Primary Debulking Surgery Research Articles

Melanoma brain metastasis treated with stereotactic radiosurgery (SRS) and systemic agents (SACT): A single centre perspective from Northeast England.

e21500 Background: Melanoma incidence rates in the UK will increase and given its proclivity for brain metastasis, it will be a growing challenge. Real-world survival data reflecting the impact of modern SACTs and SRS is lacking. Here we report our single-centre experience. Methods: All melanoma brain metastasis patients treated with both SRS and SACT in Newcastle-upon-Tyne, UK between January 2017 and January 2022 were identified. Data was collected from patient records until data-lock in January 2023. Survival analysis was performed using R (version 4.2.2). The primary objective was to measure the overall survival. Results: 51 patients were included. The median age was 60 years. Most patients had ECOG PS of 0 (43%, n = 22) or 1 (53%, n = 27). 15 (29%) had de-novo brain metastasis. 21 (41%) were on SACT before diagnosis of brain metastasis. 28 (55%) patients had solitary brain metastasis. 8 (16%) had no radiologically reported extracranial disease. Superficial spreading melanoma was the most common histological subtype (45%, n = 23). 55% (n = 26) had a sensitizing BRAF mutation. 25 patients (49%) received SRS before SACT. 12 (26%) patients had undergone primary debulking surgery. The median time to start SRS was 54 days (IQR 35 - 90) from brain metastasis diagnosis. Median extracranial progression-free survival was 25 months (95% CI 10 – NA). Median intracranial progression-free survival was 29 months (95% CI 15 – NA). 17 (33%) patients had both intra and extracranial progression. 7 (13%) had in-field intracranial progression. The median target volume was similar between subgroups that had infield (1.78mL, IQR 0.56 - 13.81), out-of-field (1.78mL, IRQ 1.62 - 3.97) or no intracranial progression (2.38mL, IQR 1.29 - 6.73). The median total dose to target was 21 Grays for all subgroups. Median overall survival was 27 months (95% CI 16 - NA). With intracranial progression, the median overall survival was 21 months (95% CI 10 –36). The survival was 15 months (95% CI 9.5 - 27) with extracranial progression, which was significantly less than without extracranial progression (HR = 0.25, 95% CI 0.11 – 0.60, p = 0.002). In the absence of intracranial progression, median overall survival was not reached. Patients with infield progression had an overall survival of 8.6 months (95% CI 6.8 – NA), HR 2.83 (95% CI 1.20 - 6.7), p = 0.018. Those with melanoma-specific Graded Prognostic Assessment score (molGPA) > 2.5 had a median overall survival of 31 months (95% CI 14 – NA) with a HR of 0.73 (95% CI 0.32 - 1.64, p = 0.4). Conclusions: Survival in our cohort is notably better than reports from prior series. This is despite our catchment in the North East of England being adversely affected by health disparity. This could be explained by the selection bias of our cohort. However, in the wake of improved treatment modalities, the need for more up-to-date cancer data tracking cannot be overstated.

69P Use of bevacizumab for patients with FIGO stage IIIB to IV epithelial ovarian cancer undergoing primary debulking surgery and its association with oncologic outcomes: A German cancer registry study

69P Use of bevacizumab for patients with FIGO stage IIIB to IV epithelial ovarian cancer undergoing primary debulking surgery and its association with oncologic outcomes: A German cancer registry study

Primary cytoreductive surgery followed by chemotherapy compared to neoadjuvant chemotherapy followed by cytoreduction as a treatment for stage III and IV ovarian cancer (literature review)

Standard treatment for advanced ovarian cancer (OC) consists of a combination of chemotherapy and cytoreductive surgery, but practice varies depending on the order of these 2 procedures: neoadjuvant chemotherapy followed by interval debulking surgery or primary cytoreduction followed by adjuvant chemotherapy. The aim of the work is to evaluate methods of treatment of OC of stages III, IV according to FIGO.The literature review includes publications in English from the PubMed, CochraneLibrary and Google Scholar databases on the use of neoadjuvant therapy and primary cytoreduction in late stages of OC (FIGO III–IV). 6 randomized controlled trials, 8 meta-analyses, 8 systematic reviews, 1 case report were identified. Data from publications were distributed according to the criteria for assessing the effectiveness of the treatment: overall and relapse-free survival, perioperative complications, quality of life of patients and the grade of cytoreduction.Neoadjuvant chemotherapy + interval debulking surgery is not inferior to primary debulking surgery + adjuvant chemotherapy in terms of survival outcomes in selected patients, but treatment with neoadjuvant chemotherapy + interval debulking surgery improves perioperative outcomes and optimal cytoreduction rates. It is needed to focus on finding optimal criteria for selecting patients in both groups in future studies of this issue. It is necessary to take into account X-ray, histological studies, the molecular subtype of the tumor, the patient’s condition, the qualifications of the surgical team, the drugs included in chemotherapy.

