Advanced Stage Epithelial Ovarian Carcinoma Research Articles

Role of systematic lymphadenectomy at the time of interval debulking surgery for patients with advanced-stage epithelial ovarian carcinoma who achieved complete gross resection

ObjectiveTo evaluate the role of systematic lymphadenectomy at the time of interval cytoreductive surgery for patients with advanced-stage epithelial ovarian carcinoma who achieved complete gross resection.MethodsThe National Cancer DataBase was...

Higher rates of neo-adjuvant chemotherapy use among high-risk patients with advanced stage epithelial ovarian carcinoma is associated with improved outcomes (1235)

Higher rates of neo-adjuvant chemotherapy use among high-risk patients with advanced stage epithelial ovarian carcinoma is associated with improved outcomes (1235)

The Role of Perioperative C-Reactive Protein in Predicting the Prognosis of Epithelial Ovarian Carcinoma.

Increasing epidemiological evidence supported that chronic inflammatory factors might be involved in the carcinogenesis and progression of various cancers. The present study tried to investigate the prognostic value of perioperative C-reactive protein (CRP) in prognosis of patients with epithelial ovarian carcinoma (EOC) from a tertiary university teaching hospital. The cutoff value of CRP was calculated according to receiver operating characteristic (ROC) curve. Variables were compared using Chi-square test. Progress-free survival (PFS) and overall survival (OS) time were assessed by Kaplan-Meier (KM) survival analysis and Log rank test based on serum CRP level. Univariate and multivariate Cox regression analyses were applied for assessing the relationship between clinicopathological parameters and survival. Higher perioperative CRP levels (preoperative ≥5.15 mg/L and postoperative ≥72.45 mg/L) were significantly associated with serous tumor, high-grade, advanced stage, elevated preoperative CA125, suboptimal surgery, chemotherapy resistance, recurrence and death in EOC (P < 0.01). KM analysis suggested patients with elevated preoperative, postoperative and perioperative CRP had shorter survival (P < 0.01). Elevated perioperative CRP was an independent risk factor for PFS (HR 1.510, 95% CI 1.124-2.028; P = 0.006) and OS (HR 1.580, 95% CI 1.109-2.251; P = 0.011). Similar results were obtained for elevated preoperative CRP. Subgroup analysis further suggested that elevated perioperative CRP was also an independent risk factor for prognosis in advanced stage and serous EOC. Elevated perioperative CRP was an independent risk factor for poorer prognosis of EOC, particularly in advanced stage and serous patients.

Facility level variation in the utilization of neoadjuvant chemotherapy is associated with higher surgical morbidity for patients with advanced stage epithelial ovarian carcinoma

ObjectiveInvestigate outcomes for advanced stage epithelial ovarian cancer (EOC) patients based on facility-level utilization of neoadjuvant chemotherapy (NACT). MethodsStage III-IV EOC patients diagnosed between 2010 and 2016 were identified in the National Cancer Database. Percentage of patients managed with NACT was calculated for facilities, reporting ≥120 patients. Facilities with lowest and highest quartile of NACT rate comprised the low and high-utilizing groups. Clinico-pathological characteristics were collected, and appropriate statistical analysis performed. ResultsHigh- and low-utilizing facilities managed on average 54.1% and 25.4% of patients with NACT respectively. Patients managed at high-utilizing facilities were significantly more likely to be >65 (p = 0.029), have stage IV disease (p < 0.001) and comorbidities (p < 0.001). Patients managed with primary debulking surgery (PDS) at low-utilizing facilities were significantly more likely to be >65, have stage IV disease, and have comorbidities (all, p < 0.001). Patients undergoing PDS at low-utilizing facilities were significantly less likely to achieve complete gross resection (p < 0.001), and were significantly more likely to experience 90-day mortality (p < 0.001), and unplanned 30-day readmission (p < 0.001). After controlling for age, comorbidities, race, insurance status, stage, grade and histology, high-utilizing facilities trended towards better overall survival (OS) (HR: 0.92, 95% CI: 0.85–0.99). Overall, patients undergoing PDS had better OS compared to those who had NACT (median 42 vs 27 months, p < 0.001). ConclusionsDespite treating an EOC population with more advanced disease and comorbidities, high-utilizing facilities have lower surgical morbidity and mortality with no detrimental impact on long-term survival. Careful patient selection to minimize the morbidity and mortality associated with PDS is pivotal.

