How to predict treatment failure in frail patients with advanced epithelial ovarian cancer: strategies to personalize surgical effort

Fotopoulou, Christina

doi:10.3802/jgo.2020.31.e26

Cited by 5 publications

(6 citation statements)

References 12 publications

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“…Even so, patients with optimal cytoreduction in PDS had a better prognosis in the majority of studies 7 . Nevertheless, NAC has been proposed as an alternative for patients with AOC with an excessively high fragility index for PDS 8 , 9 .…”

Section: Introductionmentioning

confidence: 99%

Validation of three predictive models for suboptimal cytoreductive surgery in advanced ovarian cancer

Llueca

Climent

Escrig-Sos

et al. 2021

Sci Rep

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The standard treatment for advanced ovarian cancer (AOC) is cytoreduction surgery and adjuvant chemotherapy. Tumor volume after surgery is a major prognostic factor for these patients. The ability to perform complete cytoreduction depends on the extent of disease and the skills of the surgical team. Several predictive models have been proposed to evaluate the possibility of performing complete cytoreductive surgery (CCS). External validation of the prognostic value of three predictive models (Fagotti index and the R3 and R4 models) for predicting suboptimal cytoreductive surgery (SCS) in AOC was performed in this study. The scores of the 3 models were evaluated in one hundred and three consecutive patients diagnosed with AOC treated in a tertiary hospital were evaluated. Clinicopathological features were collected prospectively and analyzed retrospectively. The performance of the three models was evaluated, and calibration and discrimination were analyzed. The calibration of the Fagotti, R3 and R4 models showed odds ratios of obtaining SCSs of 1.5, 2.4 and 2.4, respectively, indicating good calibration. The discrimination of the Fagotti, R3 and R4 models showed an area under the ROC curve of 83%, 70% and 81%, respectively. The negative predictive values of the three models were higher than the positive predictive values for SCS. The three models were able to predict suboptimal cytoreductive surgery for advanced ovarian cancer, but they were more reliable for predicting CCS. The R4 model discriminated better because it includes the laparotomic evaluation of the peritoneal carcinomatosis index.

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Section: Introductionmentioning

confidence: 99%

Validation of three predictive models for suboptimal cytoreductive surgery in advanced ovarian cancer

Llueca

Climent

Escrig-Sos

et al. 2021

Sci Rep

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“…This finding contradicts current arguments towards the value of surgery in advanced ovarian cancer, which claim that it is mainly the tumour biology that dictates survival and also operability and not actual surgical effort. 6 , 27 Our data indicate that tumour debulking is an important factor for patient survival and maximal surgical effort can shift the patients towards a more favourable prognosis group.…”

Section: Discussionmentioning

confidence: 75%

“…Currently, all surgical decision-making processes are based mainly on infrastructural, clinical and fragility parameters as well as factors related to surgical philosophy and training. 6 …”

Section: Introductionmentioning

confidence: 99%

Discovery of a biomarker candidate for surgical stratification in high-grade serous ovarian cancer

et al. 2021

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Background Maximal effort cytoreductive surgery is associated with improved outcomes in advanced high-grade serous ovarian cancer (HGSOC). However, despite complete gross resection (CGR), there is a percentage of patients who will relapse and die early. The aim of this study is to identify potential candidate biomarkers to help personalise surgical radicality. Methods 136 advanced HGSOC cases who underwent CGR were identified from three public transcriptomic datasets. Candidate prognostic biomarkers were discovered in this cohort by Cox regression analysis, and further validated by targeted RNA-sequencing in HGSOC cases from Imperial College Healthcare NHS Trust ( n = 59), and a public dataset. Gene set enrichment analysis was performed to understand the biological significance of the candidate biomarker. Results We identified ALG5 as a prognostic biomarker for early tumour progression in advanced HGSOC despite CGR (HR = 2.42, 95% CI (1.57–3.75), p < 0.0001). The prognostic value of this new candidate biomarker was additionally confirmed in two independent datasets (HR = 1.60, 95% CI (1.03–2.49), p = 0.0368; HR = 3.08, 95% CI (1.07–8.81), p = 0.0365). Mechanistically, the oxidative phosphorylation was demonstrated as a potential biological pathway of ALG5 -high expression in patients with early relapse ( p < 0.001). Conclusion ALG5 has been identified as an independent prognostic biomarker for poor prognosis in advanced HGSOC patients despite CGR. This sets a promising platform for biomarker combinations and further validations towards future personalised surgical care.

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“…The main reasons identified were extent of disease not amenable to surgery or lack of response to NACT, patient co-morbidities preventing surgery and extent of disease. The patients who did not have debulking surgery, had an over 3-fold increase in mortality of any cause, compared to those who had surgery at some point [31,32].…”

Section: Clinical Assessmentmentioning

confidence: 95%

“…absence of lung or multiple parenchymal liver metastases on the CT scan. Liu et al [31,32] reported that more than a quarter of women with advanced ovarian cancer treated with neoadjuvant chemotherapy (NACT) do not ever undergo cytoreductive surgery. Significant risk factors contributing to the inability to undergo surgery were advanced age, low albumin levels, frailty scores and extensive disease of predominantly high-grade serous histology.…”

Section: Clinical Assessmentmentioning

confidence: 99%

The Role of Ultra-Radical Surgery in the Management of Advanced Ovarian Cancer: State or Art

Buruiana¹,

Ismail²,

Ferrari³

et al. 2021

Ovarian Cancer - Updates in Tumour Biology and Therapeutics [Working Title]

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The ovarian cancer, also known as “silent killer”, has remained the most lethal gynaecological malignancy. The single independent risk factor linked with improved survival is maximum cytoreductive effort resulting in no macroscopic residual disease. This could be gained through ultra-radical surgery which demands tackling significant tumour burden in pelvis, lower and upper abdomen which usually constitutes bowel resection, liver mobilisation, ancillary cholecystectomy, extensive peritonectomy, diaphragmatic resection, splenectomy, resection of enlarged pelvic, paraaortic, and rarely cardio-phrenic lymph nodes in order to achieve optimal debulking. The above can be achieved through a holistic approach to patient’s care, meticulous patient selection, and full engagement of the family. The decision needs to be carefully balanced after obtaining an informed consent, and an appreciation of the impact of such surgery on the quality of life against the survival benefit. This chapter will describe the complexity and surgical challenges in the management of advanced ovarian cancer.

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How to predict treatment failure in frail patients with advanced epithelial ovarian cancer: strategies to personalize surgical effort

Cited by 5 publications

References 12 publications

Validation of three predictive models for suboptimal cytoreductive surgery in advanced ovarian cancer

Validation of three predictive models for suboptimal cytoreductive surgery in advanced ovarian cancer

Discovery of a biomarker candidate for surgical stratification in high-grade serous ovarian cancer

The Role of Ultra-Radical Surgery in the Management of Advanced Ovarian Cancer: State or Art

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