Incomplete Surgical Staging Research Articles

Ovarian serous borderline tumors with recurrent or extraovarian lesions: a Japanese, retrospective, multi-institutional, population-based study.

Ovarian serous borderline tumors (SBT) are typically unilateral and are primarily treated using hysterectomy and bilateral salpingooophorectomy (SO). However, most young patients prefer fertility-sparing surgeries (FSS) with tumorectomy or unilateral SO. Micropapillary morphology and invasive implants have been designated as histopathological risk indicators for recurrence or metastasis, but their clinical impact remains controversial because of limitations like diagnostic inconsistency and incomplete surgical staging. A nationwide multi-institutional population-based retrospective surveillance was conducted with a thorough central pathology review to reveal the clinical features of SBT. Of 313 SBT patients enrolled in the Japanese Society of Clinical Oncology's Surveillance of Gynecologic Rare Tumors, 289 patient records were reviewed for clinical outcomes. The glass slides of patients at stage II-IV or with recurrence or death were re-evaluated by three gynecological pathologists. The 10-year overall and progression-free survival (PFS) rates were 98.6% and 92.3%. The median recurrence period was 40months and 77.0% was observed in the contralateral ovary within 60months. Patients aged ≤ 35years underwent FSS more frequently and relapsed more (p < .001). A clinic-pathological analysis revealed diagnosis during pregnancy, FSS, and treatment at non-university institutes as well as advanced stage and large diameter were independent risk factors of recurrence. Among patients having pathologically confirmed SBTs, PFS was not influenced by the presence of micropapillary pattern or invasive implants. The recurrence rate was lower in this cohort than previous reports, but the clinical impacts of incomplete resection and misclassification of the tumor were still significant on the treatment of SBT.

Guideline adherence in ovarian cancer for surgical staging in the Netherlands

ObjectivePrevious studies have shown low adherence to surgical staging guidelines in patients with clinical early-stage ovarian carcinoma. The aim of this study was to identify guideline adherence for surgical staging...

Surgical staging of apparent early-stage ovarian mucinous carcinoma

ObjectivesThe aim of the study was to explore the rate of upstaging after complete surgical staging among patients with apparent FIGO stage I ovarian mucinous carcinoma.MethodsOvarian mucinous carcinoma patients with surgical treatment at the Peking Union Medical College Hospital between October 2020 and January 1994 were retrospectively reviewed.ResultsIn total, 163 patients were included in this study. Surgical restaging was performed in 89 patients after initial incomplete surgical staging, and one-step complete surgical staging was performed in 74 patients. Among these initially incompletely staged patients, residual tumors were found in 16 patients (16/89, 17.9%). Among the 19 patients with apparent FIGO stage IA, no patient was found to have residual tumors after incomplete staging surgery, according to the final pathology result of restaging surgery. Ovarian cystectomy (OR=4.932, 95% CI= 1.347–18.058, P=0.016) was an independent risk factor for residual tumors after incomplete staging surgery. Among all 163 patients, upstaging occurred in 15 patients (15/163, 9.2%). Among 44 apparent FIGO stage IA patients, no patient was upstaged to FIGO II–IVB. Moreover, both a history of ovarian mucinous tumor (OR=4.745, 95% CI= 1.132–19.886, P=0.033) and bilateral ovary involvement (OR=9.739, 95% CI= 2.016–47.056, P=0.005) were independent risk factors for upstaging to FIGO stage II–IVB.ConclusionsFor patients with apparent FIGO stage IA disease, the possibility of residual tumors and upstaging is relatively low. For patients with cystectomy, bilateral mucinous carcinomas, or a history of ovarian mucinous tumors, complete staging surgery maintains greater significance.