Facility level variation in the adoption of neo-adjuvant chemotherapy is associated with higher surgical morbidity for patients with advanced stage epithelial ovarian carcinoma (558)

Facility level variation in the adoption of neo-adjuvant chemotherapy is associated with higher surgical morbidity for patients with advanced stage epithelial ovarian carcinoma (558)

Risk of Malignancy Index 3 (RMI3) Performance as a Predictor Advanced Stage Epithelial Ovarian Carcinoma used for NACT

Risk of Malignancy Index 3 (RMI3) Performance as a Predictor Advanced Stage Epithelial Ovarian Carcinoma used for NACT

Risk Of Malignancy Index 4 Performance as a Predictor Advanced Stage Epithelial Ovarian Carcinoma Used for Neoadjuvant Chemotherapy

The relatively low survival rate in patients with advanced-stage carcinoma ovaries requires early detection to improve treatment outcomes. The method currently used to determine the administration of neoadjuvant chemotherapy is ascites cytology and laparoscopic. This study aims to find a non-invasive technique in determining preoperative Neoadjuvant Chemotherapy administration, and that method can use as a predictor of advanced epithelial ovarian carcinoma. The benefit of this study is to help clinicians consider administering neoadjuvant chemotherapy with a Risk Of Malignancy Index 4 score. An analytical observational study with a retrospective cross-sectional type study with samples of all patients from January 2016 to January 2020 diagnosed at the dr. Saiful Anwar Hospital in Malang indonesia. The number of initial samples of this study is 106 samples. Between the results of the Risk Of Malignancy Index 4 score and the histopathological results, it finds that the p-value was less than 0.05 (p&lt;0.05) indicates that the Risk Of Malignancy Index 4 score is very good for predicting advanced epithelial ovarian carcinoma. With a sensitivity of 86,2%, specificity of 87,5%, the cut of value Risk Of Malignancy Index 4 to be a predictor of advanced ovarian carcinoma is 2982. This study indicates that the Risk Of Malignancy Index 4 score is excellent for predicting the stage of Epithelial Ovarian Carcinoma. This cut-off value can reference preoperative neoadjuvant therapy to avoid morbidity and mortality due to the high risk of surgery.

Ascites volume at the time of primary debulking and overall survival of patients with advanced-stage epithelial ovarian cancer

Objectives: Investigate the impact of malignant ascites volume on the overall survival of patients with advanced stage epithelial ovarian carcinoma who undergo primary debulking surgery and achieve complete gross resection. Methods: Patients without a history of another tumor diagnosed with stage III-IV epithelial ovarian carcinoma and bulky intra-abdominal disease between 2004-2015, who underwent primary debulking surgery followed by adjuvant chemotherapy and achieved complete gross resection were drawn from the National Cancer Database. Based on available information, the presence and volume of malignant ascites was assessed and categorized as absent, low (<980 ml) and high (≥980 ml) volume. Median overall survival was determined following generation of Kaplan-Meier curves and compared with the log-rank test. A multivariate Cox model was constructed to control for confounders. Results: A total of 1040 patients who met the inclusion criteria were identified; 50.4% had no ascites, 34.2% had low and 15.4% had high volume malignant ascites at the time of primary debulking surgery. Median patient age was 61 years, while the majority were White (87.7%), without co-morbidities (81.1%) and had serous tumors (91.8%). Groups were comparable in terms of patient race, presence of comorbidities, tumor histology and grade. Median OS of patients without malignant ascites was 59.79 months, compared to 50.33 months for those who had low volume and 41.95 months for those who had high volume malignant ascites. After controlling for patient age, race, insurance status, presence of comorbidities and tumor histology and grade, compared to patients with no malignant ascites those with low (HR: 1.37, 95% CI: 1.09, 1.72) and high volume ascites (HR: 1.94, 95% CI: 1.47, 2.55) had worse overall survival. Patients with low volume ascites had better survival compared to those with high volume ascites (HR: 0.71 95% CI: 0.54, 0.93) after controlling for the aforementioned confounders. Conclusions: Presence and volume of ascites at the time of primary debulking surgery may be associated with worse oncologic outcomes. Investigate the impact of malignant ascites volume on the overall survival of patients with advanced stage epithelial ovarian carcinoma who undergo primary debulking surgery and achieve complete gross resection. Patients without a history of another tumor diagnosed with stage III-IV epithelial ovarian carcinoma and bulky intra-abdominal disease between 2004-2015, who underwent primary debulking surgery followed by adjuvant chemotherapy and achieved complete gross resection were drawn from the National Cancer Database. Based on available information, the presence and volume of malignant ascites was assessed and categorized as absent, low (<980 ml) and high (≥980 ml) volume. Median overall survival was determined following generation of Kaplan-Meier curves and compared with the log-rank test. A multivariate Cox model was constructed to control for confounders. A total of 1040 patients who met the inclusion criteria were identified; 50.4% had no ascites, 34.2% had low and 15.4% had high volume malignant ascites at the time of primary debulking surgery. Median patient age was 61 years, while the majority were White (87.7%), without co-morbidities (81.1%) and had serous tumors (91.8%). Groups were comparable in terms of patient race, presence of comorbidities, tumor histology and grade. Median OS of patients without malignant ascites was 59.79 months, compared to 50.33 months for those who had low volume and 41.95 months for those who had high volume malignant ascites. After controlling for patient age, race, insurance status, presence of comorbidities and tumor histology and grade, compared to patients with no malignant ascites those with low (HR: 1.37, 95% CI: 1.09, 1.72) and high volume ascites (HR: 1.94, 95% CI: 1.47, 2.55) had worse overall survival. Patients with low volume ascites had better survival compared to those with high volume ascites (HR: 0.71 95% CI: 0.54, 0.93) after controlling for the aforementioned confounders. Presence and volume of ascites at the time of primary debulking surgery may be associated with worse oncologic outcomes.

