Platinum plus cyclophosphamide plus radiotherapy is superior to platinum alone in 'high-risk' epithelial ovarian cancer (residual negative and either stage I or II, grade 3, or stage III, any grade)

PURPOSE To evaluate the prognostic significance of p53 expression in epithelial ovarian cancer, including a subset of stage I patients, and to look for correlations between p53 expression and other disease parameters, including stage, grade, age, histologic subtype, second-look results, ploidy, and percent S phase. PATIENTS AND METHODS We analyzed p53 expression in 284 patients with epithelial ovarian cancer using immunohistochemical techniques in paraffin-embedded specimens. There were 36 patients with stage I disease, 20 with stage II disease, 186 with stage III disease, and 42 with stage IV disease. RESULTS p53 immunoreactivity was present in 177 cases (62%). p53 expression was associated with grade 3 to 4 disease (P = .003). The following factors were associated with a decrease in overall survival in a univarate analysis: stage III or IV disease (P = .0001), grade 3 or 4 disease (P = .0001), age above the median (P = .0002), and p53 reactivity (P = .04). In a multivariate analysis, stage, grade, and age retained independent prognostic significance. In the subset of 36 stage I patients, p53 positively approached statistical significance (P = .10) as a negative prognostic factor in a univariate analysis. CONCLUSION Abnormalities of p53 expression occur commonly in epithelial ovarian cancer. Although associated with decreased survival in a univariate analysis, this biologic marker did not retain independent prognostic significance in a multivariate analysis. p53 expression should be studied in a larger cohort of early-stage patients, where accurate prognostic information is needed to direct therapy.

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Outcomes of Fertility-Sparing Surgery for Stage I Epithelial Ovarian Cancer: A Proposal for Patient Selection

Journal of Clinical Oncology ◽

10.1200/jco.2009.24.8617 ◽

2010 ◽

Vol 28 (10) ◽

pp. 1727-1732 ◽

Cited By ~ 119

Author(s):

Toyomi Satoh ◽

Masayuki Hatae ◽

Yoh Watanabe ◽

Nobuo Yaegashi ◽

Osamu Ishiko ◽

...

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Clear Cell ◽

Stage I ◽

Healthy Children ◽

Favorable Histology ◽

Fertility Sparing Surgery ◽

Fertility Sparing ◽

Stage Ia ◽

Grade 3

Purpose The objective of this study was to assess clinical outcomes and fertility in patients treated conservatively for unilateral stage I invasive epithelial ovarian cancer (EOC). Patients and Methods A multi-institutional retrospective investigation was undertaken to identify patients with unilateral stage I EOC treated with fertility-sparing surgery. Favorable histology was defined as grade 1 or grade 2 adenocarcinoma, excluding clear cell histology. Results A total of 211 patients (stage IA, n = 126; stage IC, n = 85) were identified from 30 institutions. Median duration of follow-up was 78 months. Five-year overall survival and recurrence-free survival were 100% and 97.8% for stage IA and favorable histology (n = 108), 100% and 100% for stage IA and clear cell histology (n = 15), 100% and 33.3% for stage IA and grade 3 (n = 3), 96.9% and 92.1% for stage IC and favorable histology (n = 67), 93.3% and 66.0% for stage IC and clear cell histology (n = 15), and 66.7% and 66.7% for stage IC and grade 3 (n = 3). Forty-five (53.6%) of 84 patients who were nulliparous at fertility-sparing surgery and married at the time of investigation gave birth to 56 healthy children. Conclusion Our data confirm that fertility-sparing surgery is a safe treatment for stage IA patients with favorable histology and suggest that stage IA patients with clear cell histology and stage IC patients with favorable histology can be candidates for fertility-sparing surgery followed by adjuvant chemotherapy.

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Serum Vascular Endothelial Growth Factor-A as a Prognostic Biomarker for Epithelial Ovarian Cancer

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001027 ◽

2017 ◽

Vol 27 (7) ◽

pp. 1325-1332 ◽

Cited By ~ 9

Author(s):

Hiroaki Komatsu ◽

Tetsuro Oishi ◽

Hiroaki Itamochi ◽

Muneaki Shimada ◽

Shinya Sato ◽

...

Keyword(s):

Ovarian Cancer ◽

Vascular Endothelial Growth Factor ◽

Growth Factor ◽

Protein Expression ◽

Epithelial Ovarian Cancer ◽

Prognostic Biomarker ◽

Stage I ◽

Stage Iii ◽

Vascular Endothelial ◽

Endothelial Growth Factor

BackgroundBevacizumab, which targets vascular endothelial growth factor (VEGF)-A, has recently been proven to be effective for the treatment of epithelial ovarian cancer (EOC). Thus, interest in VEGF-A has increased. There are few reports on concomitant detection of both ligands and its soluble receptors in serum samples, and the significance of serum VEGF-A in EOC is unclear, unlike the situation with tissue samples. We conducted the present study to explore the levels of serum VEGF family and its receptors and to evaluate their utility as prognostic biomarkers.MethodsA total of 128 patients with EOC, who were consecutively treated at Tottori University Hospital between 2006 and 2012, were included. Blood samples were collected before initial surgery. Serum concentrations of VEGF-A, VEGF-C, VEGFR-1, and VEGFR-2 were analyzed by enzyme-linked immunosorbent assay. We also examined the mRNA and protein expression of VEGF-A in tumor tissue from 30 cases by real-time reverse transcription polymerase chain reaction and immunohistochemistry.ResultsThe levels of VEGF-A in patients with stage III/IV disease were significantly higher than those with stage I/II disease (P = 0.0036). On the other hand, the level of VEGFR-2 in stage III/IV was significantly lower than that in stage I/II (P = 0.0026). With the cutoff value of VEGF/VEGFRs at the median level, the overall survival (OS) for patients with high VEGF-A levels was significantly lower than those with low levels (P = 0.015). Patients with high VEGFR-2 levels showed better prognosis than those with low VEGFR-2 levels (P = 0.023). Multivariate analysis revealed that International Federation of Gynecology and Obstetrics stage and serum VEGF-A were independent prognostic factors for OS [hazard ratio 2.01, 95% confidence interval (1.13–3.63), P = 0.017]. There was no significant correlation between mRNA or protein expression and serum levels of VEGF-A.ConclusionsSerum VEGF-A is an independent prognostic factor for OS in patients with EOC, implying that serum VEGF-A is a prognostic biomarker for EOC. Further study to validate the data is needed.

