Prognostic factors for maximally or optimally cytoreduced stage III nonserous epithelial ovarian carcinoma treated with carboplatin/paclitaxel chemotherapy

Cüylan, Zeliha Fırat; Meydanlı, Mehmet Mutlu; Sarı, Mustafa; Akbayır, Özgür; Çelik, Hüsnü; Dede, Murat; Şahin, Hanifi; Güngördük, Kemal; Kuşçu, Esra; Özgül, Nejat; Güngör, Tayfun; Ayhan, Ali

doi:10.1111/jog.13663

Cited by 6 publications

(4 citation statements)

References 35 publications

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“…The search strategy identified 8606 unique references, of which 200 progressed to full-text screening. At this stage, 154 were excluded, leaving 46 references 12,14,55–94 reporting on 25 primary studies 12,14,55,59–65,67,69–73,79–85,92,94 that met our inclusion criteria. Searches of the gray literature did not identify any additional relevant studies (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

Residual Disease Threshold After Primary Surgical Treatment for Advanced Epithelial Ovarian Cancer, Part 1: A Systematic Review and Network Meta-Analysis

Bryant

Johnson

Grayling

et al. 2022

American Journal of Therapeutics

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Background: We present a systematic review and network meta-analysis (NMA) that is the precursor underpinning the Bayesian analyses that adjust for publication bias, presented in the same edition in AJT. The review assesses optimal cytoreduction for women undergoing primary advanced epithelial ovarian cancer (EOC) surgery.Areas of Uncertainty: To assess the impact of residual disease (RD) after primary debulking surgery in women with advanced EOC. This review explores the impact of leaving varying levels of primary debulking surgery.Data Sources: We conducted a systematic review and random-effects NMA for overall survival (OS) to incorporate direct and indirect estimates of RD thresholds, including concurrent comparative, retrospective studies of $100 adult women (18+ years) with surgically staged advanced EOC (FIGO stage III/IV) who had confirmed histological diagnoses of ovarian cancer. Pairwise meta-analyses of all directly compared RD thresholds was previously performed before conducting this NMA, and the statistical heterogeneity of studies within each comparison was evaluated using recommended methods.Therapeutic Advances: Twenty-five studies (n 5 20,927) were included. Analyses demonstrated the prognostic importance of complete cytoreduction to no macroscopic residual disease (NMRD), with a hazard ratio for OS of 2.0 (95% confidence interval, 1.8-2.2) for ,1 cm RD threshold versus NMRD. NMRD was associated with prolonged survival across all RD thresholds. Leaving NMRD was predicted to provide longest survival (probability of being best 5 99%). The results were robust to sensitivity analysis including only those studies that adjusted for extent of disease at primary surgery (hazard ratio 2.3, 95% confidence interval, 1.9-2.6). The overall certainty of evidence was moderate and statistical adjustment of effect estimates in included studies minimized bias. Conclusions:The results confirm a strong association between complete cytoreduction to NMRD and improved OS. The NMA approach forms part of the methods guidance underpinning policy making in many jurisdictions. Our analyses present an extension to the previous work in this area.

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Section: Resultsmentioning

confidence: 99%

Residual Disease Threshold After Primary Surgical Treatment for Advanced Epithelial Ovarian Cancer, Part 1: A Systematic Review and Network Meta-Analysis

Bryant

Johnson

Grayling

et al. 2022

American Journal of Therapeutics

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“… 4 5 The extent of CRS determines the prognosis in advanced EOC. 6 However, the probability of microscopic residual disease after complete CRS is around 98.14% in high-grade serous ovarian cancer and the 2-year peritoneal recurrence rate for early EOC is 20%, while it is 62.1% in advanced EOC, which strongly suggest that adjuvant locoregional therapies should be considered to prevent early recurrence and prolong disease-free survival (DFS). 7 Hence, the rationale of intraperitoneal (IP) chemotherapy in EOC is to provide sustained exposure to high concentrations of cytotoxic agents to the peritoneum, while the rest of the normal tissues are spared.…”