Impact of systematic lymphadenectomy at the time of interval debulking surgery on the survival of patients with advanced-stage epithelial ovarian carcinoma following neoadjuvant chemotherapy

<h3>Objectives:</h3> In light of evidence from the LION trial, we aimed to evaluate the impact of systematic lymphadenectomy (LN) at the time of interval debulking surgery (IDS) for patients with advanced stage epithelial ovarian carcinoma. <h3>Methods:</h3> Patients with stage III-IV epithelial ovarian carcinoma without a history of another tumor who underwent neoadjuvant chemotherapy and underwent interval debulking with complete gross resection (CGR) were identified in the National Cancer Database (2010-2015). Based on pathology report patients who did not undergo any lymphadenectomy and those who underwent systematic lymphadenectomy (defined as at least 20 lymph nodes removed) were selected for further analysis. Median overall survival was compared with the log-rank test and a Cox multivariate model was constructed to control for confounders. <h3>Results:</h3> A total of 1060 patients who met the inclusion criteria were identified. Median patient age was 64 years while the majority had serous tumors (95.8%) and did not have co-morbidities (79.2%). Systematic LND was performed for 125 (11.8%) patients with a median of 29 LNs (range 20-72) removed. Rate of positive LNs was 62.4%, while median number of positive LN was 5 (range 1-28). Patients who underwent systematic LND had higher rate of unplanned readmission (8.9% vs 1.6%, p<0.001), and median hospital stay (6 vs 4 days, p<0.001). Median OS for patients who did not undergo LND was 40.38 months compared to 44.19 for those who underwent systematic LND, p=0.40. After controlling for patient age, insurance status, race, presence of comorbidities, tumor histology, and disease stage, performance of systematic LND was not associated with better survival (HR: 0.98, 95% CI: 0.80, 1.19). Lastly, median overall survival of patients with positive LNs (n=78) was 40.05 months. <h3>Conclusions:</h3> Systematic lymphadenectomy is rarely performed at the time of interval debulking surgery and was not associated with a survival benefit.