Impact of lymph node staging in presumed early-stage ovarian carcinoma

ObjectiveOur objective was to analyze the prevalence of lymph node metastasis in early-stage ovarian carcinoma after systematic lymph node dissection and its impact on indication of adjuvant chemotherapy. Study designWe evaluated a series of 765 patients diagnosed with ovarian carcinoma who underwent surgical treatment from February 2007 to December 2019. Patients with peritoneal disease and incomplete surgical staging were excluded. All cases underwent systematic pelvic and para-aortic lymphadenectomy up to the renal vessels. ResultsA total of 142 cases were analyzed. Median pelvic and para-aortic lymph node dissected were 30 (range, 6–81) and 21 (range, 3–86), respectively. Twelve (8.4%) patients had metastatic lymph nodes – high-grade serous, 10.4% (5/48); clear cell, 17.2% (5/29) and endometrioid, 5.7% (2/35). Any other histology (low grade serous, mucinous, carcinosarcoma or mixed) had lymph node metastasis. Notably, 50% of patients with positive lymph nodes had preoperative suspicious lymph nodes in imaging. The median hospital stay length was 6 days (range, 2–33) and 4.2% cases had grade ≥ 3 complications. A total of 110 (77.6%) patients underwent adjuvant chemotherapy and all cases had indication of adjuvant chemotherapy after histological type, despite the lymph node status. After a median follow-up of 52.5 months, we noted 24 (16.9%) recurrences. The 5-year recurrence-free survival and overall survival were 86.4% and 98.1%, respectively. High grade histology was the only variable that negatively impacted disease-free survival in univariate analysis [HR 4.70 (95%CI: 1.09–20); p = 0.037]. ConclusionsWe found a positive lymph node rate of less than 10% after lymphadenectomy in presumed early-stage ovarian carcinoma. Lymph node status was not determinant for adjuvant chemotherapy.

Improved survival with combination chemotherapy and external beam radiation therapy in uterine carcinosarcoma

ObjectivesTo evaluate differences in survival and recurrence patterns in stage I–IV uterine carcinosarcoma patients treated with surgery followed by adjuvant chemotherapy alone, radiation alone, or a combination of both chemotherapy...

Incomplete surgical staging in clinical early-stage ovarian cancer: guidelines versus daily practice

BackgroundIncomplete surgical staging of patients with early-stage epithelial ovarian cancer (EOC) has been reported in up to 98% of cases, when based on the International Federation of Obstetrics and Gynecology (FIGO) staging procedure. The aim of the present retrospective study was to clarify the reasons for incomplete staging. MethodsThe PRISMA (Prevention Recovery Information System for Monitoring and Analysis) technique was used to evaluate cases with FIGO I-IIa EOC based on incomplete staging from five gynecologic oncologic center hospitals in the Netherlands in the period 2010–2014. ResultsFifty cases with an incomplete surgical staging of EOC according to national guidelines were included. The most common reasons for incomplete staging were insufficient random biopsies of the peritoneum (n = 34, 68%), and less than ten lymph nodes being resected and/or found at pathology (n = 16, 32%). The most mentioned reason for not performing biopsies was, besides forgetting to do so, believing that after careful inspection and palpation, taking biopsies is irrelevant and/or already are being taken while performing a hysterectomy (peritoneum of cul-de-sac, bladder). The value of contralateral pelvic lymph node dissection in case of a unilateral ovarian malignancy was also doubted, influencing the number of lymph nodes resected. ConclusionsThe most important reasons for incomplete staging in EOC are, besides omitting elements by accident, questioning the importance of obligatory elements of the staging procedure. A structured list of staging steps during surgery and more evidence-based consensus concerning these obligatory elements might increase the number of complete staging procedures in EOC.

Clinicopathological and survival analysis of 34 cases of uterine clear cell carcinoma

Objective: To analyze the clinicopathological features and prognostic factors of patients with uterine clear cell carcinoma (UCCC). Methods: UCCC patients who underwent surgery and complete follow-up at Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between January 1, 2004 and December 31, 2014 were retrospectively reviewed. The Kaplan-Meier method and Cox regression analysis were used for survival analysis. Results: The study included 34 patients. Only 18 patients (52.9%) were diagnosed with UCCC preoperatively and 8 patients (23.5%) underwent UCCC standard comprehensive staging surgery. Among the 34 patients, stage ⅠA was 17 cases (50.0%), stage ⅠB was 1 case (2.9%), stage Ⅱ was 4 cases (11.8%), stage ⅢA was 2 cases (5.9%), stage ⅢB was 1 case (2.9%), stage ⅢC1 was 5 cases (14.7%) and stage ⅣB was 4 cases (11.8%). The median follow-up period was 72 months, 5-years disease-free survival (DFS) rate and overall survival (OS) rates for all patients were 79.1% and 81.3%, respectively. Univariate analysis result showed that preoperative CA125 level, range of lymphadenectomy, tumor stage and peritoneal cytology were significantly associated with DFS (P<0.05). Preoperative CA125 level, range of lymphadenectomy, tumor stage, peritoneal cytology and lymph vascular space invasion were significantly associated with OS (P<0.05). Multivariate analysis result showed that peritoneal cytology was the only independent prognostic factor for DFS, the relapse risk of peritoneal cytology positive patients was 11.47 folds higher than that of the negative patients (P=0.009). Tumor stage was the only independent prognostic factor for OS, the death risk of ⅣB stage patients was 25.29 folds higher than that of theⅠA stage (P=0.009). Conclusions: The preoperative pathological diagnosis of UCCC is difficult, which results in incomplete surgical staging. Peritoneal cytology and tumor stage are independent prognostic factors for DFS and OS of UCCC patients, which deserve much more attention in clinical practice.

