Intraoperative Capsule Rupture, Postoperative Chemotherapy, and Survival of Women With Stage I Epithelial Ovarian Cancer

Matsuo, Koji; Machida, Hiroko; Yamagami, Wataru; Ebina, Yasuhiko; Kobayashi, Yoichi; Tabata, Tsutomu; Kaneuchi, Masanori; Nagase, Satoru; Enomoto, Takayuki; Mikami, Mikio

doi:10.1097/aog.0000000000003507

Cited by 51 publications

(44 citation statements)

References 31 publications

(34 reference statements)

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“…This is particularly applicable as intraoperative capsule rupture may increase the risk of cancer mortality in certain histology types, especially clear cell. 49 Of stage IC1 disease, 12% of women had recurrence compared to 23% with stage IC2 or IC3 disease (P = 0.02). Studies on FSS in stage II-III disease are very limited given it is not recommended due to recurrence rates that near 40%.…”

Section: Cancer Stagementioning

confidence: 92%

Fertility‐sparing treatment for early‐stage epithelial ovarian cancer: Contemporary oncologic, reproductive and endocrinologic perspectives

Mandelbaum

Klar

Takiuchi

et al. 2020

J of Obstet and Gynaecol

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Aim Epithelial ovarian cancer (EOC) can be a devastating diagnosis in women of reproductive age who desire future fertility. However, in early‐stage disease, fertility‐sparing surgery (FSS) can be considered in appropriately selected patients. Methods This is a narrative descriptive review of the recent literature on FSS for EOC from oncologic, reproductive and endocrinologic perspectives. Results The recurrence rate following FSS performed for stage I EOC in published retrospective studies collectively is 13% but ranges from 5 to 29%, while mortality ranges from 0 to 18%. Five‐year disease‐free survival following FSS is over 90% but decreases with higher stage and grade. Recurrences following FSS are more likely to be localized with a more favorable prognosis compared to recurrences following radical surgery. Adjuvant chemotherapy is recommended in women with high‐risk disease, and strategies to minimize gonadotoxicity during chemotherapy such as gonadotropin‐releasing hormone (GnRH) agonists may be considered. Oocyte, embryo and/or ovarian cryopreservation can also be offered to patients desiring future biologic children. Reproductive outcomes following FSS, including pregnancy and miscarriage rates, resemble those of the general population, with a chance of successful pregnancy of nearly 80%. Conclusion In retrospective data, FSS appears to be oncologically safe in stage IA and IC grade 1–2 non‐clear cell EOC. In patients with grade 3 tumors or clear cell histology, treatment can be individualized, weighing a slightly higher risk of recurrence with fertility goals. A multidisciplinary approach with oncology and reproductive endocrinology may be of utility to help these patients achieve their fertility goals.

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Section: Cancer Stagementioning

confidence: 92%

Fertility‐sparing treatment for early‐stage epithelial ovarian cancer: Contemporary oncologic, reproductive and endocrinologic perspectives

Mandelbaum

Klar

Takiuchi

et al. 2020

J of Obstet and Gynaecol

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“…Additionally, complete surgery was not performed on stage I patients; therefore, adhesions with the rectum, bladder, peritoneum, and endometriosis may have remained, which could include microscopic residual lesions. Matsuo et al reported that among apparent stage I EOCs, the clear cell type possesses a disproportionally high risk of capsule rupture during adnexectomy and is associated with the worst prognosis [ 19 ]. However, these findings are limited due to the retrospective nature of the study and the small number of recurrent stage IA/IB (n=6) and stage II (n=20) patients.…”

