Comparison of treatment invasiveness between upfront debulking surgery versus interval debulking surgery following neoadjuvant chemotherapy for stage III/IV ovarian, tubal, and peritoneal cancers in a phase III randomised trial: Japan Clinical Oncology Group Study JCOG0602

Onda, Takashi; Satoh, Toyomi; Saito, Toshiaki; Kasamatsu, Takahiro; Nakanishi, Tōru; Nakamura, Kenichi; Wakabayashi, Masashi; Takehara, Kazuhiro; Saito, Motoaki; Ushijima, Kimio; Kobayashi, Hiroaki; Kawana, Kei; Yokota, Harushige; Takano, Masashi; Takeshima, Nobuhiro; Watanabe, Yoh; Yaegashi, Nobuo; Konishi, Ikuo; Kamura, Toshiharu; Yoshikawa, Hiroyuki

doi:10.1016/j.ejca.2016.05.017

Cited by 190 publications

(132 citation statements)

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“…Up to present, there were four randomized clinical trials comparing PDS and NAC followed by IDS for women with advanced ovarian cancer [36, 43–45]. These trials demonstrated that NAC/IDS was noninferior to PDS with respect to PFS and OS and resulted in a lower incidence of treatment-related morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…The SCORPION [44, 46] trial found that complete cytoreduction was achieved in 58% of women in the NAC/IDS arm and 46% of women in the PDS arm, with a shorter median operative time in the NAC/IDS arm. In JCOG0602 [45], Optimal debulking proportions in NAC/IDS and PDS were 82 and 37%, respectively. Most of HG-SOCs are sensitive to platinum-based chemotherapy, and optimal debulking proportions increased in patients who underwent NAC.…”

Section: Discussionmentioning

confidence: 99%

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Ascites regression following neoadjuvant chemotherapy in prediction of treatment outcome among stage IIIc to IV high-grade serous ovarian cancer

Deng

et al. 2016

J Ovarian Res

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BackgroundNo consensus exists on the outcome-related factors of interval debulking surgery (IDS) in patients with advanced high-grade serous ovarian cancer (HG-SOC) who underwent neoadjuvant chemotherapy (NAC). This study aimed to explore the optimal timing for IDS and the prognosis-associated factors of International Federation of Gynecology and Obstetrics stage IIIc to IV HG-SOC patients.MethodsA total of 160 IIIc to IV stage HG-SOC patients were retrospectively analyzed. Patients with large volume ascites underwent NAC and subsequent IDS from the Jiangsu Institute of Cancer Research between 1993 and 2013. The outcome of IDS-associated factors was explored by logistic regression. To predict IDS outcome, the potential values of serum CA-125 levels and CA-125 decreasing kinetics were determined by the receiver operating characteristic curve. The associations between survival durations and covariates were assessed by Cox proportional hazards model and log-rank test.ResultsOptimal IDS was achieved in 80.6% of HG-SOC patients who underwent NAC. Multivariate analyses revealed that ascites regression (p = 0.01), serum CA-125 level (p = 0.02), and CA-125 decreasing kinetics (p = 0.01) were independent optimal IDS predictors. CA-125 decreasing kinetics, IDS outcome, and ascites volume were independently associated with overall survival (OS) (p = 0.04, p < 0.01, p = 0.03, respectively) and progression-free survival (PFS) (p < 0.01, p < 0.01, p = 0.02, respectively). Patients who exhibited disappearance of ascites (<500 ml) had longer PFS (19.7 months vs.14.9 months) and OS (32.1 months vs. 26.0 months) than patients who exhibited residual ascites (≥500 ml). Subsets with higher CA-125 decreasing kinetics (≥2.2) had longer PFS (21.4 months vs.13.1 months) and OS (29.6 months vs.26.8 months) than counterparts (kinetics < 2.2).ConclusionsAscites regression and CA-125 decreasing kinetics were independently associated with surgical outcome and prognosis in advanced HG-SOC patients who underwent NAC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ascites regression following neoadjuvant chemotherapy in prediction of treatment outcome among stage IIIc to IV high-grade serous ovarian cancer

Deng

et al. 2016

J Ovarian Res

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“…A phase III trial to compare PDS with NACT-IDS proved that the survival outcomes of NACT-IDS were not inferior to those of PDS [6,7]. NACT allowed peritoneal diseases to shrink or disappear, which simplified complicated surgical procedures and reduced the perioperative complication rate [5,8,9]. Since then, NACT-IDS has been a treatment option for patients with bulky stage IIIC-IV ovarian carcinoma.…”