Incomplete Surgical Staging in Clinical Early-Stage Ovarian Cancer: Guidelines Versus Daily Practice

Incomplete Surgical Staging in Clinical Early-Stage Ovarian Cancer: Guidelines Versus Daily Practice

Diagnosis, treatment and prognosis of uterine serous carcinoma

Objective: To investigate the diagnosis, treatment and prognosis of uterine serous carcinoma (USC), and further analyze the prognostic factors. Methods: USC patients who underwent surgery with complete follow-up at Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences between January 1, 2004 and December 31, 2014 were retrospectively reviewed. The Kaplan-Meier method and Cox regression analysis were used for survival analysis. Results: (1) Diagnosis and treatment: the study included 71 USC patients. Only 32 patients (45%, 32/71) were diagnosed preoperatively with USC, and 25 cases of them (35%, 25/71) underwent USC standard comprehensive staging surgery. Of the 25 patients, 10 cases (40%, 10/25) had up-staged after operation. (2) Prognosis: the 5-year disease free survival (DFS) rate and overall survival (OS) rate for all patients were 76.5% and 80.6%, respectively. (3) The results of prognostic factors analysis: univariate analysis on age, range of lymphadenectomy, peritoneal cytology, the depth of myometrial invasion, adnexal and (or) serosa involvement and omentum metastasis were significantly associated with 5-year DFS rate (all P<0.05); range of lymphadenectomy, range of surgical staging, peritoneal cytology, adnexal and (or) serosa involvement and postoperative adjuvant treatment were significantly associated with 5-year OS rate (all P<0.05). Multivariate analysis on range of surgical staging (HR=5.18, 95%CI: 1.04-25.70, P=0.044) and adnexal and (or) serosa involvement (HR=8.41, 95%CI: 2.28-31.05, P=0.001) were independent prognostic factors for 5-year DFS rate; range of lymphadenectomy [no lymphadenectomy vs pelvic lymphadenectomy (PLN)+para-aortic lymphadenectomy (PALN), HR=27.76, 95%CI: 1.76-437.78, P=0.018;PLN vs PLN+PALN, HR=5.98, 95%CI: 1.11-32.27, P=0.038] and peritoneal cytology (HR=5.47, 95%CI: 1.18-25.39, P=0.030) were independent prognostic factors for 5-year OS rate. Conclusions: The preoperative pathological diagnosis of USC is difficult, resulting in incomplete surgical staging and inaccurate staging. Range of surgical staging, adnexal and (or) serosa involvement, peritoneal cytology and range of lymphadenectomy are independent prognostic factors, which deserve much attention in clinical practice.

Clinico pathological features and treatment outcome of malignant epithelial ovarian tumour

Background: Ovarian cancer is the ninth most common cancer in women and it ranks fifth as the cause of cancer death in women. Epithelial ovarian cancer (EOC) represents the most lethal malignancy of the female genital tract. EOC is typically diagnosed in advanced FIGO (Federation of International Gynaecology and Obstetrics) stages due to lack of symptoms in the earlier stages. So, the aim of this study was to determine the disease free survival (DFS) of EOC after treatment and also to find out the prognostic factors such as age, FIGO stage, histopathological subtypes and grade for recurrence of disease.&#x0D; Methods: A retrospective study was conducted in gynaecological oncology department of National Institute of Cancer Research and Hospital (NICRH), Dhaka. Study period was 02 years from January 2017 to December 2018.Histopathologically confirmed epithelial ovarian malignancy after completion of treatment was included in this study. Non-epithelial ovarian malignancy was excluded from this study.&#x0D; Results: Mean age was 53 yrs (range 25-80 yrs).Final surgical staging (FIGO stage) of disease were as follows stage I; 24 (25.8%), stage II; 18 (19.4%), stage III; 45 (48.4%) and stage IV; 6 (6.5%). Mean follow-up time was 34 months (range 24-60 months). DFS according to FIGO stages were 35 months, 27 months, 25 months and 9 months respectively. DFS based on the complete and incomplete surgical staging were 27 months and 22 months respectively. At univariate analysis, factors significantly associated with decrease DFS and increase recurrence which included age (HR- 1.39 95% CI), stage (HR- 1.22, 95% CI), histopathological type (HR-1.28, 95% CI) and grade of tumor (HR-1.65, 95% CI). At multivariate analysis, FIGO stage (HR-3.9, 95% CI), histopathological type (HR-1.86, 95% CI) and grade (HR-1.11, 95% CI) having an association with decease DFS.&#x0D; Conclusion: Surgical stage was one of the strongest independent prognostic factors of DFS for EOC. Increasing age, histopathology and grade are also independent predictors of decrease DFS in patient with EOC treated with current standard therapy.&#x0D; Bangladesh Med Res Counc Bull 2020; 46(2): 115-119

