Advanced low grade serous ovarian cancer: A retrospective analysis of surgical and chemotherapeutic management in two high volume oncological centers
Simple summaryLow-grade serous ovarian cancer (LGSOC) represents an uncommon histotype of serous ovarian cancer (accounting for approximately 5% of all ovarian cancer) with a distinct behavior compared to its high-grade serous counterpart, characterized by a better prognosis and low response rate to...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-09-01
|
| Series: | Frontiers in Oncology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.970918/full |
| _version_ | 1828170284863062016 |
|---|---|
| author | Paolo Di Lorenzo Paolo Di Lorenzo Vincenza Conteduca Vincenza Conteduca Emanuela Scarpi Marco Adorni Francesco Multinu Annalisa Garbi Ilaria Betella Tommaso Grassi Tommaso Bianchi Giampaolo Di Martino Andrea Amadori Paolo Maniglio Isabella Strada Silvestro Carinelli Marta Jaconi Giovanni Aletti Giovanni Aletti Vanna Zanagnolo Angelo Maggioni Luca Savelli Ugo De Giorgi Fabio Landoni Nicoletta Colombo Nicoletta Colombo Robert Fruscio Robert Fruscio |
| author_facet | Paolo Di Lorenzo Paolo Di Lorenzo Vincenza Conteduca Vincenza Conteduca Emanuela Scarpi Marco Adorni Francesco Multinu Annalisa Garbi Ilaria Betella Tommaso Grassi Tommaso Bianchi Giampaolo Di Martino Andrea Amadori Paolo Maniglio Isabella Strada Silvestro Carinelli Marta Jaconi Giovanni Aletti Giovanni Aletti Vanna Zanagnolo Angelo Maggioni Luca Savelli Ugo De Giorgi Fabio Landoni Nicoletta Colombo Nicoletta Colombo Robert Fruscio Robert Fruscio |
| author_sort | Paolo Di Lorenzo |
| collection | DOAJ |
| description | Simple summaryLow-grade serous ovarian cancer (LGSOC) represents an uncommon histotype of serous ovarian cancer (accounting for approximately 5% of all ovarian cancer) with a distinct behavior compared to its high-grade serous counterpart, characterized by a better prognosis and low response rate to chemotherapeutic agents. Similar to high-grade serous ovarian cancer, cytoreductive surgery is considered crucial for patient survival. This retrospective study aimed to analyze the outcomes of women affected by advanced stages (III–IV FIGO) of LGSOC from two high-volume oncological centers for ovarian neoplasm. In particular, we sought to evaluate the impact on survival outcomes of optimal cytoreductive surgery [i.e., residual disease (RD) <10 mm at the end of surgery]. The results of our work confirm the role of complete cytoreduction (i.e., no evidence of disease after surgery) in the survival of patients and even the positive prognostic role of a minimal RD (i.e., <10 mm), whenever complete cytoreduction cannot be achieved.BackgroundLow-grade serous ovarian cancer (LGSOC) is a rare entity with different behavior compared to high-grade serous (HGSOC). Because of its general low chemosensitivity, complete cytoreductive surgery with no residual disease is crucial in advanced stage LGSOC. We evaluated the impact of optimal cytoreduction on survival outcome both at first diagnosis and at recurrence.MethodsWe retrospectively studied consecutive patients diagnosed with advanced LGSOCs who underwent cytoreductive surgery in two oncological centers from January 1994 to December 2018. Survival curves were estimated by the Kaplan–Meier method, and 95% confidence intervals (95% CI) were estimated using the Greenwood formula.ResultsA total of 92 patients were included (median age was 47 years, IQR 35–64). The median overall survival (OS) was 142.3 months in patients with no residual disease (RD), 86.4 months for RD 1–10 mm and 35.2 months for RD >10 mm (p = 0.002). Progression-free survival (PFS) was inversely related to RD after primary cytoreductive surgery (RD = 0 vs RD = 1–10 mm vs RD >10 mm, p = 0.002). On multivariate analysis, RD 1–10 mm (HR = 2.30, 95% CI 1.30–4.06, p = 0.004), RD >10 mm (HR = 3.89, 95% CI 1.92–7.88, p = 0.0004), FIGO stage IV (p = 0.001), and neoadjuvant chemotherapy (NACT) (p = 0.010) were independent predictors of PFS. RD >10 mm (HR = 3.13, 95% CI 1.52–6.46, p = 0.004), FIGO stage IV (p <0.0001) and NACT (p = 0.030) were significantly associated with a lower OS.ConclusionsOptimal cytoreductive surgery improves survival outcomes in advanced stage LGSOCs. When complete debulking is impossible, a RD <10 mm confers better OS compared to an RD >10 mm in this setting of patients. |
| first_indexed | 2024-04-12T03:06:26Z |
| format | Article |
| id | doaj.art-8e1e191bdf904bd3aed14edd63a78c00 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-04-12T03:06:26Z |
