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Natarajan P, Martha Schofield A, Elena Vinturache A, Ruthven S, Lane S, Duncan Macdonald R. A comparison of the clinical and histological appearances after treatment of advanced stage ovarian cancer with PlasmaJet® device. Eur J Obstet Gynecol Reprod Biol 2024; 296:311-315. [PMID: 38518485 DOI: 10.1016/j.ejogrb.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 01/09/2024] [Accepted: 03/17/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE To compare the clinical appearance of "no residual disease" to the histological assessment of the same tissue when treated with PlasmaJet®. To determine if the treated tissue with a clinical appearance of "no residual disease" demonstrated histologically apparent damage to underlying structures. AIM The main aims of the study were to compare the clinical appearance of 'no residual disease' to the histological assessment of the same tissue and to assess whether treatment with PlasmaJet® to produce a clinical appearance of 'no residual disease' causes no histologically apparent damage to the underlying structures. METHOD This prospective cohort study was conducted in Liverpool Women's NHS Foundation Trust between January 2019 and June 2020. Women with a diagnosis of advanced or presumed advanced stage ovarian cancer were approached and 20 women were recruited into the study. Tissue samples were collected from women with stage 3 or 4 ovarian cancer at either primary or interval debulking surgery. RESULTS The clinical appearance of no residual disease was confirmed histologically in 84 % (n = 16) of cases. Fat was the only underlying tissue seen damaged in 21 % (n = 4) of cases. Bowel resection with stoma formation was needed in one case (5.26 %). CONCLUSION PlasmaJet® ablated the malignant tissue in majority of the cases without causing any significant damage to the underlying tissue, it also reduced the need for stoma formation. This is a small study with encouraging results. PlasmaJet® could be a valuable tool in ovarian cancer surgery, it potentially could reduce the need for bowel surgery and allow treatment of significant mesenteric disease with reduced morbidity for the patient.
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Affiliation(s)
- Purushothaman Natarajan
- Gynaecological Oncology Department, Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool L8 7SS, United Kingdom
| | - Alice Martha Schofield
- Gynaecological Oncology Department, Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool L8 7SS, United Kingdom
| | - Angela Elena Vinturache
- Obstetrics & Gynecology Department, Grande Prairie Regional Hospital, Grande Prairie, Alberta T8V 2E8, Canada; Obstetrics & Gynecology Department, University of Alberta, Edmonton, Alberta T6G 2R3, Canada.
| | - Suart Ruthven
- Histology Department, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom
| | - Steve Lane
- University of Liverpool, Liverpool L69 3BX, United Kingdom
| | - Robert Duncan Macdonald
- Gynaecological Oncology Department, Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool L8 7SS, United Kingdom
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Chase DM, Mahajan A, Scott DA, Hawkins N, Kalilani L. The impact of varying levels of residual disease following cytoreductive surgery on survival outcomes in patients with ovarian cancer: a meta-analysis. BMC Womens Health 2024; 24:179. [PMID: 38491366 PMCID: PMC10941390 DOI: 10.1186/s12905-024-02977-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/17/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Residual disease following cytoreductive surgery in patients with ovarian cancer has been associated with poorer survival outcomes compared with no residual disease. We performed a meta-analysis to assess the impact of varying levels of residual disease status on survival outcomes in patients with ovarian cancer who have undergone primary cytoreductive surgery or interval cytoreductive surgery in the setting of new therapies for this disease. METHODS Medline, Embase, and Cochrane databases (January 2011 - July 2020) and grey literature, bibliographic and key conference proceedings, were searched for eligible studies. Fixed and random-effects meta-analyses compared progression and survival by residual disease level across studies. Heterogeneity between comparisons was explored via type of surgery, disease stage, and type of adjuvant chemotherapy. RESULTS Of 2832 database and 16 supplementary search articles screened, 50 studies were selected; most were observational studies. The meta-analysis showed that median progression-free survival and overall survival decreased progressively with increasing residual disease (residual disease categories of 0 cm, > 0-1 cm and > 1 cm). Compared with no residual disease, hazard ratios (HR) for disease progression increased with increasing residual disease category (1.75 [95% confidence interval: 1.42, 2.16] for residual disease > 0-1 cm and 2.14 [1.34, 3.39] for residual disease > 1 cm), and also for reduced survival (HR versus no residual disease, 1.75 [ 1.62, 1.90] for residual disease > 0-1 cm and 2.32 [1.97, 2.72] for residual disease > 1 cm). All comparisons were significant (p < 0.05). Subgroup analyses showed an association between residual disease and disease progression/reduced survival irrespective of type of surgery, disease stage, or type of adjuvant chemotherapy. CONCLUSIONS This meta-analysis provided an update on the impact of residual disease following primary or interval cytoreductive surgery, and demonstrated that residual disease was still highly predictive of progression-free survival and overall survival in adults with ovarian cancer despite changes in ovarian cancer therapy over the last decade. Higher numerical categories of residual disease were associated with reduced survival than lower categories.
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Affiliation(s)
- Dana M Chase
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
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Nikiforchin A, Sardi A, King MC, Baron E, Lopez-Ramirez F, Falla-Zuniga LF, Barakat P, Iugai S, Pawlikowski K, Nieroda C, Campbell K, Ryu H, Diaz-Montes T, Gushchin V. Collaborative expertise of gynecological and surgical oncologists in managing advanced epithelial ovarian cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107948. [PMID: 38183864 DOI: 10.1016/j.ejso.2023.107948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 12/31/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Most patients with epithelial ovarian cancer (EOC) present with significant peritoneal spread. We assessed collaborative efforts of surgical and gynecological oncologists with expertise in cytoreductive surgery (CRS) in the management of advanced EOC. METHODS Using a prospective single-center database (2014-2022), we described the operative and oncologic outcomes of stage IIIC-IVA primary and recurrent EOC perioperatively managed jointly by gynecological and surgical oncologists both specializing in CRS and presented components of this collaboration. RESULTS Of 199 identified patients, 132 (66 %) had primary and 53 (27 %) had recurrent EOC. Due to inoperable disease, 14 (7 %) cases were aborted and excluded from analysis. Median peritoneal cancer index (PCI) in primary and recurrent patients was 21 (IQR: 11-28) and 21 (IQR: 6-31). Upper abdominal surgery was required in 95 % (n = 125) of primary and 89 % (n = 47) of recurrent patients. Bowel resections were performed in 83 % (n = 110) and 72 % (n = 38), respectively. Complete cytoreduction (CC-0/1) with no disease or residual lesions <2.5 mm was achieved in 95 % (n = 125) of primary and 91 % (n = 48) of recurrent patients. Ninety-day Clavien-Dindo grade III-IV morbidity was 12 % (n = 16) and 21 % (n = 11), respectively. Median follow-up was 44 (95%CI: 33-55) months. Median overall survival in primary and recurrent EOC was 68 (95%CI: 45-91) and 50 (95%CI: 16-84) months. Median progression-free survival was 26 (95%CI: 22-30) and 14 (95%CI: 7-21) months, respectively. CONCLUSIONS Perioperative collaboration between surgical and gynecological oncologists specializing in CRS allows safe performance of complete cytoreduction in the majority of patients with primary and recurrent EOC, despite high tumor burden.
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Affiliation(s)
- Andrei Nikiforchin
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Armando Sardi
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA.
| | - Mary Caitlin King
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Ekaterina Baron
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Felipe Lopez-Ramirez
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Luis Felipe Falla-Zuniga
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Philipp Barakat
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Sergei Iugai
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Kathleen Pawlikowski
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Carol Nieroda
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Kurtis Campbell
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Hyung Ryu
- Gynecological Oncology, The Lya Segall Ovarian Cancer Institute, Mercy Medical Center, 227 St. Paul Place, 6th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Teresa Diaz-Montes
- Gynecological Oncology, The Lya Segall Ovarian Cancer Institute, Mercy Medical Center, 227 St. Paul Place, 6th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Vadim Gushchin
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
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Mulligan K, Corry E, Donohoe F, Glennon K, Vermeulen C, Reid-Schachter G, Thompson C, Walsh T, Shields C, McCormack O, Conneely J, Khan MF, Boyd WD, McVey R, O'Brien D, Treacy A, Mulsow J, Brennan DJ. Multidisciplinary Surgical Approach to Increase Survival for Advanced Ovarian Cancer in a Tertiary Gynaecological Oncology Centre. Ann Surg Oncol 2024; 31:460-472. [PMID: 37875740 DOI: 10.1245/s10434-023-14423-1] [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: 06/16/2023] [Accepted: 09/26/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE The purpose of this paper is to report on changes in overall survival, progression-free survival, and complete cytoreduction rates in the 5-year period after the implementation of a multidisciplinary surgical team (MDT). METHODS Two cohorts were used. Cohort A was a retrospectively collated cohort from 2006 to 2015. Cohort B was a prospectively collated cohort of patients from January 2017 to September 2021. RESULTS This study included 146 patients in cohort A (2006-2015) and 174 patients in cohort B (2017-2021) with FIGO stage III/IV ovarian cancer. Median follow-up in cohort A was 60 months and 48 months in cohort B. The rate of primary cytoreductive surgery increased from 38% (55/146) in cohort A to 46.5% (81/174) in cohort B. Complete macroscopic resection increased from 58.9% (86/146) in cohort A to 78.7% (137/174) in cohort B (p < 0.001). At 3 years, 75% (109/144) patients had disease progression in cohort A compared with 48.8% (85/174) in cohort B (log-rank, p < 0.001). Also at 3 years, 64.5% (93/144) of patients had died in cohort A compared with 24% (42/174) of cohort B (log-rank, p < 0.001). Cox multivariate analysis demonstrated that MDT input, residual disease, and age were independent predictors of overall (hazard ratio [HR] 0.29, 95% confidence interval [CI] 0.203-0.437, p < 0.001) and progression-free survival (HR 0.31, 95% CI 0.21-0.43, p < 0.001). Major morbidity remained stable throughout both study periods (2006-2021). CONCLUSIONS Our data demonstrate that the implementation of multidisciplinary-team, intraoperative approach allowed for a change in surgical philosophy and has resulted in a significant improvement in overall survival, progression-free survival, and complete resection rates.