Clinical management of malignant ovarian germ cell tumors: A 26-year experience in a tertiary care institution

BackgroundThe standard prognostic system for malignant ovarian germ cell tumors (MOGCT) has not yet been established and the scope of surgery was also controversial. Mixed ovarian malignant germ cell tumor (mGCT) is a rare histological type of MOGCT with higher malignant degree than other types. The aim of the present study was to investigate the clinical features and prognosis of mGCT, and prognostic factors for MOGCT to provide guidance for future treatment. MethodsRetrospective analysis was carried out on 137 patients, who were admitted from 1991 to 2014. Survival curves were constructed using Kaplan–Meier method and were compared with the log-rank test across various pathological types and different stages. Multivariate survival analysis was performed using Cox's proportional hazards model. ResultsThere were 29 dysgerminomas (DG), 3 embryonal carcinomas (EC), 43 immature teratomas (IT), 48 yolk sac tumors (YST) and 14 mixed germ cell tumors (mGCT). The most common type of mGCT is YST (85.7%), followed by IT (64.3%), EC (28.6%), and DG (21.4%). The respective 5-year OS rates were 100% in DG, 100% in EC, 92.5% in IT, 54.5% in YST and 66.7% in mGCT, while the corresponding 5-year PFS rate were 89.7% in DG, 100% in EC, 85.1% in IT, 55.9% in YST and 60% in mGCT. FIGO stage Ⅲ-Ⅳ, certain pathological types (Yolk sac tumors and mGCT) and the number of postoperative chemotherapy courses were independently unfavorable prognostic in a multivariate model that included age, Admission decade, fertility-sparing surgery, and comprehensive staging surgery. ConclusionsFertility-sparing surgery and incomplete surgical staging did not affect the prognosis. It might be safe to preserve fertility and shrink the scope of the surgical procedures in MOGCT patients regardless of stage or pathology. However, prospective randomized controlled trials were needed for further evaluation.

Is adjuvant chemotherapy beneficial for patients with FIGO stage IC adult granulosa cell tumor of the ovary?

BackgroundTo evaluate the association between adjuvant chemotherapy and clinical outcomes in patients with stage IC adult granulosa cell tumor (AGCT).MethodsWe performed a retrospective study of patients with stage IC AGCT diagnosed at our hospital from January 1985 to September 2015. We analyzed descriptive statistics, and performed univariate and multivariate and Kaplan–Meier survival analyses.ResultsSixty stage IC AGCT patients were identified, including 28 in the no adjuvant chemotherapy group (NACG) and 32 in the adjuvant chemotherapy group (ACG). The median follow-up time was 88 months (range: 9–334 months). Sixteen patients developed recurrences, including nine in the NACG and seven in the ACG groups. Univariate analysis identified incomplete surgical staging and initial treatment place as associated with disease-free survival (DFS) (P = 0.003 and 0.038, respectively). Incomplete surgical staging remained a risk factor for recurrence in multivariate analysis (hazard ratio (HR) = 3.883, 95% confidence interval (CI): 1.123–13.430, P = 0.032). The 5-year DFS rates in the NACG and ACG groups were 76.3% and 87.5% respectively (P = 0.197). Adjuvant chemotherapy was thus not associated with improved DFS. Furthermore, the number of chemotherapy cycles was not associated with recurrence rate (≤3 cycles vs. > 3 cycles, HR = 0.613, 95% CI: 0.112–3.351, P = 0.572).ConclusionAdministration of adjuvant chemotherapy does not improve DFS in patients with stage IC AGCT. Further studies with larger samples involving multi-institutional collaboration are needed to validate new treatment regimens for this disease.

