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Endometrial stromal sarcoma and undifferentiated endometrial sarcoma are rare tumors. Surgical resection is appropriate for patients with early-stage (I or II) disease and those with resectable, advanced-stage (III or IV) tumors. Hormone therapy may be appropriate in treating advanced and recurrent disease.

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Objective To compare outcomes of women with advanced stage low-grade serous ovarian cancer and high-grade serous ovarian cancer, and identify factors associated with survival among patients with advanced stage low-grade serous ovarian cancer. Methods A retrospective study of patients diagnosed with grade 1 or 3, advanced-stage (stage IIIC and IV) serous ovarian cancer between 2003 and 2011 was undertaken using the National Cancer Database, a large administrative database. The effect of grade on survival was analyzed using the Kaplan-Meier method. Factors predictive of outcome were compared using the Cox proportional hazards model. Among women with low-grade serous ovarian cancer, propensity score matching was used to compare all-cause mortality among similar women who underwent chemotherapy and lymph node dissection and those who did not. Results A total of 16,854 (95.7%) patients with high-grade serous ovarian cancer and 755 (4.3%) patients with low-grade serous ovarian cancer were identified. Median overall survival was 40.7 months among high-grade patients and 90.8 months among women with low-grade tumors (p<0.001). Among patients with low-grade serous ovarian cancer in the propensity-score matched cohort, the median overall survival was 88.2 months among the 140 patients who received chemotherapy and 95.9 months among the 140 that did not received chemotherapy (p=0.7). Conversely, in the lymph node dissection propensity-matched cohort, median overall survival was 106.5 months among the 202 patients who underwent lymph node dissection and 58 months among the 202 who did not (p<0.001). Conclusions When compared to high-grade serous ovarian cancer, low-grade serous ovarian cancer is associated with improved survival. In patients with advanced-stage low-grade serous ovarian cancer, lymphadenectomy but not adjuvant chemotherapy was associated with improved survival.

Total pelvic exenteration (PE) is a radical operation, involving en bloc resection of pelvic organs, including reproductive structures, bladder, and rectosigmoid. In gynecologic oncology, it is most commonly indicated for the treatment of advanced primary or locally recurrent cancer. Careful patient selection and counseling are of paramount importance when considering someone for PE. Part of the evaluation process includes comprehensive assessment to exclude unresectable or metastatic disease. PE can be curative for carefully selected patients with gynecologic cancers. Major complications can be seen in as many as 50% of patients undergoing PE, underscoring the need to carefully discuss risks and benefits of this procedure with patients considering exenterative surgery.

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Importance Uncertainty remains about the relative benefits of primary cytoreductive surgery (PCS) versus neoadjuvant chemotherapy (NACT) for advanced-stage epithelial ovarian cancer (EOC). Purpose Compare overall survival of PCS versus NACT in a large national population of women with advanced-stage EOC. Design Retrospective cohort study. Setting Hospitals across the United States reporting to the National Cancer Data Base who cared for patients with advanced-stage EOC diagnosed between 2003–2011. Participants We identified women with stage IIIC and IV EOC diagnosed between 2003–2011. We focused on patients aged ≤70 years with a Charlson comorbidity index=0 who were likely candidates for either treatment. Exposure Initial treatment approach of PCS vs. NACT, examined using an intent-to-treat analysis. Main Outcome Overall survival, defined as months from cancer diagnosis to death or date of the last contact. We used propensity score matching to compare similar women who underwent PCS and NACT. The association of treatment approach with overall survival was assessed using the Kaplan-Meier method and the log-rank test. We assessed whether the findings were influenced by differences in the prevalence of an unobserved confounder, such as limited performance status [Eastern Cooperative Oncology Group (ECOG) 1–2], pre-operative disease burden, and BRCA status. Results Among 22,962 patients, 19,836 (86.4%) received PCS and 3,126 (13.6%) underwent NACT. We matched 2,935 patients treated with NACT with similar patients who received PCS. Among propensity-score matched groups, the median overall survival was 37.3 (95% CI, 35.2–38.7) months in the PCS group and 32.1 (95% CI, 30.8–34.1) months in the NACT group (P<0.001). However, if the NACT group had a higher proportion of women with performance statuses of 1–2 compared with PCS (60% vs. 50%), the association of PCS and improved survival would not be statistically significant. Conclusions and Relevance PCS was associated with improved survival compared with NACT in healthy women aged ≤70 years. The lower survival in women who received NACT could be explained by a higher prevalence of limited performance status in women undergoing NACT.

NACT-IDS for stage IV ovarian cancer resulted in higher rates of complete resection to no residual disease, less morbidity, and equivalent OS compared to PDS.