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Affiliation(s)
- Karen Mulligan
- UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Edward Corry
- UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Fionán Donohoe
- UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Kate Glennon
- UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Carolien Vermeulen
- UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Gillian Reid-Schachter
- UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Claire Thompson
- UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Tom Walsh
- UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Conor Shields
- Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Orla McCormack
- Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - John Conneely
- Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Mohammad Faraz Khan
- Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - William D Boyd
- UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Ruaidhrí McVey
- UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
- Department of Gynaecology, St Vincent's Hospital, Elm Park, Dublin 4, Ireland
| | - Donal O'Brien
- Department of Gynaecology, St Vincent's Hospital, Elm Park, Dublin 4, Ireland
| | - Ann Treacy
- Department of Pathology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Jurgen Mulsow
- Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Donal J Brennan
- UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland.
- Department of Gynaecology, St Vincent's Hospital, Elm Park, Dublin 4, Ireland.
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Laios A, Kalampokis E, Mamalis ME, Thangavelu A, Hutson R, Broadhead T, Nugent D, De Jong D. Exploring the Potential Role of Upper Abdominal Peritonectomy in Advanced Ovarian Cancer Cytoreductive Surgery Using Explainable Artificial Intelligence. Cancers (Basel) 2023; 15:5386. [PMID: 38001646 PMCID: PMC10670755 DOI: 10.3390/cancers15225386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/02/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
The Surgical Complexity Score (SCS) has been widely used to describe the surgical effort during advanced stage epithelial ovarian cancer (EOC) cytoreduction. Referring to a variety of multi-visceral resections, it best combines the numbers with the complexity of the sub-procedures. Nevertheless, not all potential surgical procedures are described by this score. Lately, the European Society for Gynaecological Oncology (ESGO) has established standard outcome quality indicators pertinent to achieving complete cytoreduction (CC0). There is a need to define what weight all these surgical sub-procedures comprising CC0 would be given. Prospectively collected data from 560 surgically cytoreduced advanced stage EOC patients were analysed at a UK tertiary referral centre.We adapted the structured ESGO ovarian cancer report template. We employed the eXtreme Gradient Boosting (XGBoost) algorithm to model a long list of surgical sub-procedures. We applied the Shapley Additive explanations (SHAP) framework to provide global (cohort) explainability. We used Cox regression for survival analysis and constructed Kaplan-Meier curves. The XGBoost model predicted CC0 with an acceptable accuracy (area under curve [AUC] = 0.70; 95% confidence interval [CI] = 0.63-0.76). Visual quantification of the feature importance for the prediction of CC0 identified upper abdominal peritonectomy (UAP) as the most important feature, followed by regional lymphadenectomies. The UAP best correlated with bladder peritonectomy and diaphragmatic stripping (Pearson's correlations > 0.5). Clear inflection points were shown by pelvic and para-aortic lymph node dissection and ileocecal resection/right hemicolectomy, which increased the probability for CC0. When UAP was solely added to a composite model comprising of engineered features, it substantially enhanced its predictive value (AUC = 0.80, CI = 0.75-0.84). The UAP was predictive of poorer progression-free survival (HR = 1.76, CI 1.14-2.70, P: 0.01) but not overall survival (HR = 1.06, CI 0.56-1.99, P: 0.86). The SCS did not have significant survival impact. Machine Learning allows for operational feature selection by weighting the relative importance of those surgical sub-procedures that appear to be more predictive of CC0. Our study identifies UAP as the most important procedural predictor of CC0 in surgically cytoreduced advanced-stage EOC women. The classification model presented here can potentially be trained with a larger number of samples to generate a robust digital surgical reference in high output tertiary centres. The upper abdominal quadrants should be thoroughly inspected to ensure that CC0 is achievable.
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Affiliation(s)
- Alexandros Laios
- Department of Gynaecologic Oncology, St James’s University Hospital, Leeds LS9 7TF, UK; (A.T.); (R.H.); (T.B.); (D.N.); (D.D.J.)
| | - Evangelos Kalampokis
- Information Systems Lab, Department of Business Administration, University of Macedonia, 54636 Thessaloniki, Greece; (E.K.); (M.E.M.)
- Center for Research & Technology HELLAS (CERTH), 6th km Charilaou-Thermi Rd, 57001 Thessaloniki, Greece
| | - Marios Evangelos Mamalis
- Information Systems Lab, Department of Business Administration, University of Macedonia, 54636 Thessaloniki, Greece; (E.K.); (M.E.M.)
| | - Amudha Thangavelu
- Department of Gynaecologic Oncology, St James’s University Hospital, Leeds LS9 7TF, UK; (A.T.); (R.H.); (T.B.); (D.N.); (D.D.J.)
| | - Richard Hutson
- Department of Gynaecologic Oncology, St James’s University Hospital, Leeds LS9 7TF, UK; (A.T.); (R.H.); (T.B.); (D.N.); (D.D.J.)
| | - Tim Broadhead
- Department of Gynaecologic Oncology, St James’s University Hospital, Leeds LS9 7TF, UK; (A.T.); (R.H.); (T.B.); (D.N.); (D.D.J.)
| | - David Nugent
- Department of Gynaecologic Oncology, St James’s University Hospital, Leeds LS9 7TF, UK; (A.T.); (R.H.); (T.B.); (D.N.); (D.D.J.)
| | - Diederick De Jong
- Department of Gynaecologic Oncology, St James’s University Hospital, Leeds LS9 7TF, UK; (A.T.); (R.H.); (T.B.); (D.N.); (D.D.J.)
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Chase DM, Mahajan A, Scott DA, Hawkins N, Kalilani L. Correlation between progression-free survival and overall survival in patients with ovarian cancer after cytoreductive surgery: a systematic literature review. Int J Gynecol Cancer 2023; 33:1602-1611. [PMID: 37643825 PMCID: PMC10579502 DOI: 10.1136/ijgc-2023-004487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/12/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES This analysis aimed to better define the relationship between progression-free survival and overall survival in adult patients with ovarian cancer (including fallopian tube or primary peritoneal cancer) following primary cytoreductive surgery or interval cytoreductive surgery. METHODS A systematic literature review was carried out across the Medline, Embase, and Cochrane Central databases on 7 July 2020 (date limits 1 January 2011 to 7 July 2020) to identify studies with the following eligibility criteria: clinical trials/observational studies including >200 patients with ovarian cancer aged ≥18 years, evaluating overall survival/progression-free survival following cytoreductive surgery by residual disease status in the United States, Europe, Japan, or China. Weighted linear regression models were used to assess any correlation between median progression-free survival and overall survival, and between logHR for progression-free survival and logHR for overall survival. Risk of bias was assessed for all included studies. RESULTS Of the 50 studies reported, 43 were observational studies (41 retrospective and two prospective cohort studies), and seven were reporting for randomized clinical trials-of which four were retrospective data analyses. For analyses of the relationship between overall survival and progression-free survival, 21 studies were eligible. The weighted linear regression model showed a strong positive association between the two survival endpoints. Goodness-of-fit analysis measured the adjusted R2 as 0.84 (p<0.001); a positive association was also observed between logHRs for overall survival and progression-free survival in the included studies. CONCLUSIONS Median progression-free survival was predictive of median overall survival. This correlation between progression-free survival and overall survival after primary treatment for ovarian cancer highlights the validity of progression-free survival as a primary endpoint. Observational studies contributed most data, with limited information on disease stage and histology.