Ovarian granulosa cell tumor: A National Cancer Database study

ObjectiveTo provide prognostic information from a large cohort of women with granulosa cell tumor we analyzed the National Cancer Database. MethodsWe performed an observational retrospective cohort analysis of 2680 women with ovarian granulosa cell tumor from the 1998–2013 National Cancer Database. Kaplan-Meier and multivariable Cox proportional-hazards survival analyses were performed for the overall cohort and propensity score matched cohorts to examine the association of surgical staging and adjuvant chemotherapy with survival. A random forest was used to determine important prognostic factors in stages II–IV granulosa cell tumor. ResultsAdjuvant chemotherapy, hormonal therapy, and radiotherapy were not associated with survival. Older age, more comorbidities, prior malignancy, higher stage, poor differentiation, larger tumor size, incomplete surgical staging, and residual disease at a surgical margin were independently associated with increased hazard of death. Among women with stage I disease, each one centimeter increase in tumor size was associated with 4% (2–6%) increased hazard of death (P<0.001). By matched cohort analyses, the hazard ratio (HR) (95% CI) for death associated with incomplete surgical staging was 1.77 (1.30–2.41), P<0.001 among women with stage I disease. Receiving adjuvant chemotherapy was not associated with increased survival among women with stages II–IV disease compared to no adjuvant treatment. ConclusionIncomplete surgical staging was associated with increased hazard of death. There was no evidence of increased survival with use of adjuvant chemotherapy. Early and complete surgical resection remains the best evidenced treatment for ovarian granulosa cell tumor.

Analysis of outcomes and prognostic factors after fertility-sparing surgery in malignant ovarian germ cell tumors

ObjectiveTo evaluate the oncologic and reproductive outcomes and to analyze prognostic factors after fertility-sparing surgery in patients with early and advanced malignant ovarian germ cell tumors (MOGCTs). MethodsThis study included 171 patients who underwent fertility-sparing surgery. Data were gathered from patients' medical records. Survival analysis was performed using the log-rank test and Cox's proportional hazards model. Reproductive outcomes were analyzed. ResultsTwenty-five patients (14.6%) had recurrent disease, and five patients (2.9%) died of disease during the median follow-up time of 86months (range, 9–294months). The 5-year disease-free survival (DFS) was 86%, and the 5-year overall survival (OS) was 97%. The 5-year DFS was 84% for stage I and 89% for stage II–IV. The 5-year OS was 99% for stage I and 91% for stage II–IV. In multivariate analysis, yolk sac tumor, incomplete staging surgery, and residual tumor were independent risk factors for reduced DFS, and yolk sac tumor and residual tumor were independent risk factors for reduced OS. Reproductive and obstetric outcomes were evaluable in 124 patients, and 106 patients (85.5%) had regular menstruation, 12 patients (9.7%) had irregular menstruation, and six patients (4.8%) had premature menopause. Twenty patients tried to conceive, 15 patients (75%) succeeded in achieving 21 pregnancies, and 13 of the patients (65%) gave birth to 20 healthy babies. ConclusionFertility-sparing surgery has excellent survival outcomes in young women with MOGCTs, even in advanced stages. Reproductive and obstetric outcomes were promising. Yolk sac tumor, incomplete surgical staging, and residual tumor were independent prognostic factors.

The role of staging and adjuvant chemotherapy in stage I malignant ovarian germ cell tumors (MOGTs): the MITO-9 study

