Correlation between Surgeon's assessment and radiographic evaluation of residual disease in women with advanced stage ovarian cancer reported to have undergone optimal surgical cytoreduction: An NRG Oncology/Gynecologic Oncology Group study

Eskander, Ramez N.; Kauderer, James; Tewari, Krishnansu S.; Bristow, Robert E.; O’Malley, David M.; Rubin, Stephen C.; Glaser, Gretchen; Hamilton, Chad A.; Huh, Warner K.; Ueland, Frederick R.; Stephan, Jean-Marie; Burger, Robert A.

doi:10.1016/j.ygyno.2018.03.043

Cited by 24 publications

(25 citation statements)

References 30 publications

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“…Our findings are in agreement with a recent report by the NRG Oncology investigators . Similar to our work, this group performed a retrospective analysis of a prospective trial of bevacizumab to determine concordance between surgical assessment of residual disease and pretreatment CT imaging.…”

Section: Discussionsupporting

confidence: 92%

“…In ROSiA, lymph nodes were the site most commonly observed to have lesions by imaging in patients with surgeon‐reported NVR. In GOG‐0218, large residual masses were most often detected in para‐aortic lymph nodes, the right upper quadrant (including the liver and diaphragm), and the left upper quadrant (including the spleen and diaphragm) . Residual disease measuring >1 cm was reported most commonly in the right upper quadrant and central abdomen in Chi et al's series and the central abdomen and left upper quadrant in Sala et al's study.…”

Section: Discussionmentioning

confidence: 94%

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Outcome according to residual disease (surgeon's report vs pre‐chemotherapy imaging) in patients with bevacizumab‐treated ovarian cancer: Analysis of the ROSiA study

Korach

Colombo

Mendiola

et al. 2019

Journal of Surgical Oncology

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Background and Objectives:The single-arm ROSiA study evaluated frontline bevacizumab for advanced ovarian cancer. We explored how discordant surgically and radiologically assessed postoperative residual disease affects outcomes. Methods: After debulking surgery, 1021 patients received 4 to 8 cycles of carboplatin-paclitaxel plus bevacizumab until progression or up to 24 months. The primary endpoint was safety; progression-free survival (PFS) was a secondary endpoint. We performed post hoc exploratory PFS analyses in four subgroups: surgeon-reported no visible residuum (NVR) without target lesions; surgeon-reported NVR with target lesions; macroscopic (≤1 cm) residuum; and >1 cm residuum. Results: Surgical and radiological assessments were concordant in 94% of patients; 61 patients (6%; 21% of those with surgeon-reported NVR) had NVR with target lesions. Median PFS was numerically longest in patients with concordant surgically/ radiologically assessed NVR (35.5 months), intermediate for surgeon-reported NVR with target lesions (31.8 months), and shortest for visible residuum (27.9 and 20.2 months for visible residuum ≤1 and >1 cm, respectively). One-year and 2-year PFS rates showed the same pattern. Conclusions: These analyses suggest that prognosis is potentially worse in patients with radiologically detected target lesions despite surgeon-reported NVR compared with concordant NVR by both assessment methods. Postsurgical imaging may add valuable prognostic information. K E Y W O R D S bevacizumab, imaging, ovarian cancer, progression-free survival, visible residuum How to cite this article: Korach J, Colombo N, Mendiola C, et al. Outcome according to residual disease (surgeon's report vs pre-chemotherapy imaging) in patients with bevacizumabtreated ovarian cancer: Analysis of the ROSiA study. J Surg Oncol. 2019;120:786-793. https://doi.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 94%

Outcome according to residual disease (surgeon's report vs pre‐chemotherapy imaging) in patients with bevacizumab‐treated ovarian cancer: Analysis of the ROSiA study