Impact of facility-volume on achieving a textbook oncologic outcome following primary debulking surgery for advanced-stage epithelial ovarian carcinoma

<h3>Objectives:</h3> Composite outcomes have emerged as a more accurate marker of optimal oncologic care. We evaluated the impact of facility-volume on achieving a ‘textbook oncologic outcome' (TOO) among patients diagnosed with advanced stage epithelial ovarian carcinoma (EOC) undergoing primary debulking surgery (PDS) followed by adjuvant chemotherapy. <h3>Methods:</h3> Patients diagnosed between 2004-2015 with stage IIIC-IV EOC who underwent PDS at the reporting facility followed by adjuvant chemotherapy were identified in the National Cancer Database. Annual facility PDS volume was calculated and high-volume facilities were defined those performing at least 12 PDS per year. TOO was defined as achievement of complete gross resection (CGR), no 90-day mortality, no prolonged hospitalization (>10 days), no unplanned readmission within 30-days from discharge, and initiation of adjuvant chemotherapy within 42 days from surgery and evaluated among patients with available data for all variables. Median overall survival (OS) was compared with the log-rank test and a Cox multivariate model was constructed to control for confounders. <h3>Results:</h3> A total of 19875 patients were used to calculate annual PDS facility-volume. Final analysis cohort included 6984 patients with available data for all variables of interest; 14.8% were managed at a high-volume center. A TOO was achieved for 1764 (25.3%) patients. Rate of CGR was 42.8%, while rate of prolonged hospitalization was 15.2%. Unplanned re-admission (8%) and death within 90-days (1.4%) were rare, while 28.6% of patients experienced a delay in chemotherapy administration. Patients managed at high-volume centers were more likely to achieve a TOO (28.1% vs 24.8%, p=0.022). After controlling for age, race, insurance, and comorbidities, PDS at a high-volume center was associated with a higher likelihood of achieving a TOO (OR: 1.17, 95% CI: 1.01, 1.36). Median OS of patients who did and did not achieve a TOO was 58.45 and 42.51 months respectively, p<0.001. After controlling for histology, stage, comorbidities, patient age, race, and type of insurance, TOO was associated with better survival (HR: 0.64, 95% CI: 0.59, 0.70). <h3>Conclusions:</h3> PDS at a high-volume center was associated with superior oncologic outcomes for patients with advanced-stage EOC. Centralization of care of these patients to centers of excellence should be considered.

Impact of delay in adjuvant chemotherapy administration for patients with advanced-stage epithelial ovarian carcinoma undergoing primary debulking surgery with bowel resection

<h3>Objectives:</h3> Patients with epithelial ovarian carcinoma (EOC) undergoing primary debulking surgery (PDS) with small or large bowel resection have a higher risk of postoperative complications that could delay administration of adjuvant chemotherapy. The aim of the present study was to evaluate the impact of chemotherapy delay in the survival of patients with EOC undergoing bowel resection using a hospital-based database. <h3>Methods:</h3> The National Cancer Database (NCDB) was accessed and patients diagnosed between 2004-2015 with stage III-IV EOC without a history of another tumor who underwent PDS that included small or large bowel resection with known surgery-chemotherapy interval and at least one month of follow-up were identified. Overall survival (OS) was compared between patients who received multi-agent chemotherapy 2-6 week (group 1), 7-9 weeks (group 2) and 10-12 weeks (group 3) from surgery with the log-rank test. A Cox multivariate model was constructed to control for confounders. Impact of chemotherapy delay was also evaluated among patients who achieved complete gross resection (CGR) and those who had macroscopic disease. <h3>Results:</h3> A total of 9274 patients who met the inclusion criteria were identified; 69.8% received adjuvant chemotherapy 2-6 weeks from surgery while 24.5% and 5.7% received chemotherapy 7-9 weeks and 10-12 weeks respectively. Patients in group 2 (30.2%) and 3 (36.6%) were more likely to experience a prolonged hospital stay (>10 days) following PDS compared to those in group 1 (19.4%), p<0.001. Rates of unplanned re-admission within 30-days from surgery in group 1,2 and 3 were 7.7%, 9.2% and 11.3% respectively, p=0.002. Median OS for patients in group 1 was 44.78 months compared to 42.25 and 39.89 for those in groups 2 and 3 respectively, p=0.103. After controlling for patient age, race, presence of comorbidities insurance, tumor histology and stage, compared to patients in group 1 those in group 2 (HR: 1.04, 95% CI: 0.98, 1.10) and group 3 (HR 1.05, 95% CI: 0.94, 1.17) did not have worse survival. Status of residual disease was available for 3659 patients; 46% achieved CGR. For patients with CGR, median OS for those in group 1 and 2 was 55.46 and 52.70 months compared to 42.18 for those in group 3, p=0.015. After controlling for aforementioned variables those in group 3 had worse survival (HR: 1.37, 95% CI: 1.04, 1.82) compared to patients in group 1 while there was no difference in survival between group 2 and 1 (HR: 1.06, 95% CI: 0.90, 1.27). For patients with macroscopic residual disease, timing of chemotherapy administration was not associated with survival; median OS for patients in group 1, 2 and 3 was 41.3, 42.74 and 41.13 months respectively, p=0.82. <h3>Conclusions:</h3> For patients with advanced stage EOC undergoing PDS with bowel resection extreme delay in adjuvant chemotherapy administration over 10 weeks from surgery may be associated with a negative impact on the survival of those who achieve CGR.