| publishDate | 2022-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-8e1e191bdf904bd3aed14edd63a78c002022-12-22T03:50:30ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-09-011210.3389/fonc.2022.970918970918Advanced low grade serous ovarian cancer: A retrospective analysis of surgical and chemotherapeutic management in two high volume oncological centersPaolo Di Lorenzo0Paolo Di Lorenzo1Vincenza Conteduca2Vincenza Conteduca3Emanuela Scarpi4Marco Adorni5Francesco Multinu6Annalisa Garbi7Ilaria Betella8Tommaso Grassi9Tommaso Bianchi10Giampaolo Di Martino11Andrea Amadori12Paolo Maniglio13Isabella Strada14Silvestro Carinelli15Marta Jaconi16Giovanni Aletti17Giovanni Aletti18Vanna Zanagnolo19Angelo Maggioni20Luca Savelli21Ugo De Giorgi22Fabio Landoni23Nicoletta Colombo24Nicoletta Colombo25Robert Fruscio26Robert Fruscio27Obstetrics and Gynecology Unit, Morgagni-Pierantoni Hospital, Forlì, ItalyClinic of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, ItalyDepartment of Medical Oncology, Istituto di ricovero e cura a carattere scientifico (IRCCS) Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori”, Meldola, ItalyUnit of Medical Oncology and Biomolecular Therapy, Department of Medical and Surgical Sciences, University of Foggia, Policlinico Riuniti, Foggia, ItalyBiostatistics and Clinical Trials Unit, Istituto di ricovero e cura a carattere scientifico (IRCCS) Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori”, Meldola, ItalyClinic of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, ItalyDivision of Gynecologic Oncology, European Institute of Oncology, Istituto di ricovero e cura a carattere scientifico (IRCCS), Milano, ItalyDivision of Gynecologic Oncology, European Institute of Oncology, Istituto di ricovero e cura a carattere scientifico (IRCCS), Milano, ItalyDivision of Gynecologic Oncology, European Institute of Oncology, Istituto di ricovero e cura a carattere scientifico (IRCCS), Milano, ItalyClinic of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, ItalyClinic of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, ItalyClinic of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, ItalyObstetrics and Gynecology Unit, Morgagni-Pierantoni Hospital, Forlì, ItalyObstetrics and Gynecology Unit, Morgagni-Pierantoni Hospital, Forlì, ItalyObstetrics and Gynecology Unit, Morgagni-Pierantoni Hospital, Forlì, ItalyDepartment of Pathology, European Institute of Oncology, Istituto di ricovero e cura a carattere scientifico (IRCCS), Milano, ItalyDepartment of Pathology, San Gerardo Hospital, University of Milano-Bicocca, Monza, ItalyDivision of Gynecologic Oncology, European Institute of Oncology, Istituto di ricovero e cura a carattere scientifico (IRCCS), Milano, ItalyDepartment of Hemato-Oncology, University of Milan, Milano, ItalyDivision of Gynecologic Oncology, European Institute of Oncology, Istituto di ricovero e cura a carattere scientifico (IRCCS), Milano, ItalyDivision of Gynecologic Oncology, European Institute of Oncology, Istituto di ricovero e cura a carattere scientifico (IRCCS), Milano, ItalyObstetrics and Gynecology Unit, Morgagni-Pierantoni Hospital, Forlì, ItalyDepartment of Medical Oncology, Istituto di ricovero e cura a carattere scientifico (IRCCS) Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori”, Meldola, ItalyClinic of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, ItalyDivision of Gynecologic Oncology, European Institute of Oncology, Istituto di ricovero e cura a carattere scientifico (IRCCS), Milano, Italy0Department of Medicine and Surgery, University of Milano-Bicocca, Monza, ItalyClinic of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy0Department of Medicine and Surgery, University of Milano-Bicocca, Monza, ItalySimple summaryLow-grade serous ovarian cancer (LGSOC) represents an uncommon histotype of serous ovarian cancer (accounting for approximately 5% of all ovarian cancer) with a distinct behavior compared to its high-grade serous counterpart, characterized by a better prognosis and low response rate to chemotherapeutic agents. Similar to high-grade serous ovarian cancer, cytoreductive surgery is considered crucial for patient survival. This retrospective study aimed to analyze the outcomes of women affected by advanced stages (III–IV FIGO) of LGSOC from two high-volume oncological centers for ovarian neoplasm. In particular, we sought to evaluate the impact on survival outcomes of optimal cytoreductive surgery [i.e., residual disease (RD) <10 mm at the end of surgery]. The results of our work confirm the role of complete cytoreduction (i.e., no evidence of disease after surgery) in the survival of patients and even the positive prognostic role of a minimal RD (i.e., <10 mm), whenever complete cytoreduction cannot be achieved.BackgroundLow-grade serous ovarian cancer (LGSOC) is a rare entity with different behavior compared to high-grade serous (HGSOC). Because of its general low chemosensitivity, complete cytoreductive surgery with no residual disease is crucial in advanced stage LGSOC. We evaluated the impact of optimal cytoreduction on survival outcome both at first diagnosis and at recurrence.MethodsWe retrospectively studied consecutive patients diagnosed with advanced LGSOCs who underwent cytoreductive surgery in two oncological centers from January 1994 to December 2018. Survival curves were estimated by the Kaplan–Meier method, and 95% confidence intervals (95% CI) were estimated using the Greenwood formula.ResultsA total of 92 patients were included (median age was 47 years, IQR 35–64). The median overall survival (OS) was 142.3 months in patients with no residual disease (RD), 86.4 months for RD 1–10 mm and 35.2 months for