Low-grade serous carcinoma (LGSC): A Canadian multicenter review of practice patterns and patient outcomes

Scott, Stephanie; Fernández, Marta Llauradó; Kim, Hannah; Elit, Laurie; Nourmoussavi, Melica; Glaze, Sarah; Roberts, Lesley F.; Offman, Saul; Rahimi, Kurosh; Lytwyn, Alice; Sur, Monalisa; Gilks, C. Blake; Matheson, Kara; Köbel, Martin; Dawson, Amy; Tinker, Anna V.; Kwon, Janice S.; Hoskins, Paul; Santos, Jennifer L.; Cheung, Andrea; Provencher, Diane; Carey, Mark

doi:10.1016/j.ygyno.2020.01.021

Cited by 16 publications

(20 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The outcome of debulking surgery seems to be a prognostic factor in LGSC patients in our study. In the PDS group, relative survival was best following surgery with no macroscopic residual disease and in the IDS group, this applied to patients without macroscopic or ≤1 cm residual disease, in line with other studies 10,36–38 . Better survival following PDS than after neo‐adjuvant chemotherapy followed by IDS was found, which is in accordance with two recent studies, but this was not confirmed in another cohort of stage II–IV LGSC patients 38–40 .…”

Section: Discussionsupporting

confidence: 81%

“…In the PDS group, relative survival was best following surgery with no macroscopic residual disease and in the IDS group, this applied to patients without macroscopic or ≤1 cm residual disease, in line with other studies 10,36–38 . Better survival following PDS than after neo‐adjuvant chemotherapy followed by IDS was found, which is in accordance with two recent studies, but this was not confirmed in another cohort of stage II–IV LGSC patients 38–40 . It is important to note that these differences might be caused not by the surgery itself but rather by the extent of disease 13 .…”

Section: Discussionsupporting

confidence: 81%

See 1 more Smart Citation

Stage, treatment and survival of low‐grade serous ovarian carcinoma in the Netherlands: A nationwide study

Decker

Wenzel

Bart

et al. 2023

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

Introduction Serous ovarian carcinomas constitute the largest group of epithelial ovarian cancer (60%–75%) and are further classified into high‐ and low‐grade serous carcinoma. Low‐grade serous carcinoma (LGSC) is a relatively rare subtype (approximately 5% of serous carcinomas) and epidemiologic studies of large cohorts are scarce. With the present study we aimed to report trends in stage, primary treatment and relative survival of LGSC of the ovary in a large cohort of patients in an effort to identify opportunities to improve clinical practice and outcome of this relatively rare disease. Material and Methods Patients diagnosed with LGSC between 2000 and 2019 were identified from the Netherlands Cancer Registry (n = 855). Trends in FIGO stages and primary treatment were analyzed with the Cochran–Armitage trend test, and differences in and trends of 5‐year relative survival were analyzed using multivariable Poisson regression. Results Over time, LGSC was increasingly diagnosed as stage III (39.9%–59.0%) and IV disease (5.7%–14.4%) and less often as stage I (34.6%–13.5%; p < 0.001). Primary debulking surgery was the most common strategy (76.2%), although interval debulking surgery was preferred more often over the years (10.6%–31.1%; p < 0.001). Following primary surgery, there was >1 cm residual disease in only 15/252 patients (6%), compared with 17/95 patients (17.9%) after interval surgery. Full cohort 5‐year survival was 61% and survival after primary debulking surgery was superior to the outcome following interval debulking surgery (60% vs 34%). Survival following primary debulking surgery without macroscopic residual disease (73%) was better compared with ≤1 cm (47%) and >1 cm residual disease (22%). Survival following interval debulking surgery without macroscopic residual disease (51%) was significantly higher than after >1 cm residual disease (24%). Except FIGO stage II (85%–92%), survival did not change significantly over time. Conclusions Over the years, LGSC has been diagnosed as FIGO stage III and stage IV disease more often and interval debulking surgery has been increasingly preferred over primary debulking in these patients. Relative survival did not change over time (except for stage II) and worse survival outcomes after interval debulking surgery were observed. The results support the common recommendation to perform primary debulking surgery in patients eligible for primary surgery.

