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Correlation of Pattern of Spread and Outcomes in Advanced Epithelial Ovarian Cancers

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Abstract

The purpose of this study was to correlate the pattern of spread with oncological outcomes in advanced ovarian cancer patients. This is a retrospective analysis of 55 consecutive patients who had advanced epithelial ovarian cancer or primary peritoneal carcinomatosis (stages 3C and 4) with primary surgical intervention as the initial modality of treatment. Based on the spread of disease, they were further classified into class A: disease confined to the pelvis (excluded); class B: disease extending to the lower abdomen and omentum; class C: diffuse small-bowel disease with or without A, B, or D; and class D: disease in the upper abdomen. There were 17 patients (30.9%) in class B, 17 (30.9%) in class C, and 21 (38.2%) in class D. The number of patients with suboptimal cytoreduction was highest in class C (six patients). At the end of follow-up (median 38.6 months), 16 patients had no evidence of disease and 26 patients were alive with disease. The 3-year overall survival rates in classes B, C, and D were 94.1, 52.5, and 93.3%, respectively. The 3-year progression-free survival rates were 55.8, 11.8, and 41.9%, respectively. The rates were lowest for class C. The differences in the overall survival rate (p < 0.001) and progression-free survival rate (p = 0.001) were statistically significant. In advanced ovarian cancer patients, the presence of disease in the small-bowel serosa and mesentery results in poorer outcomes in terms of overall and progression-free survival. The number of patients with suboptimal cytoreduction was also highest in this group.

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References

  1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 1(5):136

    Google Scholar 

  2. Heintz AP, Odicino F, Maisonneuve P, Quinn MA, Benedet JL, Creasman WT, Ngan HY, Pecorelli S, Beller U (2006) Carcinoma of the ovary. FIGO 26th annual report on the results of treatment in gynecological cancer. Int J Gynaecol Obstet 95(Suppl 1):S161–S192

    Article  PubMed  Google Scholar 

  3. Elattar A, Bryant A, Winter-Roach BA, Hatem M, Naik R 2011.Optimal primary surgical treatment for advanced epithelial ovarian cancer. Cochrane Database Syst Rev. 10;(8)

  4. Chi DS, Eisenhauer EL, Lang J, Huh J, Haddad L, Abu-Rustum NR, Sonoda Y, Levine DA, Hensley M, Barakat RR (2006) What is the optimal goal of primary cytoreductive surgery for bulky stage IIIC epithelial ovarian carcinoma (EOC)? Gynecol Oncol 103(2):559–564

    Article  PubMed  CAS  Google Scholar 

  5. Eisenkop SM, Spirtos NM, Lin WC (2006) Optimal cytoreduction for advanced epithelial ovarian cancer: a commentary. Gynecol Oncol 103(1):329–335

    Article  PubMed  Google Scholar 

  6. Morgan RJ Jr, Alvarez RD, Armstrong DK, Burger RA, Chen LM, Copeland L,Crispens MA, Gershenson DM, Gray HJ, Hakam A, Havrilesky LJ, Johnston C, Lele S, Martin L, Matulonis UA, O'Malley DM, Penson RT, Powell MA, Remmenga SW, Sabbatini P, Santoso JT, Schink JC, Teng N, Werner TL, Dwyer MA, Hughes M; National comprehensive cancer networks. Ovarian cancer, version 2.2013. J Natl Compr Cancer Netw 2013;11(10):1199–1209.

