Background: The population of interest to this study comprised individuals with advanced-stage ovarian carcinoma who were exposed to neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS). Those who had not received systematic lymphadenectomy (SL; Group 1) were compared to those who had received SL (Group 2). Outcome measures included progression-free survival (PFS), overall survival (OS), and surgical complications. Methods: This was a retrospective, multicenter cohort study in nine referral centers of France between January 2000 and June 2017. OS analysis using the multivariate Cox regression model was performed. PFS and surgery-related morbidity were analyzed. Results: Of the 255 patients included, 100 were in Group 1 and 155 in Group 2. Patient majority was, on average, younger and less comorbid, with predominant R0 surgery in Group 2. Dindo–Clavien score was similar between the two groups (p = 0.15). Median OS was 26.8 months in Group 2 and 27.6 months in Group 1. SL was not statistically significant on OS (p = 0.7). Median PFS was 18.3 months in Group 2 and 16.6 months in Group 1. SL had positive impact on PFS (p = 0.005). Conclusions: patients who had received SL (Group 2) had significantly higher PFS regardless of node-positivity status when compared to those who had not received SL (Group 1).
Background
Borderline ovarian tumors (BOTs) are tumors with a favorable prognosis but whose management by consensus is essential to limit the risk of invasive recurrence. This study aimed to conduct an inventory of surgical practices for BOT in France and to evaluate the conformity of the treatment according to the current French guidelines.
Methods
This retrospective, multicenter cohort study included nine referral centers of France between January 2001 and December 2018. It analyzed all patients with serous and mucinous BOT who had undergone surgery. A peritoneal staging in accordance with the recommendations was defined by performance of a peritoneal cytology, an omentectomy, and at least one peritoneal biopsy.
Results
The study included 332 patients. A laparoscopy was performed in 79.5% of the cases. Treatment was conservative in 31.9% of the cases. The recurrence rate was significantly increased after conservative treatment (17.3% vs 3.1%; p < 0.001). Peritoneal cytology was performed for 95.5%, omentectomy for 83.1%, and at least one biopsy for 82.2% of the patients. The overall recurrence rate was 7.8%, and the recurrence was invasive in 1.2% of the cases. No link was found between the recurrence rate and the conformity of peritoneal staging. The overall rate of staging noncompliance was 22.9%.
Conclusion
The current standards for BOT management seem to be well applied.
unanimously accepted. The work aims to specify the pathological and clinical features and to highlight the prognostic factors of these tumors. Methodology Our study was retrospective and descriptive including 49 cases of primary borderline mucinous tumors of the ovary, diagnosed at the Department of Anatomical Pathology and Cytology of Salah Azaiez Institute, for a period of 27 years, going from 1992 to 2019. Result(s)* The mean age of our patients was 48 years old. Histologically, the cases were divided into 34 cases of pure MBT, 13 cases with intraepithelial carcinoma, and 2 cases associating an intraepithelial carcinoma with microinvasion. The majority of our cases were classified FIGO I and only one case was FIGO III. 14 patients received conservative treatment and 32 received radical treatment. The treatment wasn't specified in 3 patients. The progress was good in the majority of cases. Only one patient had a contralateral recurrence after a follow-up period of 3 years. There was no significant difference regarding the risk of recurrence and risk factors such as age, gestation, hormonal contraception, hormonal status, FIGO stage, presence of peritoneal pseudomyxoma, intraepithelial carcinoma, and microinvasion. Conclusion* The prognosis of TMBL depends closely on their FIGO stage, stage I tumors have a good prognosis. The presence of intraepithelial carcinoma does not influence their prognosis. However, it is necessary to multiply samples to avoid missing a carcinomatous focus with an anarchic invasion of the stroma which constitutes a poor prognosis factor.
In view of the high morbidity to complete lymphadenectomy, the sentinel node procedure is currently being investigated in different cancers with the aim of reducing morbidity and of achieving oncological outcomes similar to complete lymphadenectomy. In this review, a parallel will be drawn between the evolutions of the place of lymph node surgery in the management of melanoma and gynecologic cancers. Currently, in the case of cutaneous melanoma, the indications of lymph node surgery are becoming increasingly rare. In contrast with the scarce available evidence in gynecologic cancer, this trend is supported by multicenter randomized studies with a large number of patients for cutaneous melanoma. The second difference is the demonstrated therapeutic benefit of immunotherapies and targeted therapies in cutaneous melanoma, which are less significant in gynecological cancers for which the mainstay of treatment is surgery.According to this review, it seems that in gynecologic oncology, we could in the next decades follow the same pathway currently taken in the management of lymph nodes in malignant melanoma.
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