Trends in specific procedures performed at the time of cytoreduction for ovarian cancer: Is interval debulking surgery truly less radical? A Memorial Sloan Kettering Cancer Center Team Ovary study

ObjectivesTo evaluate procedures performed during primary debulking surgery (PDS) and interval debulking surgery (IDS) for ovarian cancer. MethodsPatients surgically treated at our institution for newly diagnosed stage IIIC/IV epithelial ovarian cancer between 6/1/2015–12/31/2021 were identified using a prospectively collected database. Patients were triaged to PDS or neoadjuvant chemotherapy (NACT) followed by IDS using an institutional algorithm. Data on specific procedures performed, including consultants called, were collected from operative and pathology reports. Appropriate statistical analyses were applied. ResultsOverall, 467 patients underwent PDS and 434 underwent IDS; 76% (PDS) and 71% (IDS) of cases achieved complete gross resection. Comparing PDS vs IDS cohorts, median age was 63 years (range, 23–86) vs 67 years (range, 35–95), 79% vs 86% of patients had high-grade serous histology, and 38% vs 70% had stage IV disease. Most procedures (except ostomy, distal pancreatectomy) were more common during PDS (P < .05). Bowel surgery was performed during 65% of PDS and 33% of IDS, and upper abdominal surgery during 72% of PDS and 52% of IDS; both were more common during PDS (P < .001). Estimated blood loss (median, 500 mL [PDS] vs 300 mL [IDS]) and operative time (median, 362 min [PDS] vs 267 min [IDS]) were higher for PDS (P < .001). A consulting surgeon was utilized during 31% of PDS and 18% of IDS, with hepatopancreaticobiliary as the most commonly called service (61% and 65%, respectively). ConclusionsIn our study of patients with advanced-stage ovarian cancer, while most procedures were more often performed during PDS, NACT did not obviate the need for radical surgical resection. Thus, advanced surgical skills remain essential.

Survival Outcomes Following Interval Versus Primary Debulking Surgery in Advanced Epithelial Ovarian Cancer: A Retrospective Cohort Study in Lagos, Southwest Nigeria

Survival Outcomes Following Interval Versus Primary Debulking Surgery in Advanced Epithelial Ovarian Cancer: A Retrospective Cohort Study in Lagos, Southwest Nigeria

An Audit on Factors Delaying Time to Chemotherapy in Stage IIB–IV Ovarian Cancer Patients After Primary Debulking Surgery

An Audit on Factors Delaying Time to Chemotherapy in Stage IIB–IV Ovarian Cancer Patients After Primary Debulking Surgery

Opening the Black Box: Spatial Transcriptomics and the Relevance of Artificial Intelligence–Detected Prognostic Regions in High-Grade Serous Carcinoma

Image-based deep learning models are used to extract new information from standard hematoxylin and eosin pathology slides; however, biological interpretation of the features detected by artificial intelligence (AI) remains a challenge. High-grade serous carcinoma of the ovary (HGSC) is characterized by aggressive behavior and chemotherapy resistance, but also exhibits striking variability in outcome. Our understanding of this disease is limited, partly due to considerable tumor heterogeneity. We previously trained an AI model to identify HGSC tumor regions that are highly associated with outcome status but are indistinguishable by conventional morphologic methods. Here, we applied spatially resolved transcriptomics to further profile the AI-identified tumor regions in 16 patients (8 per outcome group) and identify molecular features related to disease outcome in patients who underwent primary debulking surgery and platinum-based chemotherapy. We examined formalin-fixed paraffin-embedded tissue from (1) regions identified by the AI model as highly associated with short or extended chemotherapy response, and (2) background tumor regions (not identified by the AI model as highly associated with outcome status) from the same tumors. We show that the transcriptomic profiles of AI-identified regions are more distinct than background regions from the same tumors, are superior in predicting outcome, and differ in several pathways including those associated with chemoresistance in HGSC. Further, we find that poor outcome and good outcome regions are enriched by different tumor subpopulations, suggesting distinctive interaction patterns. In summary, our work presents proof of concept that AI-guided spatial transcriptomic analysis improves recognition of biologic features relevant to patient outcomes.