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Is There a High-Risk Subgroup of Stage I Epithelial Ovarian Cancer That Is Most Likely to Benefit From 6 Versus 3 Cycles of Adjuvant Chemotherapy?

International Journal of Gynecological Cancer ◽

10.1111/igc.0b013e3181efd843 ◽

2010 ◽

Vol 20 (7) ◽

pp. 1125-1131 ◽

Cited By ~ 5

Author(s):

Jamie N. Bakkum-Gamez ◽

Debra L. Richardson ◽

Leigh G. Seamon ◽

Giovanni D. Aletti ◽

Cecelia A. Powless ◽

...

Keyword(s):

Ovarian Cancer ◽

High Risk ◽

Adjuvant Chemotherapy ◽

Epithelial Ovarian Cancer ◽

Stage I

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P85 Cox regression versus discriminant techniques: Can we predict a high risk group in stage I epithelial ovarian cancer?

Controlled Clinical Trials ◽

10.1016/0197-2456(93)90217-2 ◽

1993 ◽

Vol 14 (5) ◽

pp. 463

Author(s):

Janet A. Dunn ◽

Catherine B. Finn

Keyword(s):

Ovarian Cancer ◽

High Risk ◽

Epithelial Ovarian Cancer ◽

Cox Regression ◽

Risk Group ◽

High Risk Group ◽

Stage I

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Five-year survival for stage IC or stage I grade 3 epithelial ovarian cancer treated with cisplatin-based chemotherapy

Gynecologic Oncology ◽

10.1016/0090-8258(92)90232-8 ◽

1992 ◽

Vol 46 (3) ◽

pp. 357-360 ◽

Cited By ~ 30

Author(s):

M.Steven Piver ◽

John Malfetano ◽

Trudy R. Baker ◽

Ronald E. Hempling

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Stage I ◽

Grade 3

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Can we predict a high risk group in stage I epithelial ovarian cancer?

International Journal of Gynecological Cancer ◽

10.1046/j.1525-1438.1993.03040226.x ◽

1993 ◽

Vol 3 (4) ◽

pp. 226-230 ◽

Cited By ~ 8

Author(s):

C. B. Finn ◽

J. Dunn ◽

E. J. Buxton ◽

D. M. Luesley ◽

M. Shafi

Keyword(s):

Ovarian Cancer ◽

High Risk ◽

Epithelial Ovarian Cancer ◽

Risk Group ◽

High Risk Group ◽

Stage I ◽

Independent Effect ◽

Independent Variables ◽

Peritoneal Washings ◽

Invasive Epithelial Ovarian Cancer

A retrospective review of 373 patients with stage I invasive epithelial ovarian cancer was undertaken over a 5 year period to develop a model to characterize the patient at high risk. Actuarial 5-year survival was 70%. To identify factors with an independent effect on 5-year survival, a logistic regression analysis was performed. Adjuvant chemotherapy, histologic grade and peritoneal washings, were identified as independent variables. A model to determine the predictivity of survival was created using a learning sample (2/3 of the cases) and the model was then used to reclassify a validation sample (1/3 of the cases). Using all the independent variables, outcome was predicted correctly in 78% of cases. However the model failed to improve identification of those at risk of recurrence (specificity of 53%).

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Surgery and prognosis in stage III epithelial ovarian cancer

International Journal of Gynecological Cancer ◽

10.1046/j.1525-1438.1995.05060416.x ◽

1995 ◽

Vol 5 (6) ◽

pp. 416-420 ◽

Cited By ~ 1

Author(s):

G. Ing ◽

N. Semrad ◽

S. Jordan ◽

F. Latino ◽

W. G. Watring

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Tumor Grade ◽

Stage Iii ◽

Retrospective Case ◽

Second Look ◽

Significant Difference ◽

Grade 3 ◽

Retrospective Case Study

The results of this retrospective case study indicate that a composite of tumor grade, pattern of spread and substage at the time of opening affects the outcome most in the treatment of stage III epithelial tumors of the ovary. The poorest prognosis was associated with grade 3 histology, a pattern of spread requiring extensive and often difficult surgery for removal and a high substage. The best prognosis was usually associated with grade 1, with either very easily removed, isolated spread or low substage.The extent of tumor defined the degree of primary cytoreduction possible. If the tumor was minimally extensive, primary cytoreduction results were excellent. The same conclusions were reached in the case of secondary cytoreduction at the time of second-look procedure. There was no statistically significant difference (z= 1.481,P= 0.069) in 5-year survival between patients with microscopic only disease (59%) at second-look, and patients with gross disease not cytoreduced (36%).

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