Impact of Ovarian Cancer Surgery Volume on Overall and Progression-Free Survival: A Population-Based Retrospective National French Study

BACKGROUND

Data are limited on the relationship between ovarian cancer surgery volume and outcomes in France.

METHODS

For this retrospective, population-based study, patients with ovarian cancer that was diagnosed between January 1, 2012 and December 31, 2016 were identified from the French National Health Data System (SNDS). Hospitals were classified in function of their ovarian cancer surgery volume. Patient, tumor, hospital, and hospital stay characteristics also were evaluated. The hospital procedure volume effect on 5-year overall survival (OS) and recurrence-free survival (RFS) was determined with Cox-proportional hazards models.

RESULTS

This study included 8429 patients and 53.4% underwent cytoreductive surgery in hospitals with procedure volume < 20 cases/year. The 5-year OS rates were 63% and 60% in hospitals with procedure volume ≥ 20 and < 20 cases/year (p = 0.02). In multivariate analysis, OS and RFS were significantly increased when surgery was performed in hospitals doing ≥ 20 surgeries/year (vs. < 20) (hazard ratio HR = 1.18, 95% CI = 1.08-1.29 and HR = 1.10, 95% CI = 1.03-1.17). In the volume subgroup analysis, a difference was observed mainly between hospitals with < 10 surgeries/year and the other hospitals (HR = 1.27, 95% CI = 1.14-1.41 and HR = 1.14, 95% CI = 1.05-1.23). The patients' age and comorbidities, tumor stage, and hospital stay (duration, first cytoreduction surgery) were associated with OS.

CONCLUSIONS

Ovarian cancer surgery volume ≥ 20 cases/year was significantly associated with improved OS and RFS but only with a limited clinical benefit. The biggest differences in OS and RFS were observed between hospitals with procedure volume < 10 cases/year and all the other hospitals.

Study of oxaliplatin penetration into ovaries of patients treated with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal metastases of colorectal and appendiceal origin using mass spectrometry imaging

Objectives

Platinum salts are commonly used in hyperthermic intraperitoneal chemotherapy (HIPEC) for digestive tract cancer treatment. During HIPEC with oxaliplatin for peritoneal metastases (PMs) treatment, the ovaries are directly exposed to the drug, questioning about ovarian resection and the potential impact of the drug on ovarian functionality, especially in young women of childbearing age. The goal of this work is to understand unwanted damages to the ovaries during HIPEC therapy by the determination of the concentration and distribution of platinum in ovaries in order to address its potential toxicity.

Methods

Mass spectrometry imaging techniques, matrix-assisted laser desorption ionization mass spectrometry (MALDI-MS) and laser ablation inductively coupled plasma mass spectrometry (LA-ICP MS), were used to study the penetration of oxaliplatin in ovaries after HIPEC treatment.

Results

MALDI-MS allowed the localization of an oxaliplatin-derivative (m/z 456.2) at the periphery of the ovaries. The quantitative LA-ICP MS maps confirmed the localization of elemental platinum as well as in the central part of ovaries from patients who received a previous platinum salt-based chemotherapy.

Conclusions

LA-ICP MS images showed that platinum diffusion was extended in cases of previous systemic treatment, questioning about platinum derivatives gonado-toxicity when combining the two treatments.

[Identification of sentinel lymph node: Comparison between SNOLL and routine isotopic procedure]

INTRODUCTION

Axillary staging remains the most accurate predictive factor for recurrence risk and survival in patients with invasive breast carcinoma. Sentinel Node Occult Lesion Localization (SNOLL) allows with a single intra-lesion injection both localization of impalpable breast lesion and sentinel node biopsy. Our aim was to compare the efficacy of SNOLL and standard radio isotopic method for sentinel node localization by lymphoscintigraphy.

METHODS

This retrospective study enrolled 100 patients treated for breast carcinoma with indication of sentinel node biopsy between may 2017 and January 2019 in breast surgery unit of Montpellier university hospital.

RESULTS

SNOLL and standard radio isotopic method were realized in respectively 65 and 35 patients. Failure rates of sentinel node localization were respectively 34% and 11% by lymphoscintigraphy (P=0.02), 17% and 9% intraoperatively and 11% et 6% using radioisotope combined with colorimetric method.

DISCUSSION

Failure rate of sentinel node localization is higher using SNOLL. This rate is reduced by additional radioisope migration in the time between isotope injection and surgery and by the use of combined method. SNOLL should therefore be combined with colorimetric method. These results must be confirmed in a larger study.