Laparoscopic Treatment of Bulky Nodes in Primary and Recurrent Ovarian Cancer: Surgical Technique and Outcomes from Two Specialized Italian Centers.

(1) Background: Minimally invasive surgery (MIS) represents a feasible approach in early-stage ovarian cancer, while this question is still unsolved for advanced and recurrent disease. (2) Methods: In this retrospective, multicenter study, we present a series of 21 patients who underwent MIS for primitive or recurrent epithelial ovarian cancer (EOC) with bulky nodal metastasis and discuss surgical technique and outcomes in relation to the current literature. (3) Results: Complete cytoreduction at primary debulking surgery was obtained in 86% of cases. No complication occurred in our patients intraoperatively and only 11.1% of our patients experienced grade 2 and 3 postoperative complications. Notably, all the patients with isolated lymph nodal recurrence (ILNR) were successfully treated with a minimally invasive approach with no intra- or postoperative complications. (4) Conclusions: The results of our study are consistent with those reported in the literature, demonstrating that MIS may represent a safe approach in advanced and recurrent EOC with nodal metastasis if performed on selected patients by expert surgeons with an adequate setting and appropriate technique.

Potential utility of pretreatment serum miRNAs for optimal treatment selection in advanced high-grade serous ovarian cancer.

The primary treatment of patients with advanced ovarian cancer is selected from whether primary debulking surgery or neoadjuvant chemotherapy. We investigated whether pretreatment serum microRNA profiles are useful for selecting patients with advanced high-grade serous ovarian cancer who obtain better outcomes from undergoing primary debulking surgery or neoadjuvant chemotherapy. Consecutive patients with clinical stage IIIB-IVB and serum microRNA data were selected. Patients who underwent primary debulking surgery or neoadjuvant chemotherapy were subjected to 1:1 propensity score matching before comparing their progression-free survival using Cox modelling. Progression-free probabilities for the selected microRNA profiles were calculated, and the estimated progression-free survival with the recommended primary treatment was determined and compared with the actual progression-free survival of the patients. Of the 108 patients with stage IIIB-IVB disease, the data of 24 who underwent primary debulking surgery or neoadjuvant chemotherapy were compared. Eleven and three microRNAs were independent predictors of progression-free survival in patients who underwent primary debulking surgery and neoadjuvant chemotherapy, respectively. Two microRNAs correlated significantly with complete resection of the tumours in primary debulking surgery. No differences were found between the actual and estimated progression-free survival in the primary debulking surgery and neoadjuvant chemotherapy groups (P>0.05). The recommended and actual primary treatments were identical in 27 (56.3%) of the 48 patients. The median improved survival times between recommended and actual treatment were 11.7 and 32.6months for patients with actual primary debulking surgery and neoadjuvant chemotherapy, respectively. Pretreatment microRNA profiles could be used to select subgroups of patients who benefited more from primary debulking surgery or neoadjuvant chemotherapy and might contribute to selecting the optimal primary treatment modality in advanced high-grade serous ovarian cancer patients.

Profiling of Tumour-Infiltrating Lymphocytes and Tumour-Associated Macrophages in Ovarian Epithelial Cancer-Relation to Tumour Characteristics and Impact on Prognosis.

Early evidence suggests a strong impact of tumour-infiltrating lymphocytes (TILs) on both the prognosis and clinical behaviour of ovarian cancer. Proven associations, however, have not yet translated to successful immunotherapies and further work in the field is urgently needed. We aimed to analyse the tumour microenvironment of a well-characterised cohort of ovarian cancer samples. Tumour markers were selected owing to their comparative underrepresentation in the current literature. Paraffin-embedded, formalin-fixed tumour tissue blocks of 138 patients representative of the population and including early stage disease were identified, stained for CD3, CD20, CD68 and CD163 and analysed for both the stromal and intertumoral components. Data were statistically analysed in relation to clinical details, histological subtype, borderline vs. malignant status, survival and management received. Mean stromal CD3, total CD3 count, mean stromal CD20 and total CD20 count all correlated negatively with survival. Malignant ovarian tumours consistently demonstrated significantly higher infiltration of all analysed immune cells than borderline tumours. Assessment of the stromal compartment produced a considerably higher proportion of significant results when compared to the intra-tumoural infiltrates. Customary assessment of solely intra-tumoural cells in advanced stage disease patients undergoing primary debulking surgery should be challenged, with recommendations for future scoring systems provided.