Section: Introductionmentioning

confidence: 99%

NIPEC with Single-Dose Intraperitoneal Cisplatin and Paclitaxel in Stage III Epithelial Ovarian Cancer

Saldanha

Desai

Patel

et al. 2022

South Asian J Cancer

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Objectives Epithelial ovarian cancer (EOC) is a heterogeneous, essentially peritoneal disease. Standard treatment consists of staging, cytoreductive surgery (CRS), and adjuvant chemotherapy. In this study, we intended to assess the effectiveness of single-dose intraperitoneal (IP) chemotherapy in optimally debulked advanced EOC patients. Materials and Methods A prospective randomized study of 87 patients with advanced EOC was done from January 2017 to May 2021 in a tertiary care center. Patients who underwent primary and interval cytoreduction received a single dose of IP chemotherapy for 24 hours after being divided into four groups: group A, IP cisplatin; group B, IP paclitaxel; group C, IP paclitaxel and cisplatin; and group D, saline. Pre- and postperitoneal IP cytology was assessed along with possible complications. Statistical Analysis Logistic regression analysis was used to assess for intergroup significance in cytology and complications. Kaplan–Meir analysis was done to assess disease-free survival (DFS). Results Of 87 patients, 17.2% of patients had FIGO stage IIIA, 47.2% had IIIB, and 35.6% had IIIC. Also, 22 (25.3%) patients were in group A (cisplatin), 22 (25.3%) patients in group B (paclitaxel), 23 (26.4%) in group C (cisplatin and paclitaxel), and 20 (23%) in group D (saline). Cytology samples taken during staging laparotomy were positive, and 48 hours post-IP chemotherapy, 2 (9%) of 22 samples in cisplatin group and 14 (70%) of 20 samples in saline group were positive; all of the post-IP samples in groups B and C were negative. No major morbidity was noted. In our study, DFS in saline group was 15 months, while in IP chemotherapy group it was 28 months and was statistically significant based log-rank test. However, there was no significant difference in DFS between different IP chemotherapy groups. Conclusion Complete or optimal CRS in advanced EOC does have a possibility of microscopic peritoneal residue. Adjuvant locoregional strategies should be considered to prolong DFS. Single-dose normothermic IP chemotherapy can be offered to the patients with minimal morbidity, and its prognostic benefits are comparable to hyperthermic IP chemotherapy. Future clinical trials are required to validate these protocols.

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“…, yaitu 19 bulan, 9 bulan, dan 6 bulan, secara berturut-turut.22 Beberapa studi juga melaporkan hal yang sama, baik pada kanker ovarium epitelial serosa maupun non-serosa, yaitu pembedahan radikal yang bertujuan tidak meninggalkan residu sama sekali atau paling sedikit dengan diameter < 1 cm, memiliki luaran waktu terjadinya rekurensi dan kelangsungan hidup yang lebih panjang dibandingkan dengan volume residu ≥1 cm atau pada tindakan biopsi jaringan saja.22,23 Pada penelitian ini tidak ditemukan hubungan bermakna antara jenis operasi dengan skor ROVAR, hal ini mungkin disebabkan oleh karena operasi yang dilakukan masih meninggalkan residu < 1 cm, bukan operasi radikal atau R0, sehingga luaran yang dihasilkan tidak berbeda jauh. Pada penelitian ini ditemukan rerata waktu rekurensi adalah 13,28±10,31 bulan.…”

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“…Waktu terjadinya rekurensi pada setiap studi bervariasi, berkaitan dengan stadium saat terdiagnosis, siklus kemoterapi, dan residu post operasi. Colombo N et al (2006) melaporkan bahwa rerata waktu rekurensi terdeteksi pada 12-18 bulan, Ushijima K et al (2009) melaporkan interval median rekurensi primer pada kasus kanker ovarium adalah 18 -24 bulan, dan Corrado G (2017) melaporkan interval median rekurensi primer dalam waktu 12-24 bulan.22,23,24 Sedangkan untuk kondisi akhir subyek, ditemukan 20 pasien meninggal dengan rerata waktu hidup 19,05±11,77 bulan. Rata-rata harapan hidup pasien kanker ovarium epitelial yang mengalami rekurensi adalah antara 12 sampai 18 bulan, namun hal ini tergantung pada rangkaian dan karakteristik penyakit 25.…”

