The detrimental effect of adopting interval debulking surgery in advanced stage low-grade serous ovarian cancer

Abstract

ObjectiveTo examine outcomes of patients having treatments for newly diagnosed advanced stage low-grade serous ovarian cancer (LGSC).MethodsWe conducted a retrospective case series of women affected by advanced stage (stage IIIB or more) LGSC undergoing surgery in a single oncologic center between January 2000 and December 2017. Survival outcomes were assessed using Kaplan-Meier and Cox models.ResultsData of 72 patients were retrieved. Primary cytoreductive surgery was attempted in 68 (94.4%) patients: 19 (27.9%) had residual disease (RD) >1 cm after primary surgery. Interval debulking surgery (IDS) was attempted in 15 of these 19 (78.9%) patients and the remaining 4 patients having not primary debulking surgery. Twelve out of 19 (63.1%) patients having IDS had RD. After a mean (±standard deviation) follow-up was 61.6 (±37.2) months, 50 (69.4%) and 22 (30.5%) patients recurred and died of disease, respectively. Via multivariate analysis, non-optimal cytoreduction (hazard ratio [HR]=2.79; 95% confidence interval [CI]=1.16–6.70; p=0.021) and International Federation of Obstetrics and Gynecologists (FIGO) stage IV (HR=3.15; 95% CI=1.29–7.66; p=0.011) were associated with worse disease-free survival. Via multivariate analysis, absence of significant comorbidities (HR=0.56; 95% CI=0.29–1.10; p=0.093) and primary instead of IDS (HR=2.95; 95% CI=1.12–7.74; p=0.027) were independently associated with an improved overall survival.ConclusionLGSC is at high risk of early recurrence. However, owing to the indolent nature of the disease, the majority of patients are long-term survivors. Further prospective studies and innovative treatment modalities are warranted to improve patients care.

Low‐grade serous ovarian carcinoma: A comprehensive literature review

“…3 IDS may have a lesser role than for HGSOC, whereby a 2019 retrospective study (n = 72) showed that of the 68 (94.4%) patients who had primary CRS, 19 (27.9%) had RD > 1 cm. 13 IDS was attempted in 15, of whom 12 (63.1%) had RD > 1 cm, with the OS of this group being lower than those with upfront CRS (HR = 3.00, P = 0.014). 13 The limitations of this study included no data being available regarding peritoneal involvement of disease and there is a possibility that patients undergoing IDS have a higher burden LGSOC, 10.7% of women had positive lymph nodes (LN).…”

“…13 IDS was attempted in 15, of whom 12 (63.1%) had RD > 1 cm, with the OS of this group being lower than those with upfront CRS (HR = 3.00, P = 0.014). 13 The limitations of this study included no data being available regarding peritoneal involvement of disease and there is a possibility that patients undergoing IDS have a higher burden LGSOC, 10.7% of women had positive lymph nodes (LN). 34 Interestingly the upstaging of patients due to LN involvement alone occurred in only 2.4% of women and there was no significant difference in OS or PFS between LN positive and negative patients.…”

“…The aforementioned review of 4447 women did not find ethnicity to be associated with overall survival (OS); however, older age, advanced stage and government insurance were independently associated with worse OS . Another retrospective study highlighted risk factors for worse progression‐free survival (PFS) as non‐optimal cytoreduction (hazards ratio (HR) = 2.79) and International Federation of Gynecology and Obstetrics (FIGO) stage IV (HR = 3.15), with the absence of significant comorbidities (HR = 0.56) and primary vs interval debulking surgery (IDS) (HR = 2.95) associated with improved OS …”

“…IDS may have a lesser role than for HGSOC, whereby a 2019 retrospective study ( n = 72) showed that of the 68 (94.4%) patients who had primary CRS, 19 (27.9%) had RD > 1 cm . IDS was attempted in 15, of whom 12 (63.1%) had RD > 1 cm, with the OS of this group being lower than those with upfront CRS (HR = 3.00, P = 0.014) .…”

“…18 Another retrospective study highlighted risk factors for worse progression-free survival (PFS) as non-optimal cytoreduction (hazards ratio (HR) = 2.79) and International Federation of Gynecology and Obstetrics (FIGO) stage IV (HR = 3.15), with the absence of significant comorbidities (HR = 0.56) and primary vs interval debulking surgery (IDS) (HR = 2.95) associated with improved OS. 13 A comparison between the features of LGSOC and HGSOC are listed in Table 1.…”