A randomized controlled trial to compare short-term outcomes following infragastric and infracolic omentectomy at the time of primary debulking surgery for epithelial ovarian cancer with normal-appearing omentum

BackgroundOmentectomy is an important procedure in surgery for epithelial ovarian cancer, but the scope of omentectomy is not recommended in the guidelines. This study was performed to evaluate the benefits and risks of infragastric omentectomy in patients with epithelial ovarian cancer.MethodsThis trial is a single center prospective study. Primary epithelial ovarian cancer patients with normal-appearing omentum were randomly assigned to either the control or experimental group and underwent infracolic or infragastric omentectomy, respectively. The primary endpoint was progression-free survival. This trial is registered on Chinese clinical trial registry site (ChiCTR1800018771).ResultsA total of 106 patients meeting the inclusion criteria for ovarian cancer were included during the study period. Of these, 53 patients underwent infracolic omentectomy, whereas 53 patients received infragastric omentectomy. Multivariate analysis revealed that infragastric omentectomy could improve the detection rate of omental metastases (OR: 6.519, P = 0.005). Infragastric omentectomy improved progression-free survival significantly for those cases with higher than stage IIB disease (HR: 0.456, P = 0.041). Based on the short-term results, infragastric omentectomy did not cause more perioperative complications.ConclusionsCompared with infracolic omentectomy, infragrastric omentectomy may be a more appropriate surgical procedure for stage IIB-IIIC epithelial ovarian cancer patients with normal-appearing omentum.

Ovarian surveillance including endometrial cytology for patients with hereditary breast and ovarian cancer before risk-reducing salpingo-oophorectomy: A retrospective analysis.

Ovarian surveillance in women with hereditary breast and ovarian cancer who do not undergo risk-reducing salpingo-oophorectomy has been controversial. Therefore, this study aimed to demonstrate the clinical features of ovarian surveillance at our institution using a technique that combines serum cancer antigen 125 measurements, transvaginal ultrasonography, and uterine endometrial cytology. We retrospectively examined 65 women, who had not undergone risk-reducing salpingo-oophorectomy diagnosed with hereditary breast and ovarian cancer between 2000 and 2021 at our hospital. Clinical information was obtained and analyzed through a chart review. The details of the treatment course were reviewed for patients who had developed ovarian cancer. Overall, 5 of the 65 women were diagnosed with ovarian cancer based on abnormal findings during periodic surveillance. All patients who developed ovarian cancer were asymptomatic, even if the cancer was at an advanced stage. Two of the 65 patients had endometrial cytology abnormalities, both of whom had ovarian cancer. All patients who developed ovarian cancer underwent primary debulking surgery, and complete gross resection was achieved. None of the patients experienced ovarian cancer recurrence. The ovarian surveillance strategy at our institution for women with hereditary breast and ovarian cancer who do not undergo risk-reducing salpingo-oophorectomy can identify asymptomatic ovarian cancer and contribute to achieving complete gross resection during primary surgery. Ovarian surveillance may contribute to a reduction in ovarian cancer mortality.

A comparison of the clinical and histological appearances after treatment of advanced stage ovarian cancer with PlasmaJet® device