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Hubungan antara Ekspresi Heat Shock Protein-70 (HSP70) dengan Skor Risk of Ovarian Cancer Relapse (ROVAR) pada Pasien Kanker Ovarium Epitelial yang Dilakukan Operasi dan Dilanjutkan dengan Kemoterapi

Damaianty,

Kusumanto,

Dewanto

2022

Jurnal Kespro

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Background: Ovarian cancer is one of the leading causes of death in gynecological malignancies which occupies the third place in the world. One of largest challenge in epithelial ovarian cancer therapy is resistance to chemotherapy. Increased of Heat Shock Protein-70 (HSP70) expression associated with the progressivity of tumor cells growth through the resistance process against chemotherapy, whereas Risk Of Ovarian Cancer Relapse (ROVAR) score is a tool that used to predict the ovarian cancer recurrence risk in patient who underwent surgery followed by chemotherapy.Objective: This study is aimed to evaluate the correlation between HSP70 expression and ROVAR score in patient with epithelial ovarian cancer who underwent first line therapy. Method: This is a retrospective cohort study that involve 42 subjects with epithelial ovarian cancer who had been through surgery (optimal or suboptimal surgery) followed by chemotherapy. Immunohistochemical staining of pre chemotherapy paraffin blocks was performed using HSP70 antibody and recurrence risk was calculated using ROVAR scores after surgery followed by chemotherapy. The external variables evaluated were age, parity, Body Mass Index (BMI), menopause history, and surgical type. Data analysis used Chi Square test, spearman test, and logistic regression analysis.Result and Discussion: Of the total 42 subjects who met the inclusion criteria, most found in advanced stage with the age mean is 54,3 years old. In the ROVAR score measurement, in high risk category is found about 32(76.19%), while in the medium risk and low risk category is 10 (23.81%). On the other hand, strong HSP70 expression was found in 36(85,71%), moderate HSP70 expression in 6(14,39%), and weak HSP70 expression was not found. Based on Spearman's correlative test, there was a positive, very strong, and significant correlation between the expression of HSP70 and risk allocation according to ROVAR score (r=0.717, p=0.000). As well as in multivariate analysis, HSP70 expression had a statistically and clinically significant relationship with ROVAR score (p=0.017; RR 2.710; 95% CI 0.366-5.054) which strong HSP70 expression was 2.71 times more likely to have a high risk of recurrence according to ROVAR score.Conclusion: There is a positive, very strong, and significantly meaning between HSP70 expression and ROVAR score. Increased in HSP70 expression may lead to increased recurrence risk according to ROVAR score. Both could be used to predict recurrence in epithelial ovarian cancer post first line therapy.Keywords: Epithelial ovarian cancer, HSP70, ROVAR score, recurrence.

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Prognostic factors for maximally or optimally cytoreduced stage III nonserous epithelial ovarian carcinoma treated with carboplatin/paclitaxel chemotherapy

Abstract: The extent of CRS seems to be the only modifiable prognostic factor associated with stage III nonserous EOC. Complete cytoreduction to no gross residual disease should be the main goal of management in these women.

Cited by 6 publications

References 35 publications

Residual Disease Threshold After Primary Surgical Treatment for Advanced Epithelial Ovarian Cancer, Part 1: A Systematic Review and Network Meta-Analysis

Residual Disease Threshold After Primary Surgical Treatment for Advanced Epithelial Ovarian Cancer, Part 1: A Systematic Review and Network Meta-Analysis

NIPEC with Single-Dose Intraperitoneal Cisplatin and Paclitaxel in Stage III Epithelial Ovarian Cancer

Hubungan antara Ekspresi Heat Shock Protein-70 (HSP70) dengan Skor Risk of Ovarian Cancer Relapse (ROVAR) pada Pasien Kanker Ovarium Epitelial yang Dilakukan Operasi dan Dilanjutkan dengan Kemoterapi

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