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Affiliation(s)
- Dana M Chase
- Gyncologic Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Park SJ, Na KJ, Lee M, Park IK, Chung HH, Kang CH, Kim JW, Park NH, Kim YT, Song YS, Park S, Kim HS. Impact of supradiaphragmatic lymphadenectomy on the survival of patients in stage IVB ovarian cancer with thoracic lymph node metastasis. Front Oncol 2023; 13:1203127. [PMID: 37637060 PMCID: PMC10448516 DOI: 10.3389/fonc.2023.1203127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/11/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction To evaluate the survival impact of supradiaphragmatic lymphadenectomy as part of debulking surgery in stage IVB ovarian cancer with thoracic lymph node metastasis (LNM). Methods We retrospectively enrolled patients diagnosed with stage IVB ovarian, fallopian or primary peritoneal cancer between 2010 and 2020, carrying cardiophrenic, parasternal, anterior mediastinal or supraclavicular lymph nodes ≥5 mm on axial chest computed tomography. All tumors were classified into the abdominal (abdominal tumors and cardiophrenic lymph nodes) and supradiaphragmatic (parasternal, anterior mediastinal or supraclavicular lymph nodes) categories depending on the area involved. Residual tumors were classified into <5 vs ≥5 mm in the abdominal and supradiaphragmatic areas. Based on the site of recurrence, they were divided into abdominal, supradiaphragmatic and other areas. Results A total of 120 patients underwent primary debulking surgery (PDS, n=68) and interval debulking surgery after neoadjuvant chemotherapy (IDS/NAC, n=53). Residual tumors in the supradiaphragmatic area ≥5 mm adversely affected progression-free survival (PFS) and overall survival (OS) with marginal significance after PDS despite the lack of effect on survival after IDS/NAC (adjusted hazard ratios [HRs], 6.478 and 6.370; 95% confidence intervals [CIs], 2.224-18.864 and 0.953-42.598). Further, the size of residual tumors in the abdominal area measuring ≥5 mm diminished OS after IDS/NAC (adjusted HR, 9.330; 95% CIs, 1.386-62.800). Conclusion Supradiaphragmatic lymphadenectomy during PDS may improve survival in patients diagnosed with stage IVB ovarian cancer manifesting thoracic LNM. Further, suboptimal debulking surgery in the abdominal area may be associated with poor OS after IDS/NAC. Trial registration ClinicalTrials.gov (NCT05005650; https://clinicaltrials.gov/ct2/show/NCT05005650; first registration, 13/08/2021).Research Registry (Research Registry UIN, researchregistry7366; https://www.researchregistry.com/browse-the-registry#home/?view_2_search=researchregistry7366&view_2_page=1).
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Affiliation(s)
- Soo Jin Park
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kwon Joong Na
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Maria Lee
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Noh Hyun Park
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young-Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong Sang Song
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
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Upper-Abdominal Cytoreduction for Advanced Ovarian Cancer—Therapeutic Rationale, Surgical Anatomy and Techniques of Cytoreduction. SURGICAL TECHNIQUES DEVELOPMENT 2022. [DOI: 10.3390/std12010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cytoreductive surgery (CRS) is the cornerstone of treating advanced ovarian cancer. Approximately 60–70% of patients with advanced ovarian cancer will have involvement in the upper abdomen or the supracolic compartment of the abdominal cavity. Though the involvement of this region results in poorer survival compared, complete cytoreduction benefits overall survival, making upper-abdominal cytoreduction an essential component of CRS for advanced ovarian cancer. The upper abdomen constitutes several vital organs and large blood vessels draped with the parietal or visceral peritoneum, common sites of disease in ovarian cancer. A surgeon treating advanced ovarian cancer should be well versed in upper-abdominal cytoreduction techniques, including diaphragmatic peritonectomy and diaphragm resection, lesser omentectomy, splenectomy with or without distal pancreatectomy, liver resection, cholecystectomy, and suprarenal retroperitoneal lymphadenectomy. Other procedures such as clearance of the periportal region, Glisson’s capsulectomy, clearance of the superior recess of the lesser sac, and Morrison’s pouch are essential as these regions are often involved in ovarian cancer. This manuscript covers the surgical anatomy of the upper abdomen, the techniques and therapeutic rationale of upper-abdominal cytoreduction, and specific measures for perioperative management of these patients. The main focus is the description of various peritonectomies and regional lymphadenectomies.
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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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Surgery in Advanced Ovary Cancer: Primary versus Interval Cytoreduction. Diagnostics (Basel) 2022; 12:diagnostics12040988. [PMID: 35454036 PMCID: PMC9026414 DOI: 10.3390/diagnostics12040988] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 12/01/2022] Open
Abstract
Primary debulking surgery (PDS) has remained the only treatment of ovarian cancer with survival advantage since its development in the 1970s. However, survival advantage is only observed in patients who are optimally resected. Neoadjuvant chemotherapy (NACT) has emerged as an alternative for patients in whom optimal resection is unlikely and/or patients with comorbidities at high risk for perioperative complications. The purpose of this review is to summarize the evidence to date for PDS and NACT in the treatment of stage III/IV ovarian carcinoma. We systematically searched the PubMed database for relevant articles. Prior to 2010, NACT was reserved for non-surgical candidates. After publication of EORTC 55971, the first randomized trial demonstrating non-inferiority of NACT followed by interval debulking surgery, NACT was considered in a wider breadth of patients. Since EORTC 55971, 3 randomized trials—CHORUS, JCOG0602, and SCORPION—have studied NACT versus PDS. While CHORUS supported EORTC 55971, JCOG0602 failed to demonstrate non-inferiority and SCORPION failed to demonstrate superiority of NACT. Despite conflicting data, a subset of patients would benefit from NACT while preserving survival including poor surgical candidates and inoperable disease. Further randomized trials are needed to assess the role of NACT.
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Ye S, Wang Y, Chen L, Wu X, Yang H, Xiang L. The surgical outcomes and perioperative complications of bowel resection as part of debulking surgery of advanced ovarian cancer patients. BMC Surg 2022; 22:81. [PMID: 35246104 PMCID: PMC8895854 DOI: 10.1186/s12893-022-01531-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/23/2022] [Indexed: 12/24/2022] Open
Abstract
Background To review the utilization of bowel resection in ovarian cancer surgery in our institution. Methods All ovarian cancer patients who received bowel resection between 2006/01 and 2018/12 were identified. Postoperative morbidities were assessed according to the Clavien–Dindo classification (CDC). Results There were 182 patients in the anastomosis group and 100 patients in the ostomy group, yielding a total of 282 patients. The median age was 57 years, and most patients had high-grade serous histology (88.7%). Forty-nine (17.3%) patients received neoadjuvant chemotherapy. During the operation, 78.7% of patients had ascites, and the median volume was 800 mL. Extensive bowel resection (at least two-segment) and upper abdominal operation were performed in 29 (10.2%) and 69 (24.4%) patients, respectively. The rectosigmoid colon was the most commonly resected (83.8%) followed by right hemicolectomy (5.9%) and small bowel resection (2.8%). No macroscopic residual disease was observed in 42.9% of the patients, whereas 87.9% had residual disease ≤ 1 cm. Among the entire cohort, 23.0% (65/282) experienced different complications. Severe complications (CDC 3–5) accounted for 9.2% of complications and were mostly categorized as pleural effusion requiring drainage (3.5%) followed by wound dehiscence requiring delayed repair in the operating room (1.8%). Nine patients experienced anastomotic leakage (AL): one in the ostomy group with extensive bowel resection and eight in the anastomosis group. The overall AL rate was 4.2% (9/212) per anastomosis. Conclusions The execution of bowel resection as part of debulking surgery in patients with newly diagnosed ovarian cancer resulted in a severe morbidity rate of 9.2%.
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Affiliation(s)
- Shuang Ye
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yiyong Wang
- Department of Obstetrics and Gynecology, Baoshan Luodian Hospital, Shanghai, China
| | - Lei Chen
- Department of Radiology, Minhang Branch of Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaohua Wu
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Huijuan Yang
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Libing Xiang
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China. .,Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai, China.
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Jiang R, Zhu J, Kim JW, Liu J, Kato K, Kim HS, Zhang Y, Zhang P, Zhu T, Aoki D, Yu A, Chen X, Wang X, Zhu D, Zhang W, Jia H, Shi T, Gao W, Yin S, Feng Y, Xiang L, Okamoto A, Zang R. Study of upfront surgery versus neoadjuvant chemotherapy followed by interval debulking surgery for patients with stage IIIC and IV ovarian cancer, SGOG SUNNY (SOC-2) trial concept. J Gynecol Oncol 2021; 31:e86. [PMID: 32808504 PMCID: PMC7440987 DOI: 10.3802/jgo.2020.31.e86] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Two randomized phase III trials (EORTC55971 and CHORUS) showed similar progression-free and overall survival in primary or interval debulking surgery in ovarian cancer, however both studies had limitations with lower rate of complete resection and lack of surgical qualifications for participating centers. There is no consensus on whether neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) could be a preferred approach in the management of advanced epithelial ovarian cancer (EOC) in the clinical practice. METHODS The Asian SUNNY study is an open-label, multicenter, randomized controlled, phase III trial to compare the effect of primary debulking surgery (PDS) to NACT-IDS in stages IIIC and IV EOC, fallopian tube cancer (FTC) or primary peritoneal carcinoma (PPC). The hypothesis is that PDS enhances the survivorship when compared with NACT-IDS in advanced ovarian cancer. The primary objective is to clarify the role of PDS and NACT-IDS in the treatment of advanced ovarian cancer. Surgical quality assures include at least 50% of no gross residual (NGR) in PDS group in all centers and participating centers should be national cancer centers or designed ovarian cancer section or those with the experience participating surgical trials of ovarian cancer. Any participating center should be monitored evaluating the proportions of NGR by a training set. The aim of the surgery in both arms is maximal cytoreduction. Tumor burden of the disease is evaluated by diagnostic laparoscopy or positron emission tomography/computed tomography scan. Patients assigned to PDS group will undergo upfront maximal cytoreductive surgery within 3 weeks after biopsy, followed by 6 cycles of standard adjuvant chemotherapy. Patients assigned to NACT group will undergo 3 cycles of NACT-IDS, and subsequently 3 cycles of adjuvant chemotherapy. The maximal time interval between IDS and the initiation of adjuvant chemotherapy is 8 weeks. Major inclusion criteria are pathologic confirmed stage IIIC and IV EOC, FTC or PPC; ECOG performance status of 0 to 2; ASA score of 1 to 2. Major exclusion criteria are non-epithelial tumors as well as borderline tumors; low-grade carcinoma; mucinous ovarian cancer. The sample size is 456 subjects. Primary endpoint is overall survival. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02859038.