ObjectiveTo compare the clinical appearance of “no residual disease” to the histological assessment of the same tissue when treated with PlasmaJet®. To determine if the treated tissue with a clinical appearance of “no residual disease” demonstrated histologically apparent damage to underlying structures. AimThe main aims of the study were to compare the clinical appearance of ‘no residual disease’ to the histological assessment of the same tissue and to assess whether treatment with PlasmaJet® to produce a clinical appearance of ‘no residual disease’ causes no histologically apparent damage to the underlying structures. MethodThis prospective cohort study was conducted in Liverpool Women’s NHS Foundation Trust between January 2019 and June 2020. Women with a diagnosis of advanced or presumed advanced stage ovarian cancer were approached and 20 women were recruited into the study. Tissue samples were collected from women with stage 3 or 4 ovarian cancer at either primary or interval debulking surgery. ResultsThe clinical appearance of no residual disease was confirmed histologically in 84 % (n = 16) of cases. Fat was the only underlying tissue seen damaged in 21 % (n = 4) of cases. Bowel resection with stoma formation was needed in one case (5.26 %). ConclusionPlasmaJet® ablated the malignant tissue in majority of the cases without causing any significant damage to the underlying tissue, it also reduced the need for stoma formation. This is a small study with encouraging results. PlasmaJet® could be a valuable tool in ovarian cancer surgery, it potentially could reduce the need for bowel surgery and allow treatment of significant mesenteric disease with reduced morbidity for the patient.

Genome-wide association analyses of ovarian cancer patients undergoing primary debulking surgery identify candidate genes for residual disease

Survival from ovarian cancer depends on the resection status after primary surgery. We performed genome-wide association analyses for resection status of 7705 ovarian cancer patients, including 4954 with high-grade serous carcinoma (HGSOC), to identify variants associated with residual disease. The most significant association with resection status was observed for rs72845444, upstream of MGMT, in HGSOC (p = 3.9 × 10−8). In gene-based analyses, PPP2R5C was the most strongly associated gene in HGSOC after stage adjustment. In an independent set of 378 ovarian tumours from the AGO-OVAR 11 study, variants near MGMT and PPP2R5C correlated with methylation and transcript levels, and PPP2R5C mRNA levels predicted progression-free survival in patients with residual disease. MGMT encodes a DNA repair enzyme, and PPP2R5C encodes the B56γ subunit of the PP2A tumour suppressor. Our results link heritable variation at these two loci with resection status in HGSOC.

Abstract A078: In vivo tumor micro-environment characterization: preliminary results of an ovarian cancer patients-derived co-colture organoids platform

Abstract Introduction: Most patients with ovarian cancer (OC) are diagnosed at advanced stage. Current standard of care is based on surgery and platinum-based chemotherapy (CHT) in association with target therapies according to molecular characteristics (BRCA status and Homologous Recombination Repair (HRR) status). However, 15-20% progressed to first line CHT and mechanisms of resistance remain far from being completely known. In this scenario the role of tumoral microenvironment (TME) represents an open question. Methods: We designed a study to establish OC patients-derived co-colture organoids (ID PICTURE, IRB approval 4531). Both peripheral Blood Mononuclear Cells (PBMC) and isolated immune infiltrating cells from tumor tissue were planned to be used. The first endpoint of the study was the feasibility of this approach including (i) establishment OC patients-derived organoids (ii) PBMC isolation from whole blood and characterization (iii) immune infiltrate isolation from tumor tissue and characterization. For the latter, the evaluation of the immune phenotype was carried out by cytofluorimetry analyses, through target cells labelling with monoclonal antibodies conjugates with fluorescent molecules (CD45, CD19, CD3, CD4, CD8, 7AAD). Correlation between tumor immune infiltrate and mutational and clinical findings was also accomplished. Results: From January 2022 to May 2023, 36 patients with EOC, 92% with high grade serous OC and 95% with an advanced stage (from stage III according to FIGO, all high tumor load according to the Fagotti’s score) were enrolled. 23 patients (64%) were BRCA wild type while HRR status was available only for 17 patients of whom 28% were deficient. Considering the model feasibility, 5 organoids were obtained, and 8 and 20 million immune cells were isolated from tissue and peripheral blood, respectively. The immune infiltrate analysis was performed on 21 samples obtained from primary debulking surgery and 15 from diagnostic laparoscopies. 75% were treated with carboplatin paclitaxel (weekly or q21); among patients undergoing neoadjuvant treatment, 3 had a complete response (CRS3). The infiltration of B and T lymphocytes was described in all patients: 73% were positive for CD3, 20% for CD45, 7% for CD19. The lymphocytes T characterization was available for 7 patients with a median value of CD4+ 51.3, CD8+ 44.4, CD8+CD4+ 2,6 and CD8-CD4- 1.6. A trend for statistically significant difference was observed for CD45+ in stage IV vs stage I-III (p=0.021) and in CD19+ B cells in BRCA mutant vs BRCA WT (p=0.026). Finally, CD3+ T cells showed a significantly higher concentration in the 4 patients experiencing progression of disease at 6 months follow-up (p=0.014). Conclusion: These preliminary results suggest that patients-derived organoids co-cultured with tumor immune infiltrate could be challenging because of small numbers of overall cell content. Nevertheless, a correlation between specific components of B and T cells and molecular features and cancer progression deserves further investigation. Citation Format: Floriana Camarda, Clara Di Mario, Camilla Nero, Barbara Tolusso, Stefano Alivernini, Francesca Sillano, Sonia Mastrogiovanni, Tina Pasciuto, Elisa Gremese, Eleonora Cesari, Alessandra Ciucci, Claudio Sette, Giovanni Scambia. In vivo tumor micro-environment characterization: preliminary results of an ovarian cancer patients-derived co-colture organoids platform [abstract]. In: Proceedings of the AACR Special Conference on Ovarian Cancer; 2023 Oct 5-7; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(5 Suppl_2):Abstract nr A078.