Korach

Colombo

Mendiola

et al. 2019

Journal of Surgical Oncology

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“…This was not in accordance with current recommendations, since almost 10% of patients with SL were not R0 at the end of surgery. R0, even for an expert surgeon according to the study by Eskander et al, had 40% mismatch between surgeon and CT study [ 38 ]. In our series, a high CA 125 level at diagnosis was a poor prognostic factor for OS (HR = 1.5, 95% CI 1–2.4, p < 0.007; and HR = 1.9, 95% CI 1.1–3.1, p = 0.01 in uni- and multivariate analyses, respectively).…”

Section: Discussionmentioning

confidence: 99%

Impact of Lymphadenectomy on Survival of Patients with Serous Advanced Ovarian Cancer After Neoadjuvant Chemotherapy: A French National Multicenter Study (FRANCOGYN)

Bund

Lecointre

Velten

et al. 2020

JCM

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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).

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“…This may indicate that surgical evaluation is influenced by subjective criteria or that it does not include a full examination of the peritoneal cavity in older (≥75 years) and/or frailer women. The question of subjective operative assessment of residual disease at the end of an intervention was reported in other studies, although not specifically linked to age [23][24][25]. Ezkander et al analyzed 639 women who underwent primary surgery for stage III ovarian cancer and who had been evaluated as having achieved an optimal outcome (residual disease ≤1 cm) by the surgeons [23].…”

Section: Discussionmentioning

confidence: 99%

Ovarian Cancer in the Elderly: Time to Move towards a More Logical Approach to Improve Prognosis—A Study from the FRANCOGYN Group

Dion

Mimoun

Timoh

et al. 2020

JCM

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Background and objective: Elderly and/or frail women with ovarian cancer are often undertreated. The aim of the study is to compare the effects of age and frailty on surgical approaches, postoperative complications, and prognosis in elderly women with ovarian cancer. Methods: A retrospective multicenter study of women ≥70 years were treated for ovarian cancer at seven French university hospitals between 2007 and 2015. Results: Of the 1119 women treated for ovarian cancer during the study period, 147 were ≥70 years and had complete data. Of these women, 65 were aged 70–74 years, and 82 were aged ≥75 years. Overall, 77% of the younger women (49/65) received optimal treatment compared with 51% (40/82) of the older women (p = 0.018). Women ≥75 years underwent fewer bowel resections (32% vs. 67%, p < 0.001) and experienced fewer postoperative complications (22.6% vs. 38.9%, p < 0.001); 53.2% of the women in this age group were treated by primary surgery or surgery only. These women also received more chemotherapy with platinum only (15% [9/56] vs. 2% [1/57], p = 0.007) and less bevacizumab (9% [5/56] vs. 32% [18/57], p = 0.003). Patients with greater frailty (a modified Charlson Comorbidity Index [mCCI] score >3) had a five-year survival rate of 30% versus 62% for those with a score ≤3 (p < 0.001). Conclusions: Surgeons modify their approach to treating ovarian cancer in women ≥75 years probably to reduce immediate postoperative complications. The prognosis is significantly worse in patients with greater frailty. Improvements to the sequence of treatments administered, with priority given to neoadjuvant chemotherapy in patients with greater frailty, could help increase the number of women who receive optimal treatment and improve their prognosis.

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Correlation between Surgeon's assessment and radiographic evaluation of residual disease in women with advanced stage ovarian cancer reported to have undergone optimal surgical cytoreduction: An NRG Oncology/Gynecologic Oncology Group study

Cited by 24 publications

References 30 publications

Outcome according to residual disease (surgeon's report vs pre‐chemotherapy imaging) in patients with bevacizumab‐treated ovarian cancer: Analysis of the ROSiA study

Outcome according to residual disease (surgeon's report vs pre‐chemotherapy imaging) in patients with bevacizumab‐treated ovarian cancer: Analysis of the ROSiA study

Impact of Lymphadenectomy on Survival of Patients with Serous Advanced Ovarian Cancer After Neoadjuvant Chemotherapy: A French National Multicenter Study (FRANCOGYN)

Ovarian Cancer in the Elderly: Time to Move towards a More Logical Approach to Improve Prognosis—A Study from the FRANCOGYN Group

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