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Affiliation(s)
- Rong Jiang
- Shanghai Gynecologic Oncology Group and Ovarian Cancer Program, Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianqing Zhu
- Shanghai Gynecologic Oncology Group and Department of Gynecologic Oncology, Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Jae Weon Kim
- Korean Gynecologic Oncology Group and Department of Obstetrics and Gynecology, Seoul National University, Seoul, Korea
| | - Jihong Liu
- Shanghai Gynecologic Oncology Group and Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Kazuyoshi Kato
- Japanese Gynecologic Oncology Group and Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan
| | - Hee Seung Kim
- Korean Gynecologic Oncology Group and Department of Obstetrics and Gynecology, Seoul National University, Seoul, Korea
| | - Yuqin Zhang
- Shanghai Gynecologic Oncology Group and Ovarian Cancer Program, Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ping Zhang
- Shanghai Gynecologic Oncology Group and Department of Gynecologic Oncology, Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Tao Zhu
- Shanghai Gynecologic Oncology Group and Department of Gynecologic Oncology, Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Daisuke Aoki
- Japanese Gynecologic Oncology Group and Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Aijun Yu
- Shanghai Gynecologic Oncology Group and Department of Gynecologic Oncology, Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Xiaojun Chen
- Shanghai Gynecologic Oncology Group and Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xipeng Wang
- Shanghai Gynecologic Oncology Group and Department of Gynecology and Obstetrics, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ding Zhu
- Shanghai Gynecologic Oncology Group and Department of Gynecology, Hunan Provincial People's Hospital, Changsha, China
| | - Wei Zhang
- Shanghai Gynecologic Oncology Group and Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Huixun Jia
- Shanghai Gynecologic Oncology Group and Clinical Statistics Center, Shanghai General Hospital, Shanghai, China
| | - Tingyan Shi
- Shanghai Gynecologic Oncology Group and Ovarian Cancer Program, Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen Gao
- Shanghai Gynecologic Oncology Group and Department of Gynecologic Oncology, Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Sheng Yin
- Shanghai Gynecologic Oncology Group and Ovarian Cancer Program, Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yanling Feng
- Shanghai Gynecologic Oncology Group and Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Libing Xiang
- Shanghai Gynecologic Oncology Group and Ovarian Cancer Program, Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Aikou Okamoto
- Japanese Gynecologic Oncology Group and Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Rongyu Zang
- Shanghai Gynecologic Oncology Group and Ovarian Cancer Program, Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai, China
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Segura-Sampedro JJ, Craus-Miguel A, González-Argenté X, Morales-Soriano R. ASO Author Reflections: Diaphragmatic Resection Often Is Needed in CRS/HIPEC But Does Not Increase Respiratory Complications. Ann Surg Oncol 2021; 28:4683-4684. [PMID: 33423125 DOI: 10.1245/s10434-020-09530-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Juan José Segura-Sampedro
- General and Digestive Surgery Department, University Hospital Son Espases, Palma de Mallorca, Spain. .,Health Research Institute of Balearic Islands, Palma de Mallorca, Spain. .,School of Medicine, University of Balearic Islands, Palma de Mallorca, Spain.
| | - Andrea Craus-Miguel
- General and Digestive Surgery Department, University Hospital Son Espases, Palma de Mallorca, Spain.,Health Research Institute of Balearic Islands, Palma de Mallorca, Spain
| | - Xavier González-Argenté
- General and Digestive Surgery Department, University Hospital Son Espases, Palma de Mallorca, Spain.,Health Research Institute of Balearic Islands, Palma de Mallorca, Spain.,School of Medicine, University of Balearic Islands, Palma de Mallorca, Spain
| | - Rafael Morales-Soriano
- General and Digestive Surgery Department, University Hospital Son Espases, Palma de Mallorca, Spain.,Health Research Institute of Balearic Islands, Palma de Mallorca, Spain
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Segura-Sampedro JJ, Morales-Soriano R, Arjona-Sánchez Á, Cascales-Campos P. Secondary surgical cytoreduction needs to be assessed taking into account surgical technique, completeness of cytoreduction, and extent of disease. World J Surg Oncol 2020; 18:92. [PMID: 32393274 PMCID: PMC7216587 DOI: 10.1186/s12957-020-01853-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023] Open
Abstract
Recent evidence suggested that secondary surgical cytoreduction followed by chemotherapy does not result in longer overall survival in patients with platinum-sensitive recurrent ovarian cancer. This statement is based on a phase III multicenter, randomized clinical trial that lacks a description of the surgical protocol, the surgical technique, and the surgical variables. In a study that evaluates surgical cytoreduction, it is mandatory to assess the grade of cytoreductive surgery achieved (Sugarbaker PH, Langenbeck’s Arch Surg 384:576–87, 1999), the extent of disease using PCI (Peritoneal Cancer Index), the technique itself, and the existence of a multidisciplinary approach with extensive upper abdominal procedures in experienced centers (Ren et al, BMC Cancer 15:1-12, 2015). There is evidence proving that the quality of cytoreduction (Al Rawahi et al, Cochrane Database Syst Rev 2013, 2013), the measurement of the amount of disease by PCI (Elzarkaa et al, J Gynecol Oncol 29, 2018), and a multidisciplinary approach with supramesocolic procedures (Ren et al, BMC Cancer 15:1-12, 2015) impact overall survival. This study fails to compare chemotherapy with secondary cytoreductive surgery since, due to the lack of variables, we can assess neither the performed surgery nor its criteria. This study should not be taken into account to recommend chemotherapy alone over a surgical approach in this group of patients.
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Affiliation(s)
- Juan José Segura-Sampedro
- Department of General and Digestive Surgery, Son Espases University Hospital, Spain, 07010 Palma de Mallorca, Spain. Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain. School of Medicine, University of the Balearic Islands (UIB), Palma de Mallorca, Spain.
| | - Rafael Morales-Soriano
- Department of General and Digestive Surgery, Son Espases University Hospital, Spain, 07010 Palma de Mallorca, Spain. Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Álvaro Arjona-Sánchez
- General & Digestive Surgery Department, University Hospital Reina Sofía, School of Medicine, University of Córdoba, Córdoba, Spain
| | - Pedro Cascales-Campos
- General & Digestive Surgery Department, University Hospital Virgen de la Arrixaca, School of Medicine, University of Murcia, Murcia, Spain
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Dabi Y, Huchon C, Ouldamer L, Bendifallah S, Collinet P, Bricou A, Daraï E, Ballester M, Lavoue V, Haddad B, Touboul C. Patients with stage IV epithelial ovarian cancer: understanding the determinants of survival. J Transl Med 2020; 18:134. [PMID: 32293460 PMCID: PMC7087387 DOI: 10.1186/s12967-020-02295-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 03/11/2020] [Indexed: 01/10/2023] Open
Abstract
Background The most appropriate management for patients with stage IV ovarian cancer remains unclear. Our objective was to understand the main determinants associated with survival and to discuss best surgical management. Methods Data of 1038 patients with confirmed ovarian cancer treated between 1996 and 2016 were extracted from maintained databases of 7 French referral gynecologic oncology institutions. Patients with stage IV diseases were selected for further analysis. The Kaplan–Meier method was used to estimate the survival distribution. A Cox proportional hazards model including all the parameters statistically significant in univariable analysis, was used to account for the influence of multiple variables. Results Two hundred and eight patients met our inclusion criteria: 65 (31.3%) never underwent debulking surgery, 52 (25%) underwent primary debulking surgery (PDS) and 91 (43.8%) neoadjuvant chemotherapy and interval debulking surgery (NACT-IDS). Patients not operated had a significantly worse overall survival than patients that underwent PDS or NACT–IDS (p < 0.001). In multivariable analysis, three factors were independent predictors of survival: upfront surgery (HR 0.32 95% CI 0.14–0.71, p = 0.005), postoperative residual disease = 0 (HR 0.37 95% CI 0.18–0.75, p = 0.006) and association of Carboplatin and Paclitaxel regimen (HR 0.45 95% CI 0.25–0.80, p = 0.007). Conclusions Presence of distant metastases should not refrain surgeons from performing radical procedures, whenever the patient is able to tolerate. Maximal surgical efforts should be done to minimize residual disease as it is the main determinant of survival.
