Predicting Surgical Outcome in Patients With International Federation of Gynecology and Obstetrics Stage III or IV Ovarian Cancer Using Computed Tomography

2015 ◽  
Vol 25 (3) ◽  
pp. 407-415 ◽  
Author(s):  
Marianne Jetske Rutten ◽  
Roelien van de Vrie ◽  
Annemarie Bruining ◽  
Anje M. Spijkerboer ◽  
Ben Willem Mol ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ovarian Cancer ◽  
Surgical Outcome ◽  
International Federation ◽  
Stage Iii ◽  
Gynecology And Obstetrics

Stage III disease of ovarian, tubal and peritoneal cancers can be accurately diagnosed with pre-operative CT. Japan Clinical Oncology Group Study JCOG0602

2020 ◽  
Author(s):  
Takashi Onda ◽  
Yumiko Oishi Tanaka ◽  
Satomi Kitai ◽  
Tomoko Manabe ◽  
Mitsuya Ishikawa ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
International Federation ◽  
Stage Iii ◽  
Debulking Surgery ◽  
Peritoneal Disease ◽  
Predictive Values ◽  
Primary Debulking Surgery ◽  
Gynecology And Obstetrics

Abstract Purpose Computed tomography of the abdomen and pelvis is a useful imaging modality for identifying origin and extent of ovarian cancer before primary debulking surgery. However, the International Federation of Gynecology and Obstetrics staging for ovarian cancer is determined based on surgico-pathological findings. The purpose of this study is to determine whether computed tomography staging can be the surrogate for surgico-pathological International Federation of Gynecology and Obstetrics staging in advanced ovarian cancer undergoing neoadjuvant chemotherapy. Methods Computed tomography staging was compared with surgico-pathological International Federation of Gynecology and Obstetrics staging in primary debulking surgery arm patients in a randomized controlled trial comparing primary debulking surgery and neoadjuvant chemotherapy (JCOG0602). The cancer of primary debulking surgery arm was identically diagnosed regarding the origin and extent with the cancer of neoadjuvant chemotherapy arm before accrual, using imaging studies (computed tomography and/or magnetic resonance imaging), cytological examination (ascites, pleural effusion or tumor contents fluid) and tumor marker (CA125 > 200 U/mL and CEA < 20 ng/mL). Institutional computed tomography staging was also compared with computed tomography staging by central review. Results Among 149 primary debulking surgery arm patients, 147 patients who underwent primary debulking surgery immediately were analyzed. Positive predictive values and sensitivity of computed tomography staging for surgical stage III disease (extra-pelvic peritoneal disease and/or retroperitoneal lymph node metastasis) were 99%. Meanwhile, positive predictive values for the presence of small (≤2 cm) extra-pelvic peritoneal disease were low; <20% in omentum. Accuracy of institutional computed tomography staging was comparable with computed tomography staging by central review. Conclusions Preoperative computed tomography staging in each institution can be the surrogate for surgico-pathological diagnosis in stage III disease of ovarian cancer patients undergoing neoadjuvant chemotherapy without diagnostic surgery, but reliability of diagnosis of stage IIIB disease is inadequate. Clinical trial registration: UMIN000000523(UMIN-CTR).

Screening for Familial Ovarian Cancer: Failure of Current Protocols to Detect Ovarian Cancer at an Early Stage According to the International Federation of Gynecology and Obstetrics System

2005 ◽  
Vol 23 (24) ◽  
pp. 5588-5596 ◽  
Author(s):  
Diane Stirling ◽  
D. Gareth R. Evans ◽  
Gabriella Pichert ◽  
Andrew Shenton ◽  
Elaine N. Kirk ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Early Stage ◽  
Transvaginal Ultrasound ◽  
Stage Iv ◽  
International Federation ◽  
Lifetime Risk ◽  
Stage Iii ◽  
Ca 125 ◽  
Gynecology And Obstetrics ◽  
Increased Risk

PurposeTo assess the effectiveness of annual ovarian cancer screening (transvaginal ultrasound and serum CA-125 estimation) in detecting presymptomatic ovarian cancer in women at increased genetic risk.Patients and MethodsA cohort of 1,110 women at increased risk of ovarian cancer were screened between January 1991 and March 2004; 553 were moderate-risk individuals (4% to 10% lifetime risk) and 557 were high-risk individuals (> 10% lifetime risk). Outcome measurements include the number and stage of screen-detected cancers, the number and stage of cancers not detected at screening, the number of equivocal screening results requiring recall/repetition, and the number of women undergoing surgery for benign disease.ResultsThirteen epithelial ovarian malignancies (12 invasive and one borderline), developed in the cohort. Ten tumors were detected at screening: three International Federation of Gynecology and Obstetrics (FIGO) stage I (including borderline), two stage II, four stage III, and one stage IV. Of the three cancers not detected by screening, two were stage III and one was stage IV; 29 women underwent diagnostic surgery but were found not to have ovarian cancer.ConclusionAnnual surveillance by transvaginal ultrasound scanning and serum CA-125 measurement in women at increased familial risk of ovarian cancer is ineffective in detecting tumors at a sufficiently early stage to influence prognosis. With a positive predictive value of 17% and a sensitivity of less than 50%, the performance of ultrasound does not satisfy the WHO screening standards. In addition, the combined protocol has a particularly high false-positive rate in premenopausal women, leading to unnecessary surgical intervention.