  7. Aletti GD, Dowdy SC, Gostout BS, Jones MB, Stanhope CR, Wilson TO, Podratz KC, Cliby WA (2006) Aggressive surgical effort and improved survival in advanced-stage ovarian cancer. Obstet Gynecol 107(1):77–85

    Article  PubMed  Google Scholar 

  8. Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ (2002) Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. JClin Oncol 20(5):1248–1259

    Article  Google Scholar 

  9. Eisenkop SM, Friedman RL, Wang HJ (1998) Complete cytoreductive surgery is feasible and maximizes survival in patients with advanced epithelial ovarian cancer: a prospective study. Gynecol Oncol 69(2):103–108

    Article  PubMed  CAS  Google Scholar 

  10. Lengyel E (2010) Ovarian cancer development and metastasis. Am J Pathol 177(3):1053–1064

    Article  PubMed  PubMed Central  Google Scholar 

  11. Karst AM, Drapkin R (2010) Ovarian cancer pathogenesis: a model in evolution. J Oncol 2010:932371

    Article  PubMed  CAS  Google Scholar 

  12. Hamilton CA, Miller A, Miller C, Krivak TC, Farley JH, Chernofsky MR, Stany MP, Rose GS, Markman M, Ozols RF, Armstrong DK, Maxwell GL (2011) The impact of disease distribution on survival in patients with stage III epithelial ovarian cancer cytoreduced to microscopic residual: a gynecologic oncology group study. GynecolOncol 122(3):521–526

    Google Scholar 

  13. Vergote I, Tropé CG, Amant F, Kristensen GB, Ehlen T,Johnson N, Verheijen RH,van der Burg ME, Lacave AJ, Panici PB, Kenter GG, Casado A, Mendiola C, Coens C, Verleye L, Stuart GC, Pecorelli S, Reed NS; European Organization for Research and Treatment of Cancer-Gynaecological Cancer Group; NCIC Clinical Trials Group. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med 2010;363(10):943–953.

  14. Steed H, Oza AM, Murphy J, Laframboise S, Lockwood G, DE Petrillo D, Sturgeon J, Rosen B (2006) A retrospective analysis of neoadjuvant platinum-based chemotherapy versus up-front surgery in advanced ovarian cancer. Int J Gynecol Cancer 16(Suppl 1):47–53

    Article  PubMed  Google Scholar 

  15. Wahner Hendrickson AE, Hawthorne KM, Goode EL, Kalli KR, Goergen KM, Bakkum-Gamez JN, Cliby WA, Keeney GL, Visscher DW, Tarabishy Y, Oberg AL, Hartmann LC, Maurer MJ 2015. Assessment of published models and prognostic variables in epithelial ovarian cancer at Mayo Clinic. Gynecol Oncol. 22.

  16. Zivanovic O, Sima CS, Iasonos A, Hoskins WJ, Pingle PR, Leitao MM Jr, Sonoda Y, Abu-Rustum NR, Barakat RR, Chi DS (2010) The effect of primary cytoreduction on outcomes of patients with FIGO stage IIIC ovarian cancer stratified by the initial tumor burden in the upper abdomen cephalad to the greater omentum. GynecolOncol 116(3):351–357

    Google Scholar 

  17. Braicu EI, Sehouli J, Richter R, Pietzner K, Lichtenegger W, Fotopoulou C (2012) Primary versus secondary cytoreduction for epithelial ovarian cancer: a paired analysis of tumour pattern and surgical outcome. Eur J Cancer 48(5):687–694

    Article  PubMed  Google Scholar 

  18. Fotopoulou C, Richter R, Braicu EI, Schmidt SC, Lichtenegger W, Sehouli J (2010) Can complete tumor resection be predicted in advanced primary epithelial ovarian cancer? A systematic evaluation of 360 consecutive patients. Eur J Surg Oncol 36(12):1202–1210

    Article  PubMed  CAS  Google Scholar 

  19. Chéreau E, Ballester M, Selle F, Cortez A, Daraï E, Rouzier R (2010) Comparison of peritoneal carcinomatosis scoring methods in predicting resectability and prognosis in advanced ovarian cancer. Am J Obstet Gynecol 202(2):178.e1–178.e10

    Article  Google Scholar 

  20. Hoskins WJ, Bundy BN, Thigpen JT, Omura GA (1992) The influence of cytoreductive surgery on recurrence-free interval and survival in small-volume stage III epithelial ovarian cancer: a gynecologic oncology group study. Gynecol Oncol 47(2):159–166