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Affiliation(s)
- Yohann Dabi
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Faculté de médecine de Créteil UPEC-Paris XII, Créteil, France
| | - Cyrille Huchon
- Department of Gynecology and Obstetrics, Intercommunal Hospital Centre of Poissy - Saint Germain - en - Laye, 78103, Poissy, France
| | - Lobna Ouldamer
- Department of Obstetrics and Gynecology, Centre hospitalier régional universitaire de Tours, hôpital Bretonneau, Tours, France
| | - Sofiane Bendifallah
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique, Hôpitaux de Paris (AP-HP) des, University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), Paris, France
| | - Pierre Collinet
- Department of Obstetrics and Gynecology, Centre Hospitalier Régional Universitaire, Lille, France
| | - Alexandre Bricou
- Department of Obstetrics and Gynecology, Jean-Verdier University Hospital, Assistance Publique, Hôpitaux de Paris (AP-HP) des, Paris, France
| | - Emile Daraï
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique, Hôpitaux de Paris (AP-HP) des, University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), Paris, France
| | - Marcos Ballester
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique, Hôpitaux de Paris (AP-HP) des, University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), Paris, France
| | - Vincent Lavoue
- CRLCC Eugène-Marquis, Department of Gynecology, CHU de Rennes, Université de Rennes 1, Rennes, France
| | - Bassam Haddad
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Faculté de médecine de Créteil UPEC-Paris XII, Créteil, France
| | - Cyril Touboul
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Faculté de médecine de Créteil UPEC-Paris XII, Créteil, France. .,Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique, Hôpitaux de Paris (AP-HP) des, University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), Paris, France. .,Service de Gynécologie Obstétrique, Hôpital Intercommunal de Créteil, 40 Avenue de Verdun, Créteil, 94000, France.
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Liberale G, Pop CF, Polastro L, Kerger J, Moreau M, Chintinne M, Larsimont D, Nogaret JM, Veys I. A radical approach to achieve complete cytoreductive surgery improve survival of patients with advanced ovarian cancer. J Visc Surg 2019; 157:79-86. [PMID: 31837942 DOI: 10.1016/j.jviscsurg.2019.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Cytoreductive surgery of locally advanced ovarian cancer has evolved in the last few years from surgery to remove macroscopic residual disease (<1cm; R2b) to macroscopic complete cytoreductive surgery with no gross residual disease (R1). The aim of this study was to evaluate the impact of the adoption of a maximalist surgical approach on postoperative complications, disease recurrence and survival. MATERIALS AND METHODS This was a retrospective study using prospectively collected data on patients who received either conservative approach (CA) or radical approach (RA) surgical treatment for primary ovarian cancer stage IIIc/IVa/IVb between June 2006 and June 2013. RESULTS Data for 114 patients were included, 33 patients in the CA group and 68 patients in the RA group were consequently analysed. In the RA group, operative time was longer, in relation to more complex surgical procedures; with more blood losses and a higher rate of compete macroscopic resection. Totally, 77% of the patients had postoperative complications, with more grade I/II complications in the RA group but the same rates of grade III/IV complications in the both groups (P=0.14). For all patient study population, the overall and disease-free survivals were improved in case of no macroscopic residual disease. Overall survival was improved in the RA group (P=0.05), with no difference in terms of disease-free survival (P=0.29) CONCLUSION: A radical approach in advanced ovarian cancer allows a higher rate of complete cytoreductive surgery impacting overall survival. However, a non-significant trend for increased mild complications (grade I/II) rate is observed in this group.
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Affiliation(s)
- G Liberale
- Surgical Oncology, Institut Jules-Bordet, Université libre de Bruxelles, 121, boulevard de Waterloo, 1000 Brussels, Belgium.
| | - C-F Pop
- Surgical Oncology, Institut Jules-Bordet, Université libre de Bruxelles, 121, boulevard de Waterloo, 1000 Brussels, Belgium
| | - L Polastro
- Medical Oncology, Institut Jules-Bordet, Université libre de Bruxelles, 1000 Brussels, Belgium
| | - J Kerger
- Medical Oncology, Institut Jules-Bordet, Université libre de Bruxelles, 1000 Brussels, Belgium
| | - M Moreau
- Statistics Department, Institut Jules-Bordet, Université libre de Bruxelles, 1000 Brussels, Belgium
| | - M Chintinne
- Pathology Department, Institut Jules-Bordet, Université libre de Bruxelles, 1000 Brussels, Belgium
| | - D Larsimont
- Pathology Department, Institut Jules-Bordet, Université libre de Bruxelles, 1000 Brussels, Belgium
| | - J M Nogaret
- Surgical Oncology, Institut Jules-Bordet, Université libre de Bruxelles, 121, boulevard de Waterloo, 1000 Brussels, Belgium
| | - I Veys
- Surgical Oncology, Institut Jules-Bordet, Université libre de Bruxelles, 121, boulevard de Waterloo, 1000 Brussels, Belgium
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17
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Xu Z, Becerra AZ, Justiniano CF, Aquina CT, Fleming FJ, Boscoe FP, Schymura MJ, Sinno AK, Chaoul J, Morrow GR, Minasian L, Temkin SM. Complications and Survivorship Trends After Primary Debulking Surgery for Ovarian Cancer. J Surg Res 2019; 246:34-41. [PMID: 31561176 DOI: 10.1016/j.jss.2019.08.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/29/2019] [Accepted: 08/29/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND We examined factors associated with postoperative complications, 1-year overall and cancer-specific survival after epithelial ovarian cancer (EOC) diagnosis. METHODS Patients who underwent surgery for EOC between 2004 and 2013 were included. Multivariable models analyzed postoperative complications, overall survival, and cancer-specific survival. RESULTS Among 5223 patients, surgical complications were common. Postoperative complications correlated with increased odds of overall and disease-specific survival at 1 y. Receipt of chemotherapy was similar among women with and without postoperative complications and was independently associated with a reduction in the hazard of overall and disease-specific death at 1-year. Extensive pelvic and upper abdomen surgery resulted in 2.26 times the odds of postoperative complication, but was associated with longer 1-year overall 0.53 (0.35, 0.82) and disease-specific survival 0.54 (0.34, 0.85). CONCLUSIONS Although extent of surgery was associated with complications, the survival benefit from comprehensive surgery offset the risk. Tailored surgical treatment for women with EOC may improve outcomes.
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Affiliation(s)
- Zhaomin Xu
- Department of Surgery, Surgical Health Outcomes and Research Enterprise, University of Rochester Medical Center, Rochester, New York
| | - Adan Z Becerra
- Department of Surgery, Surgical Health Outcomes and Research Enterprise, University of Rochester Medical Center, Rochester, New York; Department of Public Health Sciences, Social & Scientific Systems, Silver Spring, Maryland.
| | - Carla F Justiniano
- Department of Surgery, Surgical Health Outcomes and Research Enterprise, University of Rochester Medical Center, Rochester, New York
| | - Christopher T Aquina
- Department of Surgery, Surgical Health Outcomes and Research Enterprise, University of Rochester Medical Center, Rochester, New York
| | - Fergal J Fleming
- Department of Surgery, Surgical Health Outcomes and Research Enterprise, University of Rochester Medical Center, Rochester, New York
| | - Francis P Boscoe
- New York State Cancer Registry, New York State Department of Health, Albany, New York
| | - Maria J Schymura
- New York State Cancer Registry, New York State Department of Health, Albany, New York
| | - Abdulrahman K Sinno
- Department of Gynecology and Obstetrics, Olive View-UCLA Medical Center, Kagel Canyon, California
| | - Jessica Chaoul
- Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Gary R Morrow
- Department of Surgery, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Lori Minasian
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | - Sarah M Temkin
- Department of Ob/Gyn, Virginia Commonwealth University Medical Center, Richmond, Virginia
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18
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Ferron G, Narducci F, Pouget N, Touboul C. [Surgery for advanced stage ovarian cancer: Article drafted from the French Guidelines in oncology entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY under the aegis of CNGOF and endorsed by INCa]. ACTA ACUST UNITED AC 2019; 47:197-213. [PMID: 30792175 DOI: 10.1016/j.gofs.2019.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Indexed: 01/10/2023]
Abstract
Debulking surgery is the key step of advanced stage ovarian cancer treatment with chemotherapy. The quality of surgical resection is the main prognosis factor, thus a complete resection must be achieved (grade A) in an expert center (grade B). Surgery for stage IV is possible and has a benefit in case of complete peritoneal resection (LoE3). Pelvic and aortic lymphadenectomies are recommended in case of clinical or radiological suspicious lymph nodes (grade B). In absence of clinical or radiological suspicious lymph nodes and in case of complete peritoneal resection during initial debulking surgery, lymphadenectomy can be omitted because it won't change nor medical treatment nor overall survival (grade B). Neoadjuvant chemotherapy can be proposed in case of: impossibility to perform initial complete surgical resection (grade B) ; alteration of general state or co-morbidities or elderly patient (in order to decrease morbidity and increase quality of life) (grade B); stage IV with multiple intra-hepatic or pulmonary metastasis or important ascites with miliary (grade B). In case of stage III or IV ovarian cancer diagnosed on a biopsy during prior laparotomy, a neoadjuvant chemotherapy and interval debulking surgery should be preferred (gradeC). In case of palliative surgery or peroperative impossibility to perform a complete resection, no data regarding the type of surgery to perform influencing survival or quality of life is available. Peritoneal carcinosis description before resection and residual disease at the end of the surgery should be reported (size, location and reason of non-extirpability) (grade B). A score of peritoneal carcinosis such as Peritoneal Carcinosis Index (PCI) should be used in order to objectively evaluate the tumoral burden (gradeC). A standardized operative report is recommended (gradeC).