Survival Rates for International Federation of Gynecology and Obstetrics Stage III Ovarian Carcinoma by Cell Type: A Study of 262 Unselected Patients With Uniform Pathologic Review

2012 ◽  
Vol 22 (3) ◽  
pp. 367-371 ◽  
Author(s):  
Jeffrey D. Seidman ◽  
Anna Yemelyanova ◽  
Jonathan A. Cosin ◽  
Anthony Smith ◽  
Robert J. Kurman
Keyword(s):  
Ovarian Cancer ◽  
International Federation ◽  
Stage Iii ◽  
Serous Carcinoma ◽  
Published Data ◽  
Low Grade ◽  
High Grade ◽  
Cell Type ◽  
Ovarian Carcinomas ◽  
Gynecology And Obstetrics

ObjectivePublished data are conflicting on the influence of cell type on prognosis in ovarian cancer. The recent separation of low-grade serous carcinoma as a distinctive cell type of ovarian cancer with an indolent behavior, in retrospect, suggests that survival in studies that have not separated this group may be inaccurate.MethodsAn unselected series of 262 International Federation of Gynecology and Obstetrics stage III ovarian carcinomas was studied. Diagnostic classification of each tumor was made with particular attention to recent refinements in cell-type classification. Survival curves were constructed according to Kaplan-Meier and compared with the log-rank test.ResultsThe 5-year survival for 207 high-grade serous carcinomas was 40%, as compared with 71% for 18 patients with low-grade serous carcinoma (P = 0.0113). Low-grade serous carcinoma was significantly more likely to be optimally debulked (P = 0.0039) and significantly less likely to be substage IIIC (P < 0.0001). The survival for carcinosarcoma was significantly inferior to all serous carcinomas (P = 0.0322). The significance of this latter comparison was lost when carcinosarcomas were compared with only high-grade serous carcinoma (P > 0.05).ConclusionsLow-grade serous carcinoma has a significantly better prognosis than high-grade serous carcinoma and also differs with regard to substage distribution and proportion of patients optimally debulked. Because of its excellent prognosis, failure to separate low-grade serous carcinomas, notwithstanding its infrequent occurrence, can change the results of survival analyses that do not make this separation.

Sarcopenia in Advanced Serous Ovarian Cancer

2017 ◽  
Vol 27 (2) ◽  
pp. 223-232 ◽  
Author(s):  
Holger Bronger ◽  
Philipp Hederich ◽  
Alexander Hapfelmeier ◽  
Stephan Metz ◽  
Peter B. Noël ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ovarian Cancer ◽  
Skeletal Muscle ◽  
Weight Loss ◽  
Muscle Mass ◽  
Multivariable Analysis ◽  
Hazard Ratio ◽  
Prognostic Impact ◽  
Serous Ovarian Cancer ◽  
Gynecology And Obstetrics

ObjectiveCancer cachexia is a paraneoplastic syndrome comprising involuntary weight loss and muscle depletion (sarcopenia). Although weight loss has been associated with poor clinical outcome, there is only limited information on the prevalence and prognostic impact of sarcopenia in ovarian cancer so far.MethodsTotal skeletal muscle mass was determined by computed tomography image analysis of the third lumbar skeletal muscle cross-sectional area in 128 patients with advanced serous ovarian cancer. Longitudinal change of muscle mass was studied in 209 consecutive computed tomography scans from 43 patients. Association with survival was determined using Cox proportional hazards model.ResultsThe prevalence of sarcopenia at first diagnosis was 11% (12/105; 95% confidence interval [CI], 6%–20%). Sarcopenic patients had a significantly reduced progression-free (hazard ratio, 2.64; 95% CI, 1.24–5.64;P= 0.012) and overall survival (hazard ratio, 3.17; 95% CI, 1.29–7.80;P= 0.012). On multivariable analysis, these prognostic effects remained significant after adjustment for age, International Federation of Gynecology and Obstetrics stage, and postsurgical residual disease. Longitudinal analyses identified both patients with loss and gain of muscle mass. However, change in muscle mass over time was not associated with survival.ConclusionsBaseline sarcopenia is a prognostic factor in advanced serous ovarian cancer. Identification of sarcopenic patients and early enrollment in physical or nutritional education programs might thus be a feasible way to improve outcome and should be further evaluated in prospective clinical trials.

