The impact of chemotherapy on the survival of early-stage I–II epithelial ovarian cancer

ObjectivesThis study aimed to determine the incidence of lymph node (LN) metastases in presumed stage I-II low-grade epithelial ovarian cancer (EOC).MethodsEligible studies were identified from MEDLINE and EMBASE (time frame, 2015–1975), that analyzed patients with clinical or radiologic presumed early-stage EOC who underwent a complete pelvic and para-aortic lymphadenectomy as part of their surgical staging. The number and site of dissected and involved LNs and the correlation with overall outcome are analyzed. The termlow gradeand also the older termwell differentiatedwere used.ResultsThirteen of 978 identified studies were selected, and 13 of 75 studies were identified as eligible. A total of 1403 patients were analyzed in these 13 retrospective studies. The final International Federation of Gynecology and Obstetrics staging after completed surgical staging was I to II in 912 patients (65%). A total of 338 patients (24%) had grade 1 tumors whereas 473 patients (34%) had grade 2, and 502 patients (36%) had grade 3 tumors. Systematic lymphadenectomy was performed in 1159 patients (83%), whereof 1142 (82%) were pelvic and para-aortic LN dissections.In 185 patients (13%), an upstaging from an apparent clinical stage I-II to IIIC occurred because of LN involvement: 64 (35%) of the patients had only pelvic LNs metastases, 69 (37%) had only para-aortic LNs metastasis, and 51 (28%) had both a pelvic and para-aortic LN involvement. When analyzing only the patients with low-grade (grade 1 as the old classification) presumed early-stage disease (n = 273), only 8 patients (2.9%; range, 0–6.2) were identified with LNs metastases present.ConclusionsThe incidence of occult LN metastases in apparent early-stage low-grade EOC is 2.9% in a metaanalysis of retrospective studies. Future larger-scale prospectively assessed studies with established surgical quality of the LN dissection are warranted to establish the true incidence of LN metastasis in presumed early low-grade disease.

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Can Patients With Relapsed, Previously Untreated, Stage I Epithelial Ovarian Cancer Be Successfully Treated With Salvage Therapy?

Journal of Clinical Oncology ◽

10.1200/jco.2003.06.119 ◽

2003 ◽

Vol 21 (16) ◽

pp. 3113-3118 ◽

Cited By ~ 28

Author(s):

Desiree F. Kolomainen ◽

Roger A’Hern ◽

Fareeda Y. Coxon ◽

Cyril Fisher ◽

D. Michael King ◽

...

Keyword(s):

Ovarian Cancer ◽

Adjuvant Chemotherapy ◽

Epithelial Ovarian Cancer ◽

Early Stage ◽

Salvage Chemotherapy ◽

Ovarian Neoplasm ◽

Stage I ◽

European Organization ◽

Platinum Based Chemotherapy ◽

Salvage Rate

Purpose: The role of adjuvant chemotherapy in early-stage epithelial ovarian cancer (EOC) has been controversial. We have previously reported the cases of patients managed with a policy of observation only. We now present the salvage rate for the patients in that study who experienced relapse. Patients and Methods: One hundred ninety-four patients with stage I EOC presenting between 1980 and 1994 received no adjuvant chemotherapy, but were treated with platinum-based chemotherapy at relapse. We calculated the progression-free survival (PFS) and overall survival (OS) for the whole cohort and the salvage rate for those who experienced relapse. We defined salvage as freedom from relapse for 5 years after platinum treatment. Results: Sixty-one (31%) of 194 patients experienced relapse, and 55 received platinum-based chemotherapy. Twenty-four percent were progression-free at 5 years after this treatment. Clear-cell histology and cyst rupture before the patients’ original surgery were independent prognostic factors for PFS after salvage chemotherapy. The OS for all 194 patients is 72% at 10 years (median follow-up, 8.7 years), with an 80% disease-specific survival (DSS). Conclusion: We have shown that some patients with stage I EOC can be successfully treated with a salvage chemotherapy regimen after a policy of observation only. Interestingly, approximately 30% of stage I patients who die within 10 years do so from causes other than EOC (OS, 72%; DSS, 80%). Our findings need to be taken into consideration when the results from recent randomized trials of adjuvant chemotherapy in this patient population (International Collaborative Ovarian Neoplasm Trial 1/European Organization for Research and Treatment of Cancer Adjuvant Chemotherapy in Ovarian Neoplasm Trial) are being discussed with patients.

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Survival Impact of Number of Removed Para-Aortic Lymph Nodes in Stage I Epithelial Ovarian Cancer

10.21203/rs.3.rs-369390/v1 ◽

2021 ◽

Author(s):

Emre Günakan ◽

Hüseyin Akıllı ◽

Atacan Timuçin Kara ◽

Özden Altundağ ◽

Asuman Nihan Haberal ◽

...

Keyword(s):