Section: Introductionmentioning

confidence: 99%

Microscopic diseases remain in initial disseminated sites after neoadjuvant chemotherapy for stage III/IV ovarian, tubal, and primary peritoneal cancer

et al. 2020

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Objective: This study aimed to evaluate the presence of pathological residual tumor (pRT) in each initial disseminated site after neoadjuvant chemotherapy (NACT) to assess the appropriate surgical margins during interval debulking surgery (IDS) for a favorable prognosis. Methods: This prospective descriptive study included patients with stage IIIC-IV epithelial ovarian, fallopian tubal, and peritoneal cancer. One hundred eleven patients underwent diagnostic exploratory laparotomy, and their initial intra-abdominal dissemination statuses were recorded. Any tumor >1 cm in diameter found during the exploratory laparotomy was resected during IDS even if it was macroscopically invisible after NACT. The pRT rate after NACT and negative predictive value (NPV; probability that sites with macroscopically invisible tumors have no pRT) during IDS were assessed in each disseminated site. Results: A median of 5 NACT cycles were performed. Sites with a high incidence of pRT and low NPV included the rectosigmoid colon (71.4%, 38.6%), transverse mesentery (70.3%, 50.0%), greater omentum (68.3%, 51.7%), right diaphragm (61.9%, 48.1%), paracolic gutters (61.1%, 50.0%), and vesicouterine pouch (56.6%, 50.0%). Organs/tissues with a high incidence of pRT featured a low NPV. The median progression-free survival and overall survival in this cohort were 27.7 and 71.9 months, respectively. Conclusion: Even if a disseminated site >1 cm in diameter before NACT is invisible during IDS, microscopic disease remains present within it. The appropriate surgical margins for IDS with a favorable prognosis could be secured by resecting a lesion of >1 cm before NACT even if it is invisible during IDS.

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“…In the report by Uno et al,8 the 15 NAC-treated patients accounted for nearly half of the total 32 patients, and the possibility that the effects of anticancer agents in the analyzed tissue specimens had biased the results of TF immunostaining was thus unable to be excluded. No pretreatment biopsies were taken from patients with EOC undergoing NAC at our hospital if cancer of the ovaries, fallopian tubes, or peritoneum was suspected on image diagnosis; if cells consistent with a malignant surface epithelial-stromal tumor were seen in an aspiration cytology of the tumor, pleural effusion, or ascites; or if biopsy and advanced-stage diagnosis by microscopy during NAC could be skipped because the patient met the criteria of CA125 of greater than 200 U/mL and carcinoembryonic antigen of less than 20 ng/mL 9,17,18…”

Section: Discussionmentioning

confidence: 99%

Expression of Tissue Factor in Epithelial Ovarian Carcinoma Is Involved in the Development of Venous Thromboembolism

Sakurai

Matsumoto²,

Gosho³

et al. 2016

Int J Gynecol Cancer

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ObjectivesOur 2007 study of 32 patients with ovarian cancer reported the possible involvement of tissue factor (TF) in the development of venous thromboembolism (VTE) before treatment, especially in clear cell carcinoma (CCC). This follow-up study further investigated this possibility in a larger cohort.MethodsWe investigated the intensity of TF expression (ITFE) and other variables for associations with VTE using univariate and multivariate analyses in 128 patients with epithelial ovarian cancer initially treated between November 2004 and December 2010, none of whom had received neoadjuvant chemotherapy. Before starting treatment, all patients were ultrasonographically screened for VTE. The ITFE was graded based on immunostaining of surgical specimens.ResultsHistological types were serous carcinoma (n = 42), CCC (n = 12), endometrioid carcinoma (n = 15), mucinous carcinoma (n = 53), and undifferentiated carcinoma (n = 6). The prevalence of VTE was significantly higher in CCC (34%) than in non-CCC (17%, P = 0.03). As ITFE increased, the frequencies of CCC and VTE increased significantly (P < 0.001 and P = 0.014, respectively). Multivariate analysis identified TF expression and pretreatment dimerized plasmin fragment D level as significant independent risk factors for VTE development. These factors showed particularly strong impacts on advanced-stage disease (P = 0.021).ConclusionsThe 2007 cohort was small, preventing multivariate analysis. This study of a larger cohort yielded stronger evidence that the development of VTE in epithelial ovarian cancer may involve TF expression in cancer tissues.

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Comparison of treatment invasiveness between upfront debulking surgery versus interval debulking surgery following neoadjuvant chemotherapy for stage III/IV ovarian, tubal, and peritoneal cancers in a phase III randomised trial: Japan Clinical Oncology Group Study JCOG0602

Cited by 190 publications

References 12 publications

Ascites regression following neoadjuvant chemotherapy in prediction of treatment outcome among stage IIIc to IV high-grade serous ovarian cancer

Ascites regression following neoadjuvant chemotherapy in prediction of treatment outcome among stage IIIc to IV high-grade serous ovarian cancer

Microscopic diseases remain in initial disseminated sites after neoadjuvant chemotherapy for stage III/IV ovarian, tubal, and primary peritoneal cancer

Expression of Tissue Factor in Epithelial Ovarian Carcinoma Is Involved in the Development of Venous Thromboembolism

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