show abstract

Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 81%

Stage, treatment and survival of low‐grade serous ovarian carcinoma in the Netherlands: A nationwide study

Decker

Wenzel

Bart

et al. 2023

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

show abstract

“…However, some can show frank invasion in the peritoneum (peritoneal primary) or even in lymph nodes (lymph node primary) [ 10 ]. Notably, a reproducible assessment of invasion at a peritoneal site is challenging, and the frequency of peritoneal LGSC differs between centers, which might, in part, explain the survival differences for patients diagnosed with peritoneal versus ovarian LGSCs, with the former having a longer survival [ 11 , 12 ]. If metastatic adenocarcinomas (mostly from the lower or upper gastrointestinal tract) are excluded, ovarian mucinous carcinomas (MCs) arise from the ovary.…”

Section: Introductionmentioning

confidence: 99%

The Evolution of Ovarian Carcinoma Subclassification

Köbel

Kang

2022

Cancers

Self Cite

View full text Add to dashboard Cite

The phenotypically informed histotype classification remains the mainstay of ovarian carcinoma subclassification. Histotypes of ovarian epithelial neoplasms have evolved with each edition of the WHO Classification of Female Genital Tumours. The current fifth edition (2020) lists five principal histotypes: high-grade serous carcinoma (HGSC), low-grade serous carcinoma (LGSC), mucinous carcinoma (MC), endometrioid carcinoma (EC) and clear cell carcinoma (CCC). Since histotypes arise from different cells of origin, cell lineage-specific diagnostic immunohistochemical markers and histotype-specific oncogenic alterations can confirm the morphological diagnosis. A four-marker immunohistochemical panel (WT1/p53/napsin A/PR) can distinguish the five principal histotypes with high accuracy, and additional immunohistochemical markers can be used depending on the diagnostic considerations. Histotypes are further stratified into molecular subtypes and assessed with predictive biomarker tests. HGSCs have recently been subclassified based on mechanisms of chromosomal instability, mRNA expression profiles or individual candidate biomarkers. ECs are composed of the same molecular subtypes (POLE-mutated/mismatch repair-deficient/no specific molecular profile/p53-abnormal) with the same prognostic stratification as their endometrial counterparts. Although methylation analyses and gene expression and sequencing showed at least two clusters, the molecular subtypes of CCCs remain largely elusive to date. Mutational and immunohistochemical data on LGSC have suggested five molecular subtypes with prognostic differences. While our understanding of the molecular composition of ovarian carcinomas has significantly advanced and continues to evolve, the need for treatment options suitable for these alterations is becoming more obvious. Further preclinical studies using histotype-defined and molecular subtype-characterized model systems are needed to expand the therapeutic spectrum for women diagnosed with ovarian carcinomas.

show abstract

“…Across the 2 cohorts in this study and 2 previous studies, NACT use for low-grade serous ovarian cancer was associated with worse OS outcomes compared with PDS . This survival association was particularly prominent in prognostically more favorable subgroups in general (younger, healthier patients and earlier disease).…”

Section: Discussionmentioning

confidence: 99%

“…The most prevalent histologic subtype of epithelial ovarian cancer is high-grade serous carcinomas, and clear cell, low-grade serous, and mucinous carcinomas represent less common histologic subtypes in the US (2%-7%) . Due to their rarity, the use and survival outcomes associated with NACT in these less common epithelial carcinomas have been relatively understudied . Even with the available data, limited sample size and lack of comparator groups make their findings difficult to interpret and adopt.…”