RD >10 mm (p = 0.002). Progression-free survival (PFS) was inversely related to RD after primary cytoreductive surgery (RD = 0 vs RD = 1–10 mm vs RD >10 mm, p = 0.002). On multivariate analysis, RD 1–10 mm (HR = 2.30, 95% CI 1.30–4.06, p = 0.004), RD >10 mm (HR = 3.89, 95% CI 1.92–7.88, p = 0.0004), FIGO stage IV (p = 0.001), and neoadjuvant chemotherapy (NACT) (p = 0.010) were independent predictors of PFS. RD >10 mm (HR = 3.13, 95% CI 1.52–6.46, p = 0.004), FIGO stage IV (p <0.0001) and NACT (p = 0.030) were significantly associated with a lower OS.ConclusionsOptimal cytoreductive surgery improves survival outcomes in advanced stage LGSOCs. When complete debulking is impossible, a RD <10 mm confers better OS compared to an RD >10 mm in this setting of patients.https://www.frontiersin.org/articles/10.3389/fonc.2022.970918/fulllow-grade serous ovarian cancerprimary cytoreductionneoadjuvant chemotherapyresidual diseaseadjuvant treatmentsecondary cytoreductive surgery |
| spellingShingle | Paolo Di Lorenzo Paolo Di Lorenzo Vincenza Conteduca Vincenza Conteduca Emanuela Scarpi Marco Adorni Francesco Multinu Annalisa Garbi Ilaria Betella Tommaso Grassi Tommaso Bianchi Giampaolo Di Martino Andrea Amadori Paolo Maniglio Isabella Strada Silvestro Carinelli Marta Jaconi Giovanni Aletti Giovanni Aletti Vanna Zanagnolo Angelo Maggioni Luca Savelli Ugo De Giorgi Fabio Landoni Nicoletta Colombo Nicoletta Colombo Robert Fruscio Robert Fruscio Advanced low grade serous ovarian cancer: A retrospective analysis of surgical and chemotherapeutic management in two high volume oncological centers Frontiers in Oncology low-grade serous ovarian cancer primary cytoreduction neoadjuvant chemotherapy residual disease adjuvant treatment secondary cytoreductive surgery |
| title | Advanced low grade serous ovarian cancer: A retrospective analysis of surgical and chemotherapeutic management in two high volume oncological centers |
| title_full | Advanced low grade serous ovarian cancer: A retrospective analysis of surgical and chemotherapeutic management in two high volume oncological centers |
| title_fullStr | Advanced low grade serous ovarian cancer: A retrospective analysis of surgical and chemotherapeutic management in two high volume oncological centers |
| title_full_unstemmed | Advanced low grade serous ovarian cancer: A retrospective analysis of surgical and chemotherapeutic management in two high volume oncological centers |
| title_short | Advanced low grade serous ovarian cancer: A retrospective analysis of surgical and chemotherapeutic management in two high volume oncological centers |
| title_sort | advanced low grade serous ovarian cancer a retrospective analysis of surgical and chemotherapeutic management in two high volume oncological centers |
| topic | low-grade serous ovarian cancer primary cytoreduction neoadjuvant chemotherapy residual disease adjuvant treatment secondary cytoreductive surgery |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.970918/full |
| work_keys_str_mv | AT paolodilorenzo advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT paolodilorenzo advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT vincenzaconteduca advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT vincenzaconteduca advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT emanuelascarpi advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT marcoadorni advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT francescomultinu advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT annalisagarbi advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT ilariabetella advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT tommasograssi advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT tommasobianchi advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT giampaolodimartino advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT andreaamadori advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT paolomaniglio advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT isabellastrada advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT silvestrocarinelli advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT martajaconi advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT giovannialetti advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT giovannialetti advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT vannazanagnolo advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT angelomaggioni advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT lucasavelli advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT ugodegiorgi advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT fabiolandoni advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT nicolettacolombo advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT nicolettacolombo advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT robertfruscio advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters AT robertfruscio advancedlowgradeserousovariancanceraretrospectiveanalysisofsurgicalandchemotherapeuticmanagementintwohighvolumeoncologicalcenters |