Surgery followed by platinum-based chemotherapy is the standard of care for MOGCTs, except for stage IA dysgerminoma and stage IA grade 1 immature teratoma where surveillance only is recommended. The role of adjuvant chemotherapy and surgical staging is debated. Data from 144 patients with stage I MOGTs were collected among MITO centers (Multicenter Italian Trials in Ovarian Cancer) and analyzed. Fifty-five (38.2%) patients were affected by dysgerminomas, 49 (34%) by immature teratomas, 26 (18.1%) by yolk sac tumors and 14 (9.7%) by mixed tumors. Seventy-three (50.7%) patients receive surgery plus chemotherapy, while 71 (49.3%) patients underwent surgery alone. The latter group included 32 dysgerminomas (14 IA-13 Ix, 3 IB, and 2 IC), 34 immature teratomas (20 1A-13 IA grade 1, 6 Ix, 1 IB, and 7 IC), 4 mixed tumors and 1 yolk sac tumor. Forty-four patients did not received chemotherapy, even if it would have been indicated by recommended approach. 94 (65.3%) patients received peritoneal surgical staging. Twenty-three (15.9%) developed a recurrence. Incomplete surgical staging was associated with recurrence (P < 0.05; OR 2.37) at Cox regression analysis. Seven patients died. Four patients were affected by yolk sac tumors, two by mixed tumors and one by immature teratoma. Five patients died for disease, one for acute leukemia and one for suicide. Prognostic parameter analyses showed that yolk sac component is a predictor for survival (P < 0.05). Five-years OS rates were 96.8% and 88.7% in the surgically staged and the incomplete staged group, respectively, while 93.8% and 94.1% in the standard treatment and in the surveillance group, respectively. This study shows that surveillance seems not to affect survival; chemotherapy should be reserved for relapse resulting in high cure rate. Incomplete peritoneal surgical staging is associated with recurrence. Yolk sac histology worsens the prognosis.

Adjuvant chemotherapy does not improve disease-free survival in FIGO stage IC ovarian granulosa cell tumors: The MITO-9 study

ObjectiveEvidence-based management of granulosa cell tumors of the ovary (GCT) has been not yet standardized: surgery, including fertility-sparing procedures for young women, has been traditionally the standard treatment; on the other hand, chemotherapy has been used for treatment of advanced and/or recurrent disease. However, very limited experience, has been selectively focused on the role of adjuvant chemotherapy in stage IC patients. The objective of this retrospective study was to assess the efficacy of first line postoperative chemotherapy in patients with stage IC treated at the Italian Centers involved in the MITO (Multicenter Italian Trials in Ovarian cancer) Group. Patients and methodsA retrospective multi-institutional review of patients with GCT of the ovary at FIGO stage IC treated or referred to MITO centers was conducted. Surgical outcome, pathological findings and follow-up data were analysed. Kaplan–Meier and Cox proportional hazards analyses were used to determine the predictors factors for disease free survival. ResultsA total of 40 patients with primary GCT of the ovary at FIGO stage IC were identified. The median follow-up period was 96months (range 7–300). At multivariate analysis, surgical treatment outside MITO centers and incomplete surgical staging were independent poor prognostic indicators for recurrence; adjuvant chemotherapy did not retain significant predictive value for recurrence. ConclusionsThis study raises the question about the value of adjuvant chemotherapy in stage IC GCT: a comprehensive evaluation of a larger series is urgently needed in order to characterize stage IC substages who can be spared treatment toxicity.

Impact of surgical staging on prognosis in patients with borderline ovarian tumours: A meta-analysis

BackgroundTo quantify the effect of complete surgical staging (CSS) on prognosis in borderline ovarian tumour (BOT) patients through a meta-analysis. MethodsWe systematically reviewed published studies comparing CSS with incomplete surgical staging (ISS) in BOT patients through April 2015. End-points were recurrence and mortality rates. Study design features that possibly affected participant selection, recurrence/death detection, and manuscript publication were assessed. For pooled estimates of the effect of CSS on recurrence/death, random- or fixed-effects meta-analytical models were used after assessing cross-study heterogeneity. ResultsEighteen observational studies (CSS, 1297 patients; ISS, 1473 patients) met our search criteria. Fixed-effects model-based meta-analysis indicated a reduced recurrence risk among CSS patients (odds ratio [OR]=0.64; 95% confidence interval [CI]: 0.47–0.87, P < 0.05, I2 = 25.6). However, no significant between-group difference in mortality was observed (OR = 0.98; 95% CI: 0.42–2.29, P = 0.97, I2 = 0). In subgroup analysis by histology, CSS was associated with a reduced recurrence risk in 16 studies of all histologic types (OR = 0.66; 95% CI: 0.48–0.91, P < 0.05, I2 = 31.9) but not in two studies of only mucinous disease (OR = 0.41; 95% CI: 0.13–1.30, P = 0.13, I2 = 0). In subgroup analyses with four studies with recurrence data according to fertility-sparing surgery, no significant association was found (OR = 0.51; 95% CI: 0.18–1.43, P = 0.20, I2 = 0). There was no evidence of publication bias. ConclusionsIn this meta-analysis based on observational studies, CSS appeared to significantly reduce recurrence among BOT patients. No survival impact was observed. Longer-term randomised controlled trials could verify this relationship but appear infeasible for this rare tumour.

