Impact of pattern of recurrence on post-relapse survival according to surgical timing in patients with advanced ovarian cancer

Clinical Profiles and Survival Outcomes of Patients With Relapsed Ovarian Cancer: A Single-Center Study

Background Ovarian cancer is the third most prevalent form of cancer among women in India. The majority of patients are diagnosed at an advanced stage. Many women with late-stage ovarian cancer experience a recurrence and need subsequent treatment, even after initial therapy. The prognosis of patients who experience relapse after treatment is poor. The objective of this study was to assess the clinical characteristics and survival rates of individuals diagnosed with relapsed epithelial ovarian cancer (EOC). Methods This retrospective study included patients with a relapse of epithelial ovarian carcinoma who were treated at the Department of Medical Oncology, Institute of Obstetrics and Gynecology (IOG), Madras Medical College, Chennai, India, over a period of six years, from January 2015 to December 2020. Results Sixty-six patients were enrolled in this study. The median patient age was 52 years. Most patients were postmenopausal (66.67%, n=44) and multiparous (75.76%, n=50). The most common histological type was serous (72.72%, n=48), and the majority of patients were in the later stages of the illness (83.34%, n=55). The median post-relapse survival of the study population was 23 months (95% confidence interval (CI): 20.61-25.39). The median survival of patients who were upfront stage I, II, III, and IV was 30, 13, 23, and nine months, respectively (p<0.05). Patients who underwent optimal cytoreduction had better survival rates than those who did not (28 versus 18 months, p<0.05). The median post-relapse survival was better in the platinum-sensitive group than in the platinum-resistant group (26 versus 16 months, p<0.05). Patients with a single relapse site had better survival rates than those with multiple sites of recurrence (26 versus 13 months, p<0.05). Patients with mucinous histology showed maximum survival (p<0.05). Individuals who initially underwent surgery had superior median survival rates following relapse compared to those who received neoadjuvant chemotherapy as their first treatment (25 versus 23 months, p=0.404). Cox regression analysis revealed that platinum-sensitive patients were 4.204 times more likely to survive than platinum-resistant patients. Similarly, those presenting with single lesions were 7.275 times more likely to survive for a longer time than those with multiple lesions. Conclusion This study emphasizes the importance of achieving optimal cytoreduction and underscores the prognostic significance of platinum sensitivity and recurrence patterns in patients with relapsed ovarian cancer. Late detection can result in unfavorable outcomes.

Building an Efficient Peritoneal Surface Malignancies Program Despite the Lower-Middle-Income Barriers: Ukraine Experience

PURPOSE

Cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) programs are often limited to centers in developed countries because of extensive requirements. We aimed to analyze efficacy and challenges of CRS/HIPEC centers in lower-middle-income settings in the Ukraine example.

METHODS

A multicenter descriptive study was conducted using data sets (2008-2022) from Kyiv, Lviv, and Odesa centers. Patients with appendiceal neoplasm (AN); colorectal cancer (CRC); malignant peritoneal mesothelioma (MPM); and epithelial ovarian, fallopian tube, and primary peritoneal cancer (EOC) treated with CRS ± HIPEC were included. Overall survival (OS) was analyzed for N ≥ 20 cohorts using the Kaplan-Meier method.

RESULTS

We included 596 patients. At Kyiv and Lviv centers, 37 and 28 patients with AN had completeness of cytoreduction (CC-0/1) rates of 84% and 71%, respectively. Thirty-day major morbidity stood at 24% and 18%, respectively. Median OS was not reached (NR) at both centers. Nineteen patients with CRC from Kyiv, 11 from Lviv, and 156 from Odesa had CC-0/1 rates of 84%, 91%, and 86%, respectively. Thirty-day major complications occurred in 16%, 18%, and 8%, respectively. Median OS in the Odesa cohort was 35 (95% CI, 32 to 38) months. Among 15 Kyiv, five Lviv, and six Odesa patients with MPM, CC-0/1 rates were 67%, 80%, and 100%, respectively, while major complications occurred in 13%, 0%, and 17%, respectively. OS was not analyzed because of small MPM cohorts. At Kyiv, Lviv, and Odesa centers, 91, 40, and 89 patients, respectively, had primary EOC. CC-0/1 rates were 79%, 100%, and 80%, and 30-day major morbidity rates were 23%, 5%, and 6%, respectively. Median OS was NR, 71 (95% CI, 32 to 110), and 67 (95% CI, 61 to 73) months, respectively.

CONCLUSION

CRS/HIPEC programs in lower-middle-income environment can achieve safety and survival that meet global standards. Our discussion highlights common obstacles in such settings and proposes effective overcoming strategies.