Abstract
Debulking surgery followed by systemic chemotherapy—including three-weekly intravenous paclitaxel and carboplatin (GOG-158)—is the cornerstone for advanced epithelial ovarian, fallopian tubal, and peritoneal cancer (EOC) treatment. In this scenario, Federation of Gynecology and Obstetrics (FIGO) stage, cell types, completeness of surgery, lymph nodes (LN) status, adjuvant chemotherapy regimens, survival status, progression-free survival (PFS), and overall survival (OS) of 192 patients diagnosed as having stage IIIA1–IVB EOC over January 2008–December 2017 were analyzed retrospectively. Of them, 100 (52.1%) patients had been debulked optimally. Of all cases, 64.1% and 10.9% demonstrated serous and clear-cell carcinoma. Moreover, the FIGO stage, surgery completeness, and LN status affected recurrence/persistence and mortality (all p < 0.001). Clear cell carcinoma led to shorter survival than serous carcinoma (p = 0.002). Adjuvant chemotherapy regimens were divided into five main groups according to previous clinical trials. However, choice of chemotherapy failed to demonstrate significant differences in patient outcomes. Similar results were found in the sub-analysis of optimally debulked cases, except that intraperitoneal chemotherapy could reduce mortality risk when compared with GOG-158 (p = 0.042). Notably, retroperitoneal LN dissection in all cases or optimally debulked cases reduced risks of recurrence/persistence and mortality, and prolonged PFS and OS significantly (all p < 0.05). Without optimal debulking, LN dissection led to little improvement in outcomes. Various modified chemotherapy regimens did not prolong PFS and OS or reduce recurrence/persistence and mortality risks. LN dissection is strongly recommended to improve the completeness of surgery and patient outcome. Clear cell type has a poorer outcome than serous type, which requires more aggressive treatment and follow-up.
Highlights
Ovarian cancer is the second and third most common gynecologic malignancy in developed and developing countries, respectively [1]
Most cases were of Federation of Gynecology and Obstetrics (FIGO) stage IIIC (n = 100, 52.1%), and most patients (n = 144, 75%) received the traditional regimen of three-weekly intravenous infusion with paclitaxel 175 mg/m2 plus a carboplatin area under the curve (AUC) 5 for at least six courses
We found that optimal debulking surgery led to better outcomes—significantly longer progression-free survival (PFS) (22 ± 32.07 months) than suboptimal debulking (12 ± 30.18 months) and no debulking (18 ± 19.12 months, p < 0.001) as well as significantly longer overall survival (OS) (47.5 ± 33.03 months vs. 33 ± 32.68 months and 29 ± 24.40 months, p < 0.001)
Summary
Ovarian cancer is the second and third most common gynecologic malignancy in developed and developing countries, respectively [1]. Because of its non-specific symptoms and non-useful screening methods, approximately 70–75% cases are at advanced stages at the time of diagnosis. Fallopian tubal, and peritoneal cancer (EOC) is characterized by a high recurrence rate within two years after primary management and a low five-year survival rate [1]. The Federation of Gynecology and Obstetrics (FIGO) revised the staging system of EOC since 2014 [3]. Solitary retroperitoneal lympho nodes (LN) metastases without peritoneal disease was re-staged as IIIA1. Retroperitoneal LN dissection would not be performed if peritoneal carcinomatosis is encountered during a primary or interval debulking operation, which are cases with major medical problems or unstable hemodynamic condition during surgery
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