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Affiliation(s)
- G Ferron
- Inserm CRCT 19, département de chirurgie oncologique, institut Claudius Regaud, institut universitaire du cancer, 31000 Toulouse, France
| | - F Narducci
- Inserm U1192, département de chirurgie oncologique, centre Oscar Lambret, 59000 Lille, France
| | - N Pouget
- Département de chirurgie oncologique, chirurgie gynécologique et mammaire, institut Curie, site Saint-Cloud, 75005 Paris, France
| | - C Touboul
- IMRB, U955 Inserm, service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Créteil, institut Mondor de recherche biomédicale, 94000 Créteil, France.
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19
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Nieuwenhuyzen-de Boer GM, Hofhuis W, Reesink-Peters N, Ewing-Graham PC, Schoots IG, Beltman JJ, Piek JMJ, Baalbergen A, Kooi GS, van Haaften A, van Huisseling H, Haans L, Dorman M, van Beekhuizen HJ. Evaluation of effectiveness of the PlasmaJet surgical device in the treatment of advanced stage ovarian cancer (PlaComOv-study): study protocol of a randomized controlled trial in the Netherlands. BMC Cancer 2019; 19:58. [PMID: 30642296 PMCID: PMC6332622 DOI: 10.1186/s12885-019-5275-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 01/03/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The most important goal for survival benefit of advanced stage ovarian cancer is to surgically remove all visible tumour, because complete cytoreductive surgery (CCS) has been shown to be associated with prolonged survival. In a remarkable number of women, CCS is very challenging. Especially in women with many small metastases on the peritoneum and intestinal surface, conventional CCS with electrosurgery is not able to be "complete" in removing safely all visible tumour. In this randomized controlled trail (RCT) we investigate whether the use of the PlasmaJet Surgical Device increases the rate of CCS, and whether this indeed leads to a longer progression free and overall survival. The main research question is: does the use of the PlasmaJet Surgical Device in surgery for advanced stage ovarian cancer result in an increased number of complete cytoreductive surgeries when compared with conventional surgical techniques. Secondary study objectives are: 30-day morbidity, duration of surgery, blood loss, length of hospitalisation, Quality of Life, disease-free survival, overall survival, percentage colostomy, cost-effectiveness. METHODS The study design is a multicentre single-blinded superiority RCT in two university and nine non-university hospitals in The Netherlands. Three hundred and thirty women undergoing cytoreductive surgery for advanced stage ovarian carcinoma (FIGO Stage IIIB-IV) will be randomized into two arms: use of the PlasmaJet (intervention group) versus the use of standard surgical instruments combined with electrocoagulation (control group). The primary outcome is the rate of complete cytoreductive surgery in both groups. Secondary study objectives are: 30-day morbidity, duration of surgery, blood loss, length of hospitalisation, Quality of Life, disease-free survival, overall survival, percentage colostomy, cost-effectiveness. Quality of life will be evaluated using validated questionnaires at baseline, at 1 and 6 months after surgery and at 1, 2, 3 and 4 years after surgery. DISCUSSION We hypothesize the additional value of the use of the PlasmaJet in CCS for advanced stage epithelial ovarian cancer. More knowledge about efficacy, side effects, recurrence rates, cost effectiveness and pathology findings after using the PlasmaJet Device is advocated. This RCT may aid in this void. TRIAL REGISTRATION Dutch Trial Register NTR6624 . Registered 18 August 2017. Medical Ethical Committee approval number: NL62035.078.17 (Medical Ethical Committee Erasmus Medical Centre Rotterdam).
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Affiliation(s)
- G M Nieuwenhuyzen-de Boer
- Department of Gynaecologic Oncology, Erasmus MC Cancer Institute, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - W Hofhuis
- Department of Obstetrics and Gynaecology, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - N Reesink-Peters
- Department of Obstetrics and Gynaecology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - P C Ewing-Graham
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - I G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J J Beltman
- Department of Obstetrics and Gynaecology, Leids University Medical Centre, Leiden, The Netherlands
| | - J M J Piek
- Department of Obstetrics and Gynaecology, Catharina Cancer Institute, Eindhoven, The Netherlands
| | - A Baalbergen
- Department of Obstetrics and Gynaecology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - G S Kooi
- Department of Obstetrics and Gynaecology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - A van Haaften
- Department of Obstetrics and Gynaecology, Haga Hospital, The Hague, The Netherlands
| | - H van Huisseling
- Department of Obstetrics and Gynaecology, Groene Hart Hospital, Gouda, The Netherlands
| | - L Haans
- Department of Obstetrics and Gynaecology, Haags Medical Centre, The Hague, The Netherlands
| | - M Dorman
- Department of Obstetrics and Gynaecology, Bravis Hospital, Bergen op Zoom, The Netherlands
| | - H J van Beekhuizen
- Department of Gynaecologic Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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20
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Di Lorenzo G, Ricci G, Severini GM, Romano F, Biffi S. Imaging and therapy of ovarian cancer: clinical application of nanoparticles and future perspectives. Theranostics 2018; 8:4279-4294. [PMID: 30214620 PMCID: PMC6134923 DOI: 10.7150/thno.26345] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 06/08/2018] [Indexed: 12/16/2022] Open
Abstract
Despite significant advances in cancer diagnostics and treatment, ovarian cancers (OC) continue to kill more than 150,000 women every year worldwide. Due to the relatively asymptomatic nature and the advanced stage of the disease at the time of diagnosis, OC is the most lethal gynecologic malignancy. The current treatment for advanced OC relies on the synergistic effect of combining surgical cytoreduction and chemotherapy; however, beside the fact that chemotherapy resistance is a major challenge in OC management, new imaging strategies are needed to target microscopic lesions and improve both cytoreductive surgery and patient outcomes. In this context, nanostructured probes are emerging as a new class of medical tool that can simultaneously provide imaging contrast, target tumor cells, and carry a wide range of medicines resulting in better diagnosis and therapeutic precision. Herein we summarize several exemplary efforts in nanomedicine for addressing unmet clinical needs.
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Affiliation(s)
| | | | | | | | - Stefania Biffi
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
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21
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Lee YJ, Chung YS, Lee JY, Nam EJ, Kim SW, Kim S, Kim YT. Impact of increased utilization of neoadjuvant chemotherapy on survival in patients with advanced ovarian cancer: experience from a comprehensive cancer center. J Gynecol Oncol 2018; 29:e63. [PMID: 29770632 PMCID: PMC5981113 DOI: 10.3802/jgo.2018.29.e63] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/01/2018] [Accepted: 04/06/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The choice between primary debulking surgery (PDS) and neoadjuvant chemotherapy (NAC) in advanced ovarian cancer remains controversial. We evaluated NAC use in our center before and after results from a randomized trial were published, with the aim to determine the impact of changes in the neoadjuvant strategy on survival in advanced-stage ovarian cancer. METHODS We retrospectively investigated the clinical course of 435 patients with ovarian, tubal, or peritoneal carcinoma (International Federation of Gynecology and Obstetrics [FIGO] stage III or IV). According to the period of treatment, we stratified patients into a control group (n=216; diagnosed between 2006 and 2010; 83.8% underwent PDS) and a study group (n=219; diagnosed between 2011 and 2014; 48.9% received NAC followed by interval debulking surgery [IDS]). RESULTS There were no between-group differences in age, body mass index, histology findings, or tumor grade. Compared to patients in the control group, those in the study group were more likely to receive NAC followed by IDS as first-line treatment (48.9% vs. 16.2%; p<0.001), cytoreductive surgery to no-residual disease (21.5% vs. 10.2%; p<0.001), or radical surgery (57.5% vs. 35.6%; p<0.001). However, there was no between-group difference in postoperative morbidity. Kaplan-Meier analysis showed no between-group differences in progression-free or overall survival (p=0.449 and 0.952, respectively). CONCLUSION NAC incorporation resulted in increased optimal cytoreduction rates although no significant differences in survival outcomes were noted. NAC is advantageous for patients with high perioperative morbidity or unresectable disease.