    Article  PubMed  CAS  Google Scholar 

  21. Eisenkop SM, Spirtos NM, Friedman RL, Lin WC, Pisani AL, Perticucci S (2003) Relative influences of tumor volume before surgery and the cytoreductive outcome on survival for patients with advanced ovarian cancer: a prospective study. GynecolOncol 90(2):390–396

    Google Scholar 

  22. Shim SH, Lee SJ, Kim SO, Kim SN, Kim DY, Lee JJ, Kim JH, Kim YM, Kim YT, Nam JH (2015) Nomogram for predicting incomplete cytoreduction in advanced ovarian cancer patients. Gynecol Oncol 136(1):30–36

    Article  PubMed  Google Scholar 

  23. Brockbank EC, Ind TE, Barton DP, Shepherd JH, Gore ME, A'Hern R, Bridges JE (2004) Preoperative predictors of suboptimal primary surgical cytoreduction in women with clinical evidence of advanced primary epithelial ovarian cancer. Int J Gynecol Cancer 14(1):42–50

    Article  PubMed  CAS  Google Scholar 

  24. Chi DS, Zivanovic O, Palayekar MJ, Eisenhauer EL, Abu-Rustum NR, Sonoda Y, Levine DA, Leitao MM, Brown CL, Barakat RR (2009) A contemporary analysis of the ability of preoperative serum CA-125 to predict primary cytoreductive outcome in patients with advanced ovarian, tubal and peritoneal carcinoma. GynecolOncol 112(1):6–10

    CAS  Google Scholar 

  25. Suidan RS, Ramirez PT, Sarasohn DM, Teitcher JB, Mironov S, Iyer RB, Zhou Q, Iasonos A, Paul H, Hosaka M, Aghajanian CA, Leitao MM Jr, Gardner GJ, Abu-Rustum NR, Sonoda Y, Levine DA, Hricak H, Chi DS (2014) A multicenter prospective trial evaluating the ability of preoperative computed tomography scan and serum CA-125 to predict suboptimal cytoreduction at primary debulking surgery for advanced ovarian, fallopian tube, and peritoneal cancer. Gynecol Oncol 134(3):455–461

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. Kaldawy A, Segev Y, Lavie O, Auslender R, Sopic V, Narod SA (2016) Low-grade serous ovarian cancer: a review. Gynecol Oncol 143(2):433–438. doi:10.1016/j.ygyno.2016.08.320

    Article  PubMed  Google Scholar 

  27. Tewari D, Java JJ, Salani R, Armstrong DK, Markman M, Herzog T, Monk BJ, Chan JK. Long-term survival advantage and prognostic factors associated with intraperitoneal chemotherapy treatment in advanced ovarian cancer: a gynecologic oncology group study. J Clin Oncol, doi: 10.1200/JCO. 2014. 55.9898

  28. K Fuh,T.K.Kiet,L Chen,R A Brooks,A E Sherman,D S Kapp,J K Chan The use of molecular markers to predict for optimal cytoreduction in ovarian cancer.

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Authors and Affiliations

  1. Department of Gynecologic Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, Pin 682041, India

    Amrutha Ramachandran, Anupama Rajanbabu, Kiran Gulabrao Bagul & Dehannathparambil K. Vijaykumar

  2. Department of Medical Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India

    Keechilat Pavithran

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  1. Amrutha Ramachandran
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Correspondence to Anupama Rajanbabu.

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Ramachandran, A., Rajanbabu, A., Bagul, K.G. et al. Correlation of Pattern of Spread and Outcomes in Advanced Epithelial Ovarian Cancers. Indian J Surg Oncol 9, 126–132 (2018). https://doi.org/10.1007/s13193-017-0618-5

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  • DOI: https://doi.org/10.1007/s13193-017-0618-5

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