Microscopic Peritoneal Residual Disease after Complete Macroscopic Cytoreductive Surgery for Advanced High Grade Serous Ovarian Cancer.

Henri Azaïs,Catherine Uzan,Elisabeth Da Maïa,Serge Mordon,Pierre Collinet,Anne-Sophie Vignion-Dewalle,Laurine Ziane,Marine Carrier,Marianne Nikpayam,Clémentine Gonthier,Geoffroy Canlorbe,Jeremy Augustin,Alix Penel,Jérémie Belghiti

doi:10.3390/jcm10010041

Abstract

Background: Epithelial ovarian cancers (EOC) are usually diagnosed at an advanced stage and managed by complete macroscopic cytoreductive surgery (CRS) and systemic chemotherapy. Peritoneal recurrence occurs in 60% of patients and may be due to microscopic peritoneal metastases (mPM) which are neither eradicated by surgery nor controlled by systemic chemotherapy. The aim of this study was to assess and quantify the prevalence of residual mPM after complete macroscopic CRS in patients with advanced high-grade serous ovarian cancer (HGSOC). Methods: A prospective study conducted between 1 June 2018 and 10 July 2019 in a single referent center accredited by the European Society of Gynecological Oncology for advanced EOC management. Consecutive patients presenting with advanced HGSOC and eligible for complete macroscopic CRS were included. Up to 13 peritoneal biopsies were taken from macroscopically healthy peritoneum at the end of CRS and examined for the presence of mPM. A mathematical model was designed to determine the probability of presenting at least one mPM after CRS. Results: 26 patients were included and 26.9% presented mPM. There were no differences in characteristics between patients with or without identified mPM. After mathematical analysis, the probability that mPM remained after complete macroscopic CRS in patients with EOC was 98.14%. Conclusion: Microscopic PM is systematically present after complete macroscopic CRS for EOC and could be a relevant therapeutic target. Adjuvant locoregional strategies to conventional surgery may improve survival by achieving microscopic CRS.

Highlights

Epithelial ovarian cancer (EOC) is usually diagnosed at an advanced stage and the clinical situation is characterized by the presence of extensive peritoneal metastases (PM)within the abdominal cavity
This was a prospective single-center study conducted between 1 June 2018 and 10 July
Twenty-six patients with advanced high-grade serous ovarian cancer (HGSOC) were included after complete macroscopic

Summary

Introduction

Epithelial ovarian cancer (EOC) is usually diagnosed at an advanced stage and the clinical situation is characterized by the presence of extensive peritoneal metastases (PM)within the abdominal cavity. Epithelial ovarian cancer (EOC) is usually diagnosed at an advanced stage and the clinical situation is characterized by the presence of extensive peritoneal metastases (PM). Complete macroscopic cytoreductive surgery (CRS), which is the surgical removal of all peritoneal lesions suspected of cancer and visible to the surgeon, remains the cornerstone of the management of EOC, in combination with platinum-based chemotherapy [1,2,3]. One of the mechanisms leading to peritoneal recurrence could be that microscopic clusters of cancerous cells that have neither been eradicated by surgery, nor controlled by systemic chemotherapy remain after CRS [14]. Epithelial ovarian cancers (EOC) are usually diagnosed at an advanced stage and managed by complete macroscopic cytoreductive surgery (CRS) and systemic chemotherapy. Peritoneal recurrence occurs in 60% of patients and may be due to microscopic peritoneal metastases (mPM) which are neither eradicated by surgery nor controlled by systemic chemotherapy. There were no differences in characteristics between patients with or without identified mPM

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