Abstract A092: Ovarian tumor organotypic slices cultures for functional drug screening (TOSCA)

Abstract A092: Ovarian tumor organotypic slices cultures for functional drug screening (TOSCA)

A modified diffusion-weighted magnetic resonance imaging–based model from the radiologist’s perspective: improved performance in determining the surgical resectability of advanced high-grade serous ovarian cancer

BackgroundComplete resection of all visible lesions during primary debulking surgery is associated with the most favorable prognosis in patients with advanced high-grade serous ovarian cancer. An accurate preoperative assessment of resectability is pivotal for tailored management. ObjectiveTo assess the potential value of a modified model that integrates the original eight radiological criteria of the Memorial Sloan Kettering Cancer Center model with imaging features of the subcapsular/diaphragm and mesenteric lesions depicted on diffusion-weighted MRI, and growth patterns of all lesions, for predicting the resectability of advanced high-grade serous ovarian cancer. Study designThis study included 184 patients with high-grade serous ovarian cancer who underwent preoperative diffusion-weighted MRI between December 2018 and May 2023 at two medical centers. The patient cohort was divided into three subsets: a study cohort (n=100), internal validation cohort (n=46), and external validation cohort (n=38). Preoperative radiological evaluations were independently conducted by two radiologists using both the Memorial Sloan Kettering Cancer Center model and the modified diffusion-weighted MRI-based model. The morphological characteristics of the ovarian tumors depicted on MRI were assessed as either mass-like or infiltrative, and transcriptomic analysis of the primary tumor samples was performed. Univariate and multivariate statistical analyses were performed. ResultsIn the study cohort, both the scores derived using the Memorial Sloan Kettering Cancer Center (intraclass correlation coefficients of 0.980 and 0.959, respectively, both p < 0.001) and modified diffusion-weighted MRI-based models (intraclass correlation coefficients of 0.962 and 0.940, respectively, both p < 0.001) demonstrated excellent intra- and inter-observer agreement. The Memorial Sloan Kettering Cancer Center model (odds ratio = 1.825; 95% CI, 1.390–2.395; p < 0.001) and the modified diffusion-weighted MRI-based model (odds ratio = 1.776; 95% CI, 1.410–2.238; p < 0.001) independently predicted surgical resectability. The modified diffusion-weighted MRI-based model demonstrated improved predictive performance, with an area under the curve of 0.867 in the study cohort, and 0.806 and 0.913 in the internal and external validation cohorts, respectively. Using the modified diffusion-weighted MRI-based model, patients with scores of 0–2, 3–4, 5–6, 7–10, and ≥ 11 achieved complete tumor debulking rates of 90.3%, 66.7%, 53.3%, 11.8%, and 0%, respectively. Most patients with incomplete tumor debulking had infiltrative tumors, and both the Memorial Sloan Kettering Cancer Center and the modified diffusion-weighted MRI-based models yielded higher scores. The molecular differences between the two morphological subtypes were identified. ConclusionCompared to the Memorial Sloan Kettering Cancer Center model, the modified diffusion-weighted MRI-based model demonstrated enhanced accuracy in the preoperative prediction of resectability for advanced high-grade serous ovarian cancer. Patients with scores of 0–6 were eligible for primary debulking surgery.