Patterns of Chemotherapy Use for Women With Ovarian Cancer: A Population-Based Study

2003 ◽  
Vol 21 (8) ◽  
pp. 1530-1535 ◽  
Author(s):  
Rosemary D. Cress ◽  
Cynthia D. O’Malley ◽  
Gary S. Leiserowitz ◽  
Sharon L. Campleman
Keyword(s):  
Ovarian Cancer ◽  
Early Stage ◽  
Scientific Evidence ◽  
Population Based ◽  
Stage Iii ◽  
Clinical Indication ◽  
Younger Women ◽  
Treatment Information ◽  
Gynecology And Obstetrics ◽  
California Cancer Registry

Purpose: To evaluate adherence to published recommendations for chemotherapy for ovarian cancer patients in the general community and to identify factors associated with its use. Patients and Methods: The study population consisted of 2,150 women residing in Northern California with a first diagnosis of primary epithelial ovarian cancer between January 1994 and December 1996. Patients were identified through the California Cancer Registry and their physicians were surveyed to supplement registry treatment information. Results: Almost 89% of women younger than 75 years with International Federation of Gynecology and Obstetrics stage III or IV tumors received chemotherapy, with levels of treatment highest for women diagnosed at stage III. Patients 75 years of age and older were significantly less likely than younger women to receive chemotherapy (58.2% v 86.1%; P = .001) regardless of stage at diagnosis. Approximately 20% of patients younger than 55 years with early-stage (stage IC and II) cancer received no chemotherapy. Treatment in an American College of Surgeons hospital and treatment by a gynecologic oncologist increased the likelihood of receiving chemotherapy. Hospitalization for comorbid illness, race/ethnicity, census-based measures of socioeconomic status, and size or teaching status of hospital were all unrelated to probability of treatment after adjustment for other factors. Reasons reported most frequently by physicians for no treatment were lack of clinical indication and patient refusal. Conclusion: The results of this study suggest that, despite scientific evidence and published guidelines that advocate chemotherapy for most women with ovarian cancer, some groups of women did not receive optimum treatment.

scholarly journals New Hypothesis on Pathogenesis of Ovarian Cancer Lead to Future Tailored Approaches

2013 ◽  
Vol 2013 ◽  
pp. 1-13 ◽  
Author(s):  
P. Rescigno ◽  
I. Cerillo ◽  
R. Ruocco ◽  
C. Condello ◽  
S. De Placido ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Standard Treatment ◽  
Staging System ◽  
International Federation ◽  
Precursor Lesions ◽  
Histological Subtype ◽  
Tailored Therapy ◽  
Gynecology And Obstetrics ◽  
Response To Chemotherapy ◽  
New Hypothesis

In the last decades, management of epithelial ovarian cancer (EOC) has been based on the staging system of the International Federation of Gynecology and Obstetrics (FIGO), and different classifications have been proposed for EOC that take account of grade of differentiation, histological subtype, and clinical features. However, despite taxonomic efforts, EOC appears to be not a unique disease; its subtypes differ for epidemiological and genetic risk factors, precursor lesions, patterns of spread, response to chemotherapy, and prognosis. Nevertheless, carboplatin plus paclitaxel combination represents the only standard treatment in adjuvant and advanced settings. This paper summarizes theories about the classification and origin of EOC and classical and new prognostic factors. It presents data about standard treatment and novel agents. We speculate about the possibility to create tailored therapy based on specific mutations in ovarian cancer and to personalize prevention.

When and Who Should Perform Epithelial Ovarian Cancer Surgery?

2018 ◽  
Vol 28 (3) ◽  
pp. 594-599 ◽  
Author(s):  
Cecilia Escayola ◽  
Juan Jose Torrent ◽  
Gwenaël Ferron ◽  
François Quenet ◽  
Denis Querleu
Keyword(s):  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Postgraduate Training ◽  
Training Programs ◽  
Residual Tumor ◽  
International Federation ◽  
Gynecologic Malignancies ◽  
Debulking Surgery ◽  
Current Review ◽  
Gynecology And Obstetrics

AbstractEpithelial ovarian cancer is the most common cause of death due to gynecologic malignancies. Most patients will be diagnosed at an advanced stage, and despite progress in both surgical procedures and novel targeted therapies, the overall survival of these patients remains very low. Among prognostic factors, the International Federation of Gynecology and Obstetrics stage and residual tumor after debulking surgery are the most widely reported. The current review aims to highlight the disparities in the treatment of patients with ovarian cancer and the need for postgraduate training programs in order to accredit gynecologic oncologists. Despite an increase over the centralization of these patients, many are still not receiving specialized surgery.

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