Surgical staging and its prognostic impact on patients with borderline ovarian tumors (BOT): A subanalysis of the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) ROBOT study.

5562 Background: Incomplete surgical staging was shown to be a negative prognostic factor for patients with borderline ovarian tumors (BOT). However, little is known about the prognostic impact of each individual staging procedure. Methods: Clinical parameters of 950 patients with BOT (confirmed by central reference pathology) treated between 1998 and 2008 in 24 German AGO centers were analyzed. Staging quality was evaluated following German guidelines. In patients with adequate surgery regarding their reproductive organs (bilateral salpingo-oophorectomy or intended fertility preserving surgery in patients ≤55 years), other recommended staging procedures (omentectomy, peritoneal biopsies, cytology, and, for mucinous histology, appendectomy) were evaluated applying uni- and multivariate regression models with respect to progression-free survival (PFS), separately for serous and mucinous histology. Results: A total of 559 serous BOT (64.1%) were opposed to 268 mucinous BOT (30.7%). For patients with serous ...

Long-term follow-up is crucial after treatment for granulosa cell tumours of the ovary

Objective:The aim of this study is to evaluate the long-term outcome of granulosa cell tumour (GCT) of the ovary in a large series of patients treated in MITO centres (Multicentre Italian Trials in Ovarian Cancer) and to define prognostic parameters for relapse and survival.Methods:A retrospective multi-institutional review of patients with GCTs of the ovary treated or referred to MITO centres was conducted. Surgical outcome, intraoperative and pathological findings and follow-up data were analysed. Kaplan–Meier and Cox proportional hazards analyses were used to determine the predictors for survival and recurrence.Results:A total of 97 patients with primary GCT of the ovary were identified. The median follow-up period was 88 months (range 6–498). Of these, 33 patients had at least one episode of disease recurrence, with a median time to recurrence of 53 months (range 9–332). Also, 47% of recurrences occurred after 5 years from initial diagnosis. At multivariate analysis, age and stage were independent poor prognostic indicators for survival; surgical treatment outside MITO centres and incomplete surgical staging retained significant predictive value for recurrence in both univariate and multivariate analyses.Conclusions:This study confirms the generally favourable prognosis of GCTs of the ovary, with 5-year overall survival approaching 97%. Nevertheless, prognosis after 20 years was significantly poorer, with 20-year survival rate of 66.8% and a global mortality of 30–35. These findings support the need for lifelong follow-up even in early-stage GCT.

Histopathologic features of ovarian borderline tumors are not predictive of clinical outcome

ObjectivesOvarian borderline tumors (BOTs) generally have an excellent prognosis, although recurrences and malignant transformation can occur. Our aim was to compare clinicopathologic features of BOT with clinical outcome. MethodsIn seventy consecutive BOTs clinicopathologic parameters, tumor cell proliferation (Ki67) and in selected cases KRAS, BRAF and p53 mutational status were analyzed with recurrence-free and overall survival as the endpoints. ResultsSixty-one (87%) patients presented with FIGO stage I, 3 stage II, and 6 stage III. Thirty-four patients had serous and 36 mucinous BOT (30 intestinal and 6 endocervical subtypes). Non-invasive peritoneal implants occurred in 9 patients, and no invasive implants were observed. Recurrence-free and overall survival rates were 91% and 99%, respectively, at a mean follow-up of 63months.Disease recurrence occurred in 6 cases (all FIGO stage I) including 3 serous, 1 mucinous-intestinal, and 2 mucinous-endocervical subtypes. Mean time to recurrence was 27months (range 8–68). The recurrence rate following fertility-conserving surgery was 31% (5/16) compared to 2% (1/54) after bilateral salpingo-oophorectomy. Neither peritoneal implants (9/70), micropapillary pattern (2/34), microinvasion (4/70), nor increased tumor cell proliferation was associated with a higher recurrence rate. The frequency of KRAS or BRAF mutations was 50% (3/6 recurrences and 3/6 controls; 4 KRAS, 2 BRAF mutations). No p53 mutations (0/12) were detected in primary or recurrent BOTs. ConclusionsHistopathologic parameters were not predictive of BOT recurrence including previously suggested risk factors such as micropapillary pattern and microinvasion. However, fertility-conserving surgery and incomplete surgical staging were associated with a higher risk for recurrence.