Editorial: Towards better and personalized management of ovarian cancer in China

Abstract

Ovarian cancer remains the most lethal gynaecological malignancy worldwide, with 313 959 newly diagnosed cases and 207 252 deaths annually; approximately one-sixth of which occur in China.1 Despite the advances in the treatment of ovarian cancer, its 5-year survival rate has not surpassed 45%.2 In this supplement to the British Journal of Obstetrics and Gynaecology, eight manuscripts that focus on ovarian cancer therapy efficacy and consequences, therapeutic and prognostic biomarkers, shifts in treatment patterns, and establishment of big data gynaecological oncology platforms are included to outline the recent advances in our understanding of ovarian cancer management in China. Primary debulking surgery (PDS) followed by chemotherapy or neoadjuvant chemotherapy (NACT) and then interval debulking surgery (IDS) has been the standard of care for advanced epithelial ovarian cancer (EOC), and the absence of residual tumour after surgery is an important determinant of survival. Sun et al. summarised EOC-targeted fluorescent probes and open-field fluorescence imaging strategies to eradicate submillimetre and intraperitoneally scattered tumour masses to achieve complete resection. However, complete resection does not benefit all ovarian cancer subtypes. Liu et al. conducted a multicentre retrospective study and revealed that omentectomy did not improve survival and had no impact on pregnancy or live birth rates in apparently early malignant ovarian germ cell tumours. Therefore, prospective clinical trials are required to validate our conclusions. Intraperitoneally scattered tumour masses of ovarian cancer provide a rationale for the utilisation of intraperitoneal chemotherapy (IP). However, current randomised clinical trials failed to demonstrate the survival benefits of IP.3 Xiang et al. took advantage of the follow-up population of the AICE trial4 to conduct a treatment-free survival (TFS) analysis and demonstrated that patients with high tumour burden achieved significantly longer TFS and quality-adjusted overall survival (OS) compared with their counterparts with low tumour load when treated with IP followed by intravenous chemotherapy. Hyperthermic IP (HIPEC) after PDS improved the survival of EOC,5 but HIPEC in the neoadjuvant setting (NHIPEC) has not been sufficiently studied. Wu et al. demonstrated that NHIPEC plus NACT resulted in significantly prolonged progression-free survival (PFS) compared with NACT alone in patients with advanced high-grade serous ovarian cancer (HGSOC) in a retrospective study. Approximately 50% of HGSOC cases suffer from homologous recombination deficiency (HRD), which enables synthetic lethality with poly (ADP-ribose) polymerase (PARP) inhibition. Yuan et al. constructed a genomic scar model to predict HRD using machine learning algorithms, which demonstrated a sensitivity over 97% in detecting BRCA-deficient events and exhibited robustness in identifying responders to PARP inhibitors (PARPi). Treatment-naïve ovarian cancer often has a high response rate to platinum-based chemotherapy; however, platinum resistance inevitably emerges. Wu et al. revealed that co-expression of SLC7A11 and GPX4, two pivotal ferroptosis-related proteins, is significantly associated with platinum resistance and predicts worse PFS and OS. Liu et al. investigated the association among the primary treatment sequence (PDS versus NACT-IDS), recurrence characteristics, and post-relapse survival (PRS) based on real-world evidence. NACT-IDS was revealed as an independent risk factor for decreased PRS and was significantly associated with a shortened progression-free interval and a diffuse pattern of recurrence. China has the largest gynaecological oncology population worldwide and produces tremendous quantities of real-world disease- and treatment-related data. Zeng et al. established the National Union of Real-world Gynecological Oncology Research and Patient Management Platform (NUWA platform), the first large, scalable longitudinal clinico-genomic database in China that integrates multidimensional data on gynaecological oncology. They presented the implementation status and quality control methodology of the platform and leveraged the currently available data derived from 11 456 patients with ovarian cancer to display treatment pattern shifts in recent years. We are grateful to all the authors for their contributions and to British Journal of Obstetrics and Gynaecology for publishing this special issue. We believe that the contents of this issue will help readers understand the efforts of Chinese clinicians and researchers to facilitate better and personalised management of ovarian cancer in China.