Section: Introductionmentioning

confidence: 99%

Uptake and Outcomes of Neoadjuvant Chemotherapy Among US Patients With Less Common Epithelial Ovarian Carcinomas

et al. 2023

View full text Add to dashboard Cite

ImportanceRandomized clinical trials examining the effectiveness of neoadjuvant chemotherapy (NACT) for advanced ovarian cancer predominantly included patients with high-grade serous carcinomas. The use and outcomes of NACT in less common epithelial carcinomas are understudied.ObjectiveTo investigate the uptake and survival outcomes in treatment with NACT for less common histologic subtypes of epithelial ovarian cancer.Design, Setting, and ParticipantsA retrospective cohort study and systematic literature review with meta-analysis was conducted using the National Cancer Database from 2006 to 2017 and the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program from 2006 to 2019. Data analysis was performed from July 2022 to April 2023. The evaluation included patients with stage III to IV ovarian cancer with clear cell, mucinous, or low-grade serous histologic subtypes who received multimodal treatment with surgery and chemotherapy.ExposuresExposure assignment per the sequence of treatment: primary debulking surgery (PDS) followed by chemotherapy (PDS group) or NACT followed by interval surgery (NACT group).Main Outcomes and MeasuresTemporal trends and characteristics of NACT use were assessed using multivariable analysis, and overall survival (OS) was assessed with the inverse probability of treatment weighting propensity score.ResultsA total of 3880 patients were examined in the National Cancer Database including 1829 women (median age, 56 [IQR, 49-63] years) with clear cell, 1156 women (median age, 53 [IQR, 42-64] years) with low-grade serous, and 895 women (median age, 57 [IQR, 48-66] years) with mucinous carcinomas. NACT use increased in patients with clear cell (from 10.2% to 16.2%, 58.8% relative increase; P &lt; .001 for trend) or low-grade serous (from 7.7% to 14.2%, 84.4% relative increase; P = .007 for trend) carcinoma during the study period. This association remained consistent in multivariable analysis. NACT use also increased, but nonsignificantly, in mucinous carcinomas (from 8.6% to 13.9%, 61.6% relative increase; P = .07 for trend). Across the 3 histologic subtypes, older age and stage IV disease were independently associated with NACT use. In a propensity score–weighted model, the NACT and PDS groups had comparable OS for clear cell (4-year rates, 31.4% vs 37.7%; hazard ratio [HR], 1.12; 95% CI, 0.95-1.33) and mucinous (27.0% vs 26.7%; HR, 0.90; 95% CI, 0.68-1.19) carcinomas. For patients with low-grade serous carcinoma, NACT was associated with decreased OS compared with PDS (4-year rates, 56.4% vs 81.0%; HR, 2.12; 95% CI, 1.55-2.90). Increasing NACT use and histologic subtype–specific survival association were also found in the Surveillance, Epidemiology, and End Results Program cohort (n = 1447). A meta-analysis of 4 studies, including the current study, observed similar OS associations for clear cell (HR, 1.13; 95% CI, 0.96-1.34; 2 studies), mucinous (HR, 0.93; 95% CI, 0.71-1.21; 2 studies), and low-grade serous (HR, 2.11; 95% CI, 1.63-2.74; 3 studies) carcinomas.Conclusions and RelevanceDespite the lack of data on outcomes of NACT among patients with less common carcinomas, this study noted that NACT use for advanced disease has gradually increased in the US. Primary chemotherapy for advanced-stage, low-grade serous ovarian cancer may be associated with worse survival compared with PDS.

show abstract

Low-grade serous carcinoma (LGSC): A Canadian multicenter review of practice patterns and patient outcomes

Cited by 16 publications

References 21 publications

Stage, treatment and survival of low‐grade serous ovarian carcinoma in the Netherlands: A nationwide study

Stage, treatment and survival of low‐grade serous ovarian carcinoma in the Netherlands: A nationwide study

The Evolution of Ovarian Carcinoma Subclassification

Uptake and Outcomes of Neoadjuvant Chemotherapy Among US Patients With Less Common Epithelial Ovarian Carcinomas

Contact Info

Product

Resources

About