Chemotherapeutic Regimens and Chemotherapy-Free Intervals Influence the Survival of Patients with Recurrent Advanced Epithelial Ovarian Carcinoma: A Retrospective Population-Based Study.

We aimed to evaluate factors influencing the outcomes of patients with platinum-sensitive recurrent epithelial ovarian carcinoma (EOC). Patients with advanced-stage EOC, who received debulking surgery and adjuvant chemotherapy for recurrence, were obtained from the National Health Insurance Research database of Taiwan between 2000 and 2013. A total of 1038 patients with recurrent advanced-stage EOC were recruited. The platinum + paclitaxel (PT) group had the best five-year overall survival (OS) compared with the other three groups (p < 0.001). The hazard ratios (HRs) of five-year OS for the platinum + liposomal doxorubicin (PD), topotecan (TOP), and pegylated liposomal doxorubicin (PLD) groups were 1.21 (p = 0.07), 1.35 (p = 0.016), and 1.80 (p < 0.001), respectively, compared with the PT group. The PT group also had lower hazard ratios of five-year OS for patients with platinum therapy-free interval (TFIp) between 6 and 12 months compared with the other three groups (p < 0.0001). However, the HRs of five-year OS did not differ between the PT and PD groups in patients with TFIp >12 months. Patients with TFIp >12 months had lower HRs of five-year OS compared with those with TFIp of 6–12 months, regardless of whether they were treated with platinum-based (p = 0.001) or non-platinum-based (p = 0.003) regimens. Chemotherapeutic regimens and TFIp influenced the outcomes of patients with recurrent EOC. For patients with TFIp of 6–12 months, the PT regimen is the first choice based on their best overall survival result. For patients with TFIp >12 months, either platinum-based or non-platinum regimens could be used because of their similar excellent overall survival.

The role of transforming growth factor-β (TGF-β) in epithelial ovarian cancer progression via immunosuppression

Objective: Increased TGF-β signaling is associated with poorer prognosis in advanced-stage epithelial ovarian carcinoma (EOC). We sought to demonstrate the role of the TGF-β-mediated immune suppression in the progression of EOC.

Impact of hospital surgical volume on complete gross resection (CGR) rates following primary debulking surgery for advanced stage epithelial ovarian carcinoma

BackgroundTo investigate the impact of hospital surgical volume on the rate of complete gross resection for patients with advanced stage epithelial ovarian carcinoma undergoing primary debulking surgery. MethodsThe National Cancer Data Base was used to identify patients undergoing between 2010 and 2014 for an advanced stage (III-IV) epithelial ovarian cancer. For analyses purposes facility surgical volume was divided into tertiles (high, intermediate and low). Patients with bulky stage III disease who underwent primary debulking surgery with known residual disease status were selected for further analysis. ResultsA total of 8894 patients with macroscopic peritoneal disease were included. Rates of complete gross resection for patients managed in low, intermediate and high-volume centers were 41.0%, 41.6% and 43.3% respectively (p = 0.20). After controlling for year of diagnosis, age, insurance status, presence of co-morbidities, histology, size of peritoneal implants, stage, and complexity of surgery, patients undergoing primary debulking surgery at low (OR: 0.85, 95% CI: 0.74, 0.97, p = 0.013) and intermediate (OR: 0.90, 95% CI: 0.82, 0.99, p = 0.043) volume centers had a lower likelihood of achieving complete gross resection compared to those managed in high volume centers. ConclusionsAfter controlling for multiple potential confounders, patients receiving surgery in high volume centers had a higher likelihood of complete gross resection following primary debulking surgery for advanced-stage epithelial ovarian cancer.

