingo-oophorectomy vs cystectomy). It seems that although there may be some fertility compromise after surgery, pregnancy and live-birth rates are encouraging. CONCLUSION Fertility-sparing surgery is safe and feasible in women with early-stage low-risk ovarian cancer. Pregnancy outcomes for these patients also seem to be similar to those of the general population.
Collapse
Affiliation(s)
- Alexandra Bercow
- Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital (Dr. Bercow); Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital (Dr. Bercow), Boston, Massachusetts
| | - Roni Nitecki
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (Drs. Nitecki and Rauh-Hain), Houston, Texas
| | - Paula C Brady
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center (Dr. Brady), New York, New York
| | - J Alejandro Rauh-Hain
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (Drs. Nitecki and Rauh-Hain), Houston, Texas.
| |
Collapse
|
10
|
Armstrong DK, Alvarez RD, Bakkum-Gamez JN, Barroilhet L, Behbakht K, Berchuck A, Chen LM, Cristea M, DeRosa M, Eisenhauer EL, Gershenson DM, Gray HJ, Grisham R, Hakam A, Jain A, Karam A, Konecny GE, Leath CA, Liu J, Mahdi H, Martin L, Matei D, McHale M, McLean K, Miller DS, O'Malley DM, Percac-Lima S, Ratner E, Remmenga SW, Vargas R, Werner TL, Zsiros E, Burns JL, Engh AM. Ovarian Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19:191-226. [PMID: 33545690 DOI: 10.6004/jnccn.2021.0007] [Citation(s) in RCA: 320] [Impact Index Per Article: 106.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Epithelial ovarian cancer is the leading cause of death from gynecologic cancer in the United States and is the country's fifth most common cause of cancer mortality in women. A major challenge in treating ovarian cancer is that most patients have advanced disease at initial diagnosis. These NCCN Guidelines discuss cancers originating in the ovary, fallopian tube, or peritoneum, as these are all managed in a similar manner. Most of the recommendations are based on data from patients with the most common subtypes─high-grade serous and grade 2/3 endometrioid. The NCCN Guidelines also include recommendations specifically for patients with less common ovarian cancers, which in the guidelines include the following: carcinosarcoma, clear cell carcinoma, mucinous carcinoma, low-grade serous, grade 1 endometrioid, borderline epithelial, malignant sex cord-stromal, and malignant germ cell tumors. This manuscript focuses on certain aspects of primary treatment, including primary surgery, adjuvant therapy, and maintenance therapy options (including PARP inhibitors) after completion of first-line chemotherapy.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Lee-May Chen
- 7UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | - Heidi J Gray
- 12Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | | | | | | | | | - Joyce Liu
- 19Dana-Farber/Brigham and Women's Cancer Center
| | - Haider Mahdi
- 20Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Lainie Martin
- 21Abramson Cancer Center at the University of Pennsylvania
| | - Daniela Matei
- 22Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - David M O'Malley
- 26The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | - Roberto Vargas
- 20Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | |
Collapse
|
11
|
Yüksel D, Ayhan S, Korkmaz V, Çakır C, Kılıç Ç, Akgor U, Özgül N, Kılıç F, Ersak B, Esen S, Kuru O, Uncu D, Gökcü M, Özdal B, Gültekin M, Salman MC, Boran N, Toptaş T, Üreyen I, Taşcı T, Kimyon Cömert G, Türkmen O, Moraloğlu Tekin Ö, Engin Üstün Y, Turan T. Retrospective Analysis of Pure Ovarian Immature Teratoma in Patients Aged 15-39 Years: A Turkish Multicenter Study. J Adolesc Young Adult Oncol 2020; 10:697-702. [PMID: 33296263 DOI: 10.1089/jayao.2020.0155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose: To evaluate the clinicopathological characteristics and surgical outcomes in patients with pure ovarian immature teratomas (POITs). Materials and Methods: In this multicenter study, a retrospective review was made of the databases of six Gynecology Oncology Departments in Turkey to identify patients with POITs who had undergone surgery between 1993 and 2019. Results: Evaluation was made of 48 patients with a median age at diagnosis of 22.5 years (range, 15-37 years). In 40 (83%) patients, stage I was determined and in eight patients, an advanced stage (IIIB, IIIC, and IVB) was determined. Tumors were found to be grade I in 17 (35.4%) cases, grade II in 12 (25%), and grade III in 19 (39.6%). Fertility-sparing surgery was applied to 42 (87.5%) patients and radical surgery to 6 (12.5%). The median follow-up was 60 months (range, 3-246 months). Recurrence was seen in seven patients, all with grade III tumors. In the final pathological examination of recurrent tumors, mature teratoma was reported in five patients, and immature teratoma in one patient. Salvage surgery was not performed in one patient as the tumor was unresectable and so a regimen of bleomycin, etoposide, and cisplatin (BEP) was administered. Conclusion: POITs are rare tumors seen at a young age, and benign or malignant relapse can be seen in these tumors. In this cohort, the malignant recurrence rate was 4.1%, and the benign recurrence rate was 10.4%. All the recurrences were in grade III tumors. Benign recurrences can be treated with surgery alone and the malignant group should be treated with surgery followed by chemotherapy.
Collapse
Affiliation(s)
- Dilek Yüksel
- Division of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Sevgi Ayhan
- Division of Gynecologic Oncology, Ankara City Hospital, Ankara, Turkey
| | - Vakkas Korkmaz
- Division of Gynecologic Oncology, Ankara City Hospital, Ankara, Turkey
| | - Caner Çakır
- Division of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Çiğdem Kılıç
- Division of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Utku Akgor
- Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nejat Özgül
- Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Fatih Kılıç
- Division of Gynecologic Oncology, Ankara City Hospital, Ankara, Turkey
| | - Burak Ersak
- Division of Gynecologic Oncology, Ankara City Hospital, Ankara, Turkey
| | - Selin Esen
- Division of Medical Oncology, Ankara City Hospital, Ankara, Turkey
| | - Oğuzhan Kuru
- Division of Gynecologic Oncology, University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Doğan Uncu
- Division of Medical Oncology, Ankara City Hospital, Ankara, Turkey
| | - Mehmet Gökcü
- Division of Gynecologic Oncology, University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Bülent Özdal
- Division of Gynecologic Oncology, Ankara City Hospital, Ankara, Turkey
| | - Murat Gültekin
- Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Coşkun Salman
- Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nurettin Boran
- Division of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Tayfun Toptaş
- Antalya Education and Research Hospital Faculty of Medicine, University of Health Sciences, Antalya, Turkey
| | - Işın Üreyen
- Antalya Education and Research Hospital Faculty of Medicine, University of Health Sciences, Antalya, Turkey
| | - Tolga Taşcı
- Division of Gynecologic Oncology, Faculty of Medicine Bahçeşehir University, Istanbul, Turkey
| | - Günsu Kimyon Cömert
- Division of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Osman Türkmen
- Division of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | | | - Yaprak Engin Üstün
- Division of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Taner Turan
- Division of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| |
Collapse
|