Ovarian Cancer ◽

Lymph Nodes ◽

Epithelial Ovarian Cancer ◽

Multivariate Analyses ◽

Early Stage ◽

Progression Free Survival ◽

Tumor Grade ◽

Median Number ◽

Stage I ◽

Node Number

Abstract Purpose: The survival effect of presence or absence of lymphadenectomy in early stage epithelial ovarian cancer (EOC) was priorly shown but the effect of number of removed lymph nodes kept in background. We aimed to evaluate the survival impact of number of removed lymph nodes and their localizations in stage I EOC.Methods: Study included 182 patients. Best cut-off levels for number of pelvic and para-aortic lymph nodes(PaLN) were 24 and 10, respectively. Univariate and multivariate survival analyses were performed for these cut-offs and other prognostic factors. Results: Median age of the patients was 49. Median number of removed pelvic and paraartic lymph nodes were 29 and 9, respectively. Median overall(OS) and Progression-free survival(PFS) were 67 and 50 months, respectively. The OS rate was 89.6%. Recurrence occured in 24 (19.5%) patients. In univariate analyses tumor grade(p:0.005), pelvic LN number(p:0.041) and PaLN number(p:0.004) were the factors that were significantly associated with PFS. Tumor grade and PaLN number were independently and significantly associated with PFS in multivariate analyses (p:0.015 and p:0.017, respectively). In OS analyses, age, tumor grade, presence of LVI, number of pelvic and PaLNs were the significantly associated factors (p<0.05 for all). In multivariate analyses age and PaLN number were independently and significantly associated with OS (p:0.011 and p:0.21, respectively). Conclusions: The number and localizations of removed lymph nodes may have a survival affect in stage I EOC. We also think that this study may constitute a kernel point for larger prospective series on lymph node number and lymphatic regions.

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FS-C4BP (fully-sialylated alpha-chain of complement 4-binding protein) is a novel biomarker that can detect early stage epithelial ovarian cancer, especially clear cell carcinoma

10.26226/morressier.5770e29dd462b80290b4c232 ◽

2016 ◽

Author(s):

Masae Ikeda

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Cell Carcinoma ◽

Clear Cell ◽

Clear Cell Carcinoma ◽

Early Stage ◽

Binding Protein ◽

Alpha Chain ◽

Complement 4

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399 Surgical morbidity of the retroperitoneal staging in patients undergoing surgery for early stage epithelial ovarian cancer

10.1136/ijgc-2020-igcs.345 ◽

2020 ◽

Author(s):

M Dri ◽

A Lembo ◽

M Longo ◽

N Oltolina ◽

M Riva ◽

...

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Early Stage ◽

Surgical Morbidity

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Clinical Impact of Lymphadenectomy after Neoadjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer: A Review of Available Data

Journal of Clinical Medicine ◽

10.3390/jcm10020334 ◽

2021 ◽

Vol 10 (2) ◽

pp. 334

Author(s):

Stephanie Seidler ◽

Meriem Koual ◽

Guillaume Achen ◽

Enrica Bentivegna ◽

Laure Fournier ◽

...

Keyword(s):

Ovarian Cancer ◽

Lymph Node ◽

Neoadjuvant Chemotherapy ◽

Epithelial Ovarian Cancer ◽

Lymph Node Dissection ◽

Prospective Trial ◽

Node Dissection ◽

Advanced Epithelial Ovarian Cancer ◽

The Impact ◽

Systematic Lymph Node Dissection

Recent robust data allow for omitting lymph node dissection for patients with advanced epithelial ovarian cancer (EOC) and without any suspicion of lymph node metastases, without compromising recurrence-free survival (RFS), nor overall survival (OS), in the setting of primary surgical treatment. Evidence supporting the same postulate for patients undergoing complete cytoreductive surgery after neoadjuvant chemotherapy (NACT) is lacking. Throughout a systematic literature review, the aim of our study was to evaluate the impact of lymph node dissection in patients undergoing surgery for advanced-stage EOC after NACT. A total of 1094 patients, included in six retrospective series, underwent either systematic, selective or no lymph node dissection. Only one study reveals a positive effect of lymphadenectomy on OS, and two on RFS. The four remaining series fail to demonstrate any beneficial effect on survival, neither for RFS nor OS. All of them highlight the higher peri- and post-operative complication rate associated with systematic lymph node dissection. Despite heterogeneity in the design of the studies included, there seems to be a trend showing no improvement on OS for systematic lymph node dissection in node negative patients. A well-conducted prospective trial is mandatory to evaluate this matter.

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Does Time-to-Chemotherapy after Primary Complete Macroscopic Cytoreductive Surgery Influence Prognosis for Patients with Epithelial Ovarian Cancer? A Study of the FRANCOGYN Group

Journal of Clinical Medicine ◽

10.3390/jcm10051058 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1058

Author(s):

Grégoire Rocher ◽

Thomas Gaillard ◽

Catherine Uzan ◽

Pierre Collinet ◽

Pierre-Adrien Bolze ◽

...

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Cytoreductive Surgery ◽

Retrospective Cohort ◽

Early Stage ◽

Cohort Analysis ◽

Recurrence Free Survival ◽

Advanced Stage ◽

Free Survival ◽

Retrospective Cohort Analysis

To determine if the time-to-chemotherapy (TTC) after primary macroscopic complete cytoreductive surgery (CRS) influences recurrence-free survival (RFS) and overall survival (OS) in patients with epithelial ovarian cancer (EOC). We conducted an observational multicenter retrospective cohort analysis of women with EOC treated from September 2006 to November 2016 in nine institutions in France (FRANCOGYN research group) with maintained EOC databases. We included women with EOC (all FIGO stages) who underwent primary complete macroscopic CRS prior to platinum-based adjuvant chemotherapy. Two hundred thirty-three patients were included: 73 (31.3%) in the early-stage group (ESG) (FIGO I-II), and 160 (68.7%) in the advanced-stage group (ASG) (FIGO III-IV). Median TTC was 43 days (36–56). The median OS was 77.2 months (65.9–106.6). OS was lower in the ASG when TTC exceeded 8 weeks (70.5 vs. 59.3 months, p = 0.04). No impact on OS was found when TTC was below or above 6 weeks (78.5 and 66.8 months, respectively, p = 0.25). In the whole population, TTC had no impact on RFS or OS. None of the factors studied were associated with an increase in TTC. Chemotherapy should be initiated as soon as possible after CRS. A TTC greater than 8 weeks is associated with poorer OS in patients with advanced stage EOC.

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