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Affiliation(s)
- Yong Jae Lee
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Young Shin Chung
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Yun Lee
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ji Nam
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Wun Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sunghoon Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
| | - Young Tae Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
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22
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A Comparison of Thermal Plasma Energy Versus Argon Beam Coagulator-Induced Intestinal Injury After Vaporization in a Porcine Model. Int J Gynecol Cancer 2018; 27:177-182. [PMID: 27922979 DOI: 10.1097/igc.0000000000000849] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Complete cytoreduction of ovarian cancer often requires excision or ablation of bowel serosa implants. Both argon beam coagulator (ABC) and thermal plasma energy (TPE) (PlasmaJet; PlasmaSurgical, Roswell, Ga) have been used to ablate bowel serosa implants. Our objective was to identify comparable power settings as well as determine the rate of bowel perforation, depth of thermal injury, and extent of inflammatory response with ABC versus TPE in a porcine model. MATERIALS AND METHODS Nine pigs underwent vaporization of small bowel and colon serosa according to assigned treatment group (TPE vs ABC) and settings (ABC: 30, 50, and 70 W; TPE: Cut 10U, 20U, and 30U and Coagulation 10U, 20U, and 30U). Animals underwent necropsy with blinded histomorphologic evaluation on days 0, 3, and 10 postprocedure to assess for presence of bowel perforation, depth of thermal injury, and extent of inflammatory response. RESULTS At necropsy, bowel perforation was not identified in any animals. Depth of treatment with ABC in the porcine colon was variable and unrelated to power settings whereas TPE was associated with a consistent treatment depth of 1.0 mm regardless of location or power. Treatment with ABC resulted in greater tissue coagulation and desiccation as well as increased rates of mucosal necrosis, especially at higher settings (>50 W). Treatment with TPE primarily resulted in tissue ablation and minimal mucosal necrosis at low settings (Coag 10U-20U). The inflammatory response associated with TPE treatments was interpreted as biologically benign, and less than that observed with the ABC regardless of treatment settings. CONCLUSIONS Both ABC and TPE effectively ablate bowel serosa in a porcine model. The TPE seems to result in a more predictable tissue effect with less inflammatory response, especially when used at low power settings such as Coag 10U or 20U. These characteristics are appealing for ablation of bowel serosa implants during ovarian cancer surgery and warrant further investigation.
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23
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The preoperative albumin level is an independent prognostic factor for optimally debulked epithelial ovarian cancer. Arch Gynecol Obstet 2017; 296:989-995. [PMID: 28875365 DOI: 10.1007/s00404-017-4511-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 08/30/2017] [Indexed: 01/29/2023]
Abstract
PURPOSE A low albumin level has been reported to be a prognostic factor for various cancers. The aim of this study was to determine the association between preoperative serum albumin level and survival in patients with epithelial ovarian cancer (EOC). METHODS Records of 337 patients with EOC that underwent optimal cytoreductive surgery were retrospectively reviewed. Threshold albumin level was planned as 32.5 g L-1 due to the statistical analyses. RESULTS Mean overall survival was 51.5 months. Area under the ROC curve was found statistically significant for the discriminative role of albumin for survival outcome (AUC = 0.857, 95% CI 0.813-0.90, P < 0.001). The best cut-off point for albumin was determined as 32.5 g L-1. The sensitivity rate, specificity rate, positive and negative predictive values, and accuracy rate for this cut-off level were found 67.2, 91.2, 81.2, 83.1, and 82.5%, respectively. Preoperative hypoalbuminemia was noted in 101 (30.0%) of the patients, of which 6.2% had an albumin level <25 g L-1. The albumin level was independently and significantly associated with overall survival (HR 2.6; 95% CI 2.1-3.1; P < 0.001). Subgroup analysis showed that patients with an albumin level <32.5 and ≥32.5 g L-1 had mean estimated overall survival of 40.6 and 96.0 months, respectively. Age, stage, and presence of ascites were the other independent significant factors. CONCLUSIONS The preoperative albumin level is an independent prognostic factor for overall survival in optimally debulked EOC patients. Further investigations about preoperative albumin level in prognostic models will contribute to the literature.
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Xiao W, Suby N, Xiao K, Lin TY, Al Awwad N, Lam KS, Li Y. Extremely long tumor retention, multi-responsive boronate crosslinked micelles with superior therapeutic efficacy for ovarian cancer. J Control Release 2017; 264:169-179. [PMID: 28847739 DOI: 10.1016/j.jconrel.2017.08.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/25/2017] [Accepted: 08/22/2017] [Indexed: 02/05/2023]
Abstract
Mortality rates for ovarian cancer have declined only slightly in the past forty years since the "War on Cancer" was declared. The current standard care of ovarian cancer is still cytoredutive surgery followed by several cycles of chemotherapy. The severe adverse effect from chemotherapy drug is a leading cause for the patients to fail in long term therapy post-surgery. New nanocarriers able to minimize the premature drug release in blood circulation while releasing drug on-demand at tumor site have profound impact on the improvement of the efficacy and toxicity profile of the chemotherapeutic drugs. Here we reported a unique type of extremely long tumor retention, multi-responsive boronate crosslinked micelles (BCM) for ovarian cancer therapy. We systemically investigated the stability of BCM in serum and plasma, and their responsiveness to acidic pH and cis-diols (such as mannitol, a safe FDA approved drug for diuresis) through particle size measurement and förster resonance energy transfer (FRET) approach. Paclitaxel (PTX) loaded BCM (BCM-PTX) exhibited higher stability than non-crosslinked micelles (NCM) in the presence of plasma or serum. BCMs possessed a longer in vivo blood circulation time when compared to NCM. Furthermore, BCM could be disassembled in an acidic pH environment or by administrating mannitol, facilitating drug release in an acidic tumor environment and triggered by exogenous stimuli after drug enrichment in tumor mass. Near infra-red fluorescence (NIRF) imaging on SKOV-3 ovarian cancer mouse model demonstrated that the NIR dye DiD encapsulated BCM could preferentially accumulate in tumor site and their tumor retention was very long with still 66% remained on 12th day post injection. DiD-NCM had similar high-level uptake in tumor with DiD-BCM within the first 3days, its accumulation, however, decreased obviously on 4th day and only 15% dye was left 12days later. In both formulations, the dye uptake in normal organs was mostly washed away within the first 24-48h. In in vivo tumor treatment study, PTX loaded BCM showed superior therapeutic efficacy than that of NCM and Taxol. The mice could tolerate 20mg/kg PTX formulated in nano-formulations, which doubled the maximum tolerated dose (MTD) of Taxol. The administration of mannitol 24h after BCM-PTX injection further improved the tumor therapeutic effect and elongated the survival time of the mice. The novel boronate-catechol crosslinked nanocarrier platform demonstrated its superior capability in targeted drug delivery, which is not only useful for ovarian cancer treatment but will also be beneficial for the therapy of many other solid tumors.
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Affiliation(s)
- Wenwu Xiao
- Department of Biochemistry and Molecular Medicine, UC Davis Comprehensive Cancer Center, University of California Davis, Sacramento, CA 95817, USA
| | - Nell Suby
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, UC Davis Comprehensive Cancer Center, University of California Davis, Sacramento, CA 95817, USA
| | - Kai Xiao
- National Chengdu Center for Safety Evaluation of Drugs, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Tzu-Yin Lin
- Department of Internal Medicine, Division of Hematology/Oncology, University of California Davis, Sacramento, CA 95817, USA
| | - Nasir Al Awwad
- Pathology College of Clinical Pharmacy, Al-Baha University, Al-Baha City 11074, Saudi Arabia
| | - Kit S Lam
- Department of Biochemistry and Molecular Medicine, UC Davis Comprehensive Cancer Center, University of California Davis, Sacramento, CA 95817, USA.
| | - Yuanpei Li
- Department of Biochemistry and Molecular Medicine, UC Davis Comprehensive Cancer Center, University of California Davis, Sacramento, CA 95817, USA.