The role of macrophage production of transforming growth factor-ß in epithelial ovarian cancer progression.

e17100 Background: Increased Transforming Growth Factor- ß (TGF-ß) signaling is associated with poorer prognosis in advanced stage epithelial ovarian carcinoma (EOC). Macrophages are known to produce high amounts of TGF-ß which plays a significant role in immune suppression in the tumor microenvironment Methods: A syngeneic mouse model was created using ID8 cell lines with p53 knocked out. These cells were injected intraperitoneally to establish tumor challenge. One mouse model was treated with TGF-ß monoclonal antibody at the time of tumor inoculation. A second model utilized a mouse line that was engineered to eliminate production of TGF-ß from macrophages specifically. Tumors were harvested and weighed after 42 days of tumor challenge. Flow cytometry was used to analyze differences in CD8 T-cell and T regulatory cell populations. Results: Tumor weights were significantly reduced in mice treated with anti-TGF-ß monoclonal antibody (p = 0.02). Average tumor weights were 125mg vs 101mg comparing non-treated to treated mice. Also, ascites volume was measured using syringe aspiration from peritoneal cavity at the time of sacrifice. Mean ascites volume was 4.7mL vs 2.9 mL (p = 0.004) in untreated mice versus mice treated with monoclonal antibody. In mice with macrophages specific deletion of TGF-ß production, tumors were unable to be established in these mice and omental weights were comparable to tumor naive mice with a mean weight of 34mg compared to 115 mg in wild type mice. In both mouse models there was a significant difference in CD8 : Tregs ratio in omental tumor microenvironment. Conclusions: Increased amounts of TGF-ß contribute to increased tumor invasion and migration, while loss of TGF-ß results in both a decrease in tumor burden and a decrease in suppressors of T cell activity. Inhibition of TGF-ß, demonstrated with a monoclonal antibody can effectively reduce TGF-β signaling. The macrophages within the omental tumor microenvironment are a source of large amounts of TGF-ß and when lost result in an inability to establish tumors in intraperitoneal tumors.

TET1 reprograms the epithelial ovarian cancer epigenome and reveals casein kinase 2α as a therapeutic target.

Ten-eleven translocation methylcytosine dioxygenase-1, TET1, takes part in active DNA demethylation. However, our understanding of DNA demethylation in cancer biology and its clinical significance remain limited. This study showed that TET1 expression correlated with poor survival in advanced-stage epithelial ovarian carcinoma (EOC), and with cell migration, anchorage-independent growth, cancer stemness, and tumorigenicity. In particular, TET1 was highly expressed in serous tubal intraepithelial carcinoma (STIC), a currently accepted type II EOC precursor, and inversely correlated with TP53 mutations. Moreover, TET1 could demethylate the epigenome and activate multiple oncogenic pathways, including an immunomodulation network having casein kinase II subunit alpha (CK2α) as a hub. Patients with TET1high CK2αhigh EOCs had the worst outcomes, and TET1-expressing EOCs were more sensitive to a CK2 inhibitor, both in vitro and in vivo. Our findings uncover the oncogenic and poor prognostic roles of TET1 in EOC and suggest an unexplored role of epigenetic reprogramming in early ovarian carcinogenesis. Moreover, the immunomodulator CK2α represents a promising new therapeutic target, warranting clinical trials of the tolerable CK2 inhibitor, CX4945, for precision medicine against EOC. Copyright © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Clinical characteristics and outcomes after bowel surgery and ostomy formation at the time of debulking surgery for advanced-stage epithelial ovarian carcinoma.