Section: Discussionmentioning

confidence: 99%

The post-progression survival of patients with recurrent or persistent ovarian clear cell carcinoma: results from a randomized phase III study in JGOG3017/GCIG

et al. 2020

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Objective In this study we sought to investigate the clinical factors that affect post-progression survival (PPS) in patients with recurrent or persistent clear cell carcinoma (CCC). We utilized the JGOG3017/Gynecological Cancer InterGroup data to compare paclitaxel plus carboplatin (TC) and irinotecan plus cisplatin (CPT-P) in the treatment of stages I to IV CCC. Methods We enrolled 166 patients with recurrent or persistent CCC and assessed the impact of variables, including platinum sensitivity, treatment arm, crossover chemotherapy, primary stage, residual tumor at primary surgery, performance status, ethnicity, and tumor reduction surgery at recurrence on the median of PPS in patients with recurrent or persistent CCC. Results A total of 77 patients received TC, and 89 patients received CPT-P. The median PPS for patients with platinum-resistant disease was 10.9 months, compared with 18.8 months for patients with platinum-sensitive disease (hazard ratio [HR]=1.88; 95% confidence interval [CI]=1.30–2.72; log-rank p<0.001). In the multivariate analysis, the platinum sensitivity (resistant vs. sensitivity; HR=1.60; p=0.027) and primary stage (p=0.009) were identified as independent predictors of prognosis factors for PPS in recurrent or persistent CCC. Conclusions Our findings revealed that platinum sensitivity and primary stage are clinical factors that significantly affect PPS in patients with recurrent or persistent CCC as well as other histologic subtypes of ovarian cancer. PPS in patients with recurrent CCC should establish the basis for future clinical trials in this population.

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“…6 In a society-based retrospective observational study in Japan for stage IA-1C1 cases in 15 163 EOC patients, including 6107 OCCC cases, OCCC had the highest risk of intraoperative capsule rupture (57.3%) of all the histotypes, and the largest effect of rupture on decreased survival (hazard ratio [HR] = 1.99; 95% confidence interval [CI] 1.45-2.75). 7 The prognostic implications of intraoperative rupture remain unclear, but the importance of intact removal of suspicious adnexal masses was suggested. In lymphadenectomy, Takano et al found a lymph node metastasis rate of pT1 to pT2 tumors of 11% in OCCC.…”

Section: Surgerymentioning

confidence: 99%

Current and future strategies for treatment of ovarian clear cell carcinoma

Ogasawara

Sato

2020

J of Obstet and Gynaecol

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Ovarian clear cell carcinoma (OCCC) is one of the five histological types of epithelial ovarian cancer (EOC). OCCC comprises 23% of all EOC cases in Japan, whereas the rate of OCCC in North America and Europe is much lower. OCCC is generally categorized as a rare gynecologic malignancy, and there is limited evidence for specific treatment. The clinical basis for treatment of OCCC is mostly based on retrospective studies, many of which were performed in Japan. Until recently, most randomized clinical trials for EOC have included OCCC; therefore, current treatment for OCCC is basically the same as that for other histologic types of EOC. However, the clinical characteristics of OCCC differ from those of high‐grade serous carcinoma, particularly for chemosensitivity, and there is a need to develop new treatment for OCCC. The molecular background of OCCC has unique features: tumors are usually negative for p53 mutations and positive for ARID1A and/or PIK3CA mutations, whereas p53 mutations are common in high‐grade serous or endometrioid carcinomas. These features may help in development of new treatment for OCCC. In this review, we described the current evidence for treatment of OCCC, including surgery, radiotherapy, chemotherapy, molecular targeted therapy and immunotherapy, and we discuss ongoing clinical trials and preclinical studies of new treatment approaches for OCCC.

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Intraoperative Capsule Rupture, Postoperative Chemotherapy, and Survival of Women With Stage I Epithelial Ovarian Cancer

Abstract: The incidence and prognostic significance of intraoperative capsule rupture in apparent stage IA-B ovarian cancer varies across histologies, and postoperative chemotherapy was not associated with improved survival.

Cited by 51 publications

References 31 publications

Fertility‐sparing treatment for early‐stage epithelial ovarian cancer: Contemporary oncologic, reproductive and endocrinologic perspectives

Fertility‐sparing treatment for early‐stage epithelial ovarian cancer: Contemporary oncologic, reproductive and endocrinologic perspectives

The post-progression survival of patients with recurrent or persistent ovarian clear cell carcinoma: results from a randomized phase III study in JGOG3017/GCIG

Current and future strategies for treatment of ovarian clear cell carcinoma

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