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25
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Eoh KJ, Yoon JW, Lee I, Lee JY, Kim S, Kim SW, Kim YT, Nam EJ. The efficacy of systematic lymph node dissection in advanced epithelial ovarian cancer during interval debulking surgery performed after neoadjuvant chemotherapy. J Surg Oncol 2017; 116:329-336. [DOI: 10.1002/jso.24669] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 04/17/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Kyung Jin Eoh
- Institute of Women's Life Medical Science, Women's Cancer Clinic, Department of Obstetrics and Gynecology; Yonsei University College of Medicine; Seoul Korea
| | - Jung Won Yoon
- Institute of Women's Life Medical Science, Women's Cancer Clinic, Department of Obstetrics and Gynecology; Yonsei University College of Medicine; Seoul Korea
| | - Inok Lee
- Institute of Women's Life Medical Science, Women's Cancer Clinic, Department of Obstetrics and Gynecology; Yonsei University College of Medicine; Seoul Korea
| | - Jung-Yun Lee
- Institute of Women's Life Medical Science, Women's Cancer Clinic, Department of Obstetrics and Gynecology; Yonsei University College of Medicine; Seoul Korea
| | - Sunghoon Kim
- Institute of Women's Life Medical Science, Women's Cancer Clinic, Department of Obstetrics and Gynecology; Yonsei University College of Medicine; Seoul Korea
| | - Sang Wun Kim
- Institute of Women's Life Medical Science, Women's Cancer Clinic, Department of Obstetrics and Gynecology; Yonsei University College of Medicine; Seoul Korea
| | - Young Tae Kim
- Institute of Women's Life Medical Science, Women's Cancer Clinic, Department of Obstetrics and Gynecology; Yonsei University College of Medicine; Seoul Korea
| | - Eun Ji Nam
- Institute of Women's Life Medical Science, Women's Cancer Clinic, Department of Obstetrics and Gynecology; Yonsei University College of Medicine; Seoul Korea
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26
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Diaphragmatic Surgery and Related Complications In Primary Cytoreduction for Advanced Ovarian, Tubal, and Peritoneal Carcinoma. BMC Cancer 2017; 17:317. [PMID: 28476108 PMCID: PMC5420098 DOI: 10.1186/s12885-017-3311-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/01/2017] [Indexed: 11/30/2022] Open
Abstract
Background To evaluate the procedures and complications of diaphragm peritonectomy (DP) and diaphragm full-thickness resection (DFTR) during primary cytoreduction for advanced stage epithelial ovarian cancer. Methods All the patients with epithelial ovarian carcinoma who underwent diaphragm procedures at our institution between January 2009 and August 2015 were identified. Clinicopathological data were retrospectively collected from the patients’ medical records. Postoperative morbidities were assessed according to the Memorial Sloan-Kettering Cancer Center (MSKCC) grading system. Results A total of 150 patients were included in the study. The majority of the patients had ovarian cancer (96%), stage IIIC disease (76%) and serous histology (89.3%). DP and DFTR were performed in 124 (82.7%) and 26 (17.3%) patients, respectively. A total of 142 upper abdominal procedures in addition to the diaphragmatic surgery were performed in 77 (51.3%) patients. No macroscopic residual disease was observed in 35.3% of the patients, while 84% of the total patient cohort had residual disease ≤1 cm. The overall incidence of at least one major morbidity (MSKCC grades 3–5) was 18.0%, whereas pleural effusions (33.3%), pneumonia (15.3%) and pneumothorax (7.3%) were the most commonly reported morbidities. The rate of postoperative pleural drainage was 14.6% in total, while half the patients in the DFTR group received drainage intraoperatively (11.5%) and postoperatively (38.5%). The incidence of postoperative pleural effusion was associated with stage IV disease (hazard ratio [HR], 17.2; 95% confidence interval [CI]: 4.5–66.7; P < 0.001), DFTR (HR, 4.9; 95% CI: 1.2–19.9; P = 0.028) and a long surgery time (HR, 15.4; 95% CI: 4.3–55.5; P < 0.001). Conclusions Execution of DP and DFTR as part of an extensive upper abdominal procedure resulted in an acceptable morbidity rate. Pleural effusion, pneumonia and pneumothorax were the most common pulmonary morbidities. The pleural drainage rate was not high enough to justify prophylactic chest tube placement for all the patients. However, patients who underwent DFTR merited special consideration for intraoperative prophylactic drainage.
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Wallace S, Kumar A, Mc Gree M, Weaver A, Mariani A, Langstraat C, Dowdy S, Bakkum-Gamez J, Cliby W. Efforts at maximal cytoreduction improve survival in ovarian cancer patients, even when complete gross resection is not feasible. Gynecol Oncol 2017; 145:21-26. [DOI: 10.1016/j.ygyno.2017.01.029] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/24/2017] [Accepted: 01/26/2017] [Indexed: 10/20/2022]
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Kessous R, Laskov I, Abitbol J, Bitharas J, Yasmeen A, Salvador S, Lau S, Gotlieb WH. Clinical outcome of neoadjuvant chemotherapy for advanced ovarian cancer. Gynecol Oncol 2016; 144:474-479. [PMID: 28041690 DOI: 10.1016/j.ygyno.2016.12.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 12/15/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate clinical outcome in patients selected to receive neoadjuvant chemotherapy (NACT) compared to primary debulking surgery (PDS). METHODS Retrospective study including all consecutive patients diagnosed and treated for advanced (stages III-IV) ovarian cancers between the years 2003-2015. RESULTS 263 women were included in the study, of these, 127 patients were selected to receive NACT and 136 were treated with PDS followed by adjuvant chemotherapy. PDS was associated with longer OS in stage IIIc disease (median OS: 60.2 vs. 48.8months; p-value 0.039) compared with NACT. Patients achieved higher rates of complete cytoreduction in the NACT group compared to the PDS group (65.9% vs. 40.2%; p=0.001). Patients attaining complete cytoreduction after PDS had the best survival, (median OS 106months) followed by those with complete cytoreduction after NACT (median OS 71months), followed by those with residual disease after PDS (median OS 55months). Patients with residual disease following interval debulking after NACT had the worst outcome (median OS 36months). Platinum sensitivity following first line and second line chemotherapy was similar whether patients received neoadjuvant chemotherapy or not. CONCLUSION PDS was associated with improved outcome. NACT appears to improve survival outcome in patients that would have had residual disease after PDS, and attain complete cytoreduction at the time of interval cytoreduction. This treatment option can be used in selected patients that are not candidates for complete cytoreduction at PDS.
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Affiliation(s)
- Roy Kessous
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada
| | - Ido Laskov
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada
| | - Jeremie Abitbol
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada
| | - Joanna Bitharas
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada
| | - Amber Yasmeen
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada
| | - Shannon Salvador
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada
| | - Susie Lau
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada
| | - Walter H Gotlieb
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada.
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Ørskov M, Iachina M, Guldberg R, Mogensen O, Mertz Nørgård B. Predictors of mortality within 1 year after primary ovarian cancer surgery: a nationwide cohort study. BMJ Open 2016; 6:e010123. [PMID: 27103625 PMCID: PMC4853993 DOI: 10.1136/bmjopen-2015-010123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To identify predictors of mortality within 1 year after primary surgery for ovarian cancer. DESIGN Prospective nationwide cohort study from 1 January 2005 to 31 December 2012. SETTING Evaluation of data from the Danish Gynaecology Cancer Database and the Danish Civil Registration System. PARTICIPANTS 2654 women who underwent surgery due to a diagnosis of primary ovarian cancer. OUTCOME MEASURES Overall survival and predictors of mortality within 0-180 and 181-360 days after the primary surgery. Examined predictors were age, preoperative American Society of Anesthesiologists (ASA) score, body mass index (BMI), International Federation of Gynaecology and Obstetrics (FIGO) stage, residual tumour tissue after surgery, perioperative blood transfusion and calendar year of surgery. RESULTS The overall 1-year survival was 84%. Within 0-180 days after surgery, the 3 most important predictors of mortality from the multivariable model were residual tumour tissue >2 cm versus no residual tumour (HR=4.58 (95% CI 3.20 to 6.59)), residual tumour tissue ≤2 cm versus no residual tumour (HR=2.50 (95% CI 1.63 to 3.82)) and age >64 years versus age ≤64 years (HR=2.33 (95% CI 1.69 to 3.21)). Within 181-360 days after surgery, FIGO stages III-IV versus I-II (HR=2.81 (95% CI 1.75 to 4.50)), BMI<18.5 vs 18.5-25 kg/m(2) (HR=2.08 (95% CI 1.18 to 3.66)) and residual tumour tissue >2 cm versus no residual tumour (HR=1.84 (95% CI 1.25 to 2.70)) were the 3 most important predictors. CONCLUSIONS The most important predictors of mortality within 1 year after surgery were residual tumour tissue (0-180 days after surgery) and advanced FIGO stage (181-360 days after surgery). However, our results suggest that the surgeon should not just aim at radical surgery, but also pay special attention to comorbidity, nutritional state, age >64 years and the need for perioperative blood transfusion.
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Affiliation(s)
- Mette Ørskov
- Research Unit of Gynecology, Department of Gynecology and Obstetrics, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Maria Iachina
- Research Unit of Clinical Epidemiology, Centre for Clinical Epidemiology Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rikke Guldberg
- Research Unit of Clinical Epidemiology, Centre for Clinical Epidemiology Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ole Mogensen
- Research Unit of Gynecology, Department of Gynecology and Obstetrics, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bente Mertz Nørgård
- Research Unit of Clinical Epidemiology, Centre for Clinical Epidemiology Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Greggi S, Falcone F, Carputo R, Raspagliesi F, Scaffa C, Laurelli G, Giorda G, Di Vagno G, Petruzzelli F, Cormio G, Marinaccio M, Pignata S. Primary surgical cytoreduction in advanced ovarian cancer: An outcome analysis within the MITO (Multicentre Italian Trials in Ovarian Cancer and Gynecologic Malignancies) Group. Gynecol Oncol 2016; 140:425-9. [DOI: 10.1016/j.ygyno.2016.01.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/18/2016] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
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Kehoe S, Fares R, Phillips A. Ovarian cancer: is chemotherapy before surgery the way forward? INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2016. [DOI: 10.2217/ije.15.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The treatment of advanced ovarian cancer is a combination of surgery and platin-based chemotherapy, with surgery traditionally the first intervention. Neoadjuvant therapy was only used in women who were deemed unfit for an operation. However, in recent years, two prospective randomized studies have evaluated the concept of neoadjuvant chemotherapy, and in both studies the results revealed that neoadjuvant chemotherapy with delayed surgery afforded similar survival rates compared with primary surgery but with reduced treatment-related morbidity. Thus, a novel evidence-based alternative approach to advanced ovarian cancer is now available.
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Affiliation(s)
- Sean Kehoe
- Institute of Cancer & Genomics, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
- St Peter's College, New Inn Hall St, Oxford OX1 2DL, UK
| | - Rami Fares
- Institute of Cancer & Genomics, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
- Pan Birmingham Gynecological Cancer Center, City Hospital, Birmingham, West Midlands B18 7QH, UK
| | - Andrew Phillips
- Pan Birmingham Gynecological Cancer Center, City Hospital, Birmingham, West Midlands B18 7QH, UK
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