There are limited data on clinical outcomes of patients with advanced-stage epithelial ovarian cancer who require ostomy formation at the time of either primary cytoreductive surgery or interval cytoreductive surgery. The objective of this study was to evaluate patients undergoing bowel surgery and ostomy formation after primary or interval surgery. Patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC-IV epithelial ovarian cancer who underwent cytoreductive surgery between January 2010 and December 2014 were identified retrospectively. Patients with non-epithelial histology, low-grade serous histology or incomplete medical records were excluded. Demographic and clinical data were collected and analyzed. Age, stage, co-morbidity index, pre-operative CA125, pre-operative albumin, and Aletti surgical complexity score were included in a multivariable logistic regression model to assess independent associations with ostomy formation. A total of 554 patients were included in the study. Of these, 261 (47%) underwent primary cytoreduction and 293 (53%) underwent interval cytoreduction. Patients undergoing primary surgery were more likely to undergo bowel resection, compared with interval surgery patients (37.2% vs 14%, p<0.001). Of the 139 (25.1%) patients who underwent bowel surgery, 25 (18%) underwent ostomy formation (11 ileostomies and 14 colostomies). Rates of ostomy formation were similar between the groups (6.1% primary vs 3.1% interval, p=0.10). Patients undergoing ostomy formation were more likely to have longer mean operative time (335 vs 229 min, p<0.001) and undergo small and large bowel resections at the time of cytoreductive surgery (44% vs 14%, p<0.001). Multivariate analysis revealed that a high surgical complexity score was associated with ostomy formation. Of the patients who underwent ostomy formation, 13 (43.3%) underwent stoma reversal including 11 ileostomies and two colostomies. Median time to ostomy reversal was 7 months. Bowel surgery is more common among patients undergoing primary surgery as compared with interval surgery, but this does not result in an increased risk of ostomy formation.

Does adjuvant chemotherapy dose modification have an impact on the outcome of patients diagnosed with advanced stage ovarian cancer? An NRG Oncology/Gynecologic Oncology Group study

PurposeTo determine the relationship between chemotherapy dose modification (dose adjustment or treatment delay), overall survival (OS) and progression-free survival (PFS) for women with advanced-stage epithelial ovarian carcinoma (EOC) and primary peritoneal carcinoma (PPC) who receive carboplatin and paclitaxel. MethodsWomen with stages III and IV EOC and PPC treated on the Gynecologic Oncology Group phase III trial, protocol 182, who completed eight cycles of carboplatin with paclitaxel were evaluated in this study. The patients were grouped per dose modification and use of granulocyte colony stimulating factor (G-CSF). The primary end point was OS; Hazard ratios (HR) for PFS and OS were calculated for patients who completed eight cycles of chemotherapy. Patients without dose modification were the referent group. All statistical analyses were performed using the R programming language and environment. ResultsA total of 738 patients were included in this study; 229 (31%) required dose modification, 509 did not. The two groups were well-balanced for demographic and prognostic factors. The adjusted hazard ratios (HR) for disease progression and death among dose-modified patients were: 1.43 (95% CI, 1.19–1.72, P < 0.001) and 1.26 (95% CI, 1.04–1.54, P = 0.021), respectively. Use of G-CSF was more frequent in dose-modified patients with an odds ratio (OR) of 3.63 (95% CI: 2.51–5.26, P < 0.001) compared to dose-unmodified patients. ConclusionDose-modified patients were at a higher risk of disease progression and death. The need for chemotherapy dose modification may identify patients at greater risk for adverse outcomes in advanced stage EOC and PPC.

Impact of surgical volume on complete gross resection rates for women with advanced stage epithelial ovarian carcinoma

Impact of surgical volume on complete gross resection rates for women with advanced stage epithelial ovarian carcinoma

The Effect of CA125 Nadir Level on Survival of Advanced-Stage Epithelial Ovarian Carcinoma after Interval Debulking Surgery.

Purpose. The study aims at investigating the most reliable CA125-related factors in terms of predicting survival outcomes in advanced-stage epithelial ovarian carcinoma (EOC) patients received neoadjuvant chemotherapy (NAC).Methods. The EOC patients treated with NAC at Peking Union Medical College Hospital by a single gynecological oncology team were enrolled for the retrospective study. The CA125-related variables were categorized into four groups: normalizations, nadirs, half-life and percentage reductions. Associations of these variables with progress-free survival (PFS) and overall survival (OS) were evaluated.Results. Of the 101 patients included, 81 patients (80.2%) had progressed, and 51 patients (50.5%) had died of the disease progression. Univariate analysis showed that the CA125 nadir, reduction after the first, second and third postoperative chemotherapy cycles, and time to normalization were significantly (P<0.05) associated with PFS. The CA125 nadir, reduction after the first, second and third postoperative chemotherapy cycles were significantly (P<0.05) associated with OS. In the multivariate analysis, the CA125 nadir value was the most significant factor for PFS and OS, using the CA125 median level 13 U/ml as a cutoff value.Conclusions. Our study suggests that the CA125 nadir value is the most reliable prognostic factor to predict PFS and OS in advanced EOC patients treated with NAC. This information is important in patient counseling and creating individualized follow-up plans.