Preoperative serum level of CA153 and a new model to predict the sub-optimal primary debulking surgery in patients with advanced epithelial ovarian cancer

ObjectiveThe aim of this study was to establish a preoperative model to predict the outcome of primary debulking surgery (PDS) for advanced ovarian cancer (AOC) patients by combing Suidan predictive model with HE4, CA125, CA153 and ROMA index.Methods76 AOC Patients in revised 2014 International Federation of Gynecology and Obstetrics (FIGO) stage III-IV who underwent PDS between 2017 and 2019 from Yunnan Cancer Hospital were included. Clinical data including the levels of preoperative serum HE4, CA125, CA153 and mid-lower abdominal CT-enhanced scan results were collected. The logistics regression analysis was performed to find factors associated with sub-optimal debulking surgery (SDS). The receiver operating characteristic curve was used to evaluate the predictive performances of selected variables in the outcome of primary debulking surgery. The predictive index value (PIV) model was constructed to predict the outcome of SDS.ResultsOptimal surgical cytoreduction was achieved in 61.84% (47/76) patients. The value for CA125, HE4, CA153, ROMA index and Suidan score was lower in optimal debulking surgery (ODS) group than SDS group. Based on the Youden index, which is widely used for evaluating the performance of predictive models, the best cutoff point for the preoperative serum HE4, CA125, CA153, ROMA index and Suidan score to distinguish SDS were 431.55 pmol/l, 2277 KU/L, 57.19 KU/L, 97.525% and 2.5, respectively. Patients with PIV≥5 may not be able to achieve optimal surgical cytoreduction. The diagnostic accuracy, NPV, PPV and specificity for diagnosing SDS were 73.7%, 82.9%, 62.9% and 72.3%, respectively. In the constructed model, the AUC of the SDS prediction was 0.770 (95% confidence interval: 0.654-0.887), P<0.001.ConclusionPreoperative serum CA153 level is an important non-invasive predictor of primary SDS in advanced AOC, which has not been reported before. The constructed PIV model based on Suidan's predictive model plus HE4, CA125, CA153 and ROMA index can noninvasively predict SDS in AOC patients, the accuracy of this prediction model still needs to be validated in future studies.

A computer synoptic operative report versus a report dictated by a surgeon in advanced ovarian cancer

ObjectiveTo evaluate the role of a computer synoptic operative report in enhancing the quality and completeness of surgical reporting for advanced ovarian cancer surgeries.MethodsThe study was conducted at a tertiary...

PARP inhibitor maintenance treatment for newly diagnosed ovarian cancer patients: a real-world study from China.

This study evaluated the efficacy and safety in a real-world population of epithelial ovarian cancer (EOC) treated with poly (ADP-ribose) polymerase inhibitor (PARPi) as first-line maintenance therapy in the largest gynecologic oncology center in Western China. This study included patients newly diagnosed EOC who received PARPi as first-line maintenance therapy in West China Second University Hospital from August 1, 2018 to September 31, 2022. The primary endpoints were progression-free survival (PFS) and safety evaluated by Common Terminology Criteria for Adverse Events Version 5.0(CTCAE 5.0). The secondary endpoints were overall survival (OS) and prognostic factors influencing the PFS of patients in real world. Among the eligible 164 patients, 104 patients received olaparib and 60 patients received niraparib. 100 patients (61.0%) had mutations in breast cancer susceptibility gene (BRCA). 87 patients (53.0%) received primary debulking surgery (PDS) while 77 patients (47.0%) received interval debulking surgery (IDS). 94 patients (94/164, 57.3%) achieved R0 and 39 patients (23.8%) achieved R1 after PDS/IDS. 112 (68.3%) achieved complete response (CR) after first-line chemotherapy, while 49 (29.9%) achieved partial response (PR). The median follow-up time was 17.0 months (95% CI 15.6-18.4), and the median PFS has not been reached yet. Multivariate analysis demonstrated that BRCA mutations and CR/PR after platinum-based chemotherapy were independent factors associated with prolonged PFS. Hematologic toxicity was the most common grade≥3 AE. There were no incidence of myelodysplastic syndromes/acute myelogenous leukemia (MDS/AML). Focusing on PARPi as first-line maintenance therapy for patients with EOC, this study represented the largest single-center real-world study in China to date. Two independent factors were identified to prolong the PFS of patients: BRCA mutated type and CR/PR after primary treatment, which should be further confirmed with long-term follow-up and large sample sizes.