Examining Survival Outcomes of 852 Women With Advanced Ovarian Cancer: A Multi-institutional Cohort Study

2018 ◽  
Vol 28 (5) ◽  
pp. 925-931 ◽  
Author(s):  
Taymaa May ◽  
Alon Altman ◽  
Jacob McGee ◽  
Lin Lu ◽  
Wei Xu ◽  
...  
Keyword(s):  
Cytoreductive Surgery ◽  
Residual Disease ◽  
Cohort Analysis ◽  
Advanced Ovarian Cancer ◽  
Survival Advantage ◽  
Survival Outcomes ◽  
Gynecologic Oncologist ◽  
Kaplan Meier ◽  
Wilcoxon Rank Sum Test ◽  
Retrospective Cohort Analysis

IntroductionThis study examines patterns of clinical practice in the management of women with advanced high-grade serous ovarian carcinoma (HGSC).MethodsA total of 852 patients with advanced HGSC were included in this retrospective cohort analysis. Patients underwent primary cytoreductive surgery (PCS) or neoadjuvant chemotherapy (NACT). Wilcoxon rank-sum test and χ2 test were applied. Univariate- and multivariate-analyses were performed, and survival outcomes were measured using Kaplan–Meier curves.ResultsA total of 449 (53%) of 852 patients underwent PCS, and 403(47%) of 852 patients underwent NACT. The median 5-year overall survival (OS) was 3.89 in PCS and 2.48 in NACT. Patients with 0 mm residual had OS of 4.66, compared with 1- to 9-mm residual (OS = 2.80) and 10-mm residual or longer (OS = 2.50). The survival advantage harbored by the extent of surgical cytoreduction was more pronounced in PCS compared with NACT (P < 0.001). Patients who had PCS with 1- to 9-mm residual had similar OS to NACT patients with 0-mm residual (P = 0.17) and superior OS to NACT with 1- to 9-mm residual (P < 0.001).ConclusionsIn this multicenter study, 53% of women with advanced HGSC seen by a gynecologic oncologist were selected for PCS. Survival was longer in patients who underwent PCS than patients who underwent NACT. Within each group, survival was highest in those who had complete cytoreduction to 0-mm residual disease. We believe all patients with advanced HGSC should be assessed by a gynecologic oncologist for the feasibility of surgical resection. Primary cytoreductive surgery should be the favorable treatment modality with the goal of complete resection to 0 mm residual disease. Importantly, if 0 mm residual is not feasible, PCS to a residual of 1 to 9 mm should be attempted given the survival advantage in this group over patients who were treated with NACT.

The rate and role of diaphragmatic peritonectomy in optimal cytoreduction in patients with advanced stage ovarian cancer: a prospective study of 100 patients

2014 ◽  
Vol 21 (1) ◽  
pp. 1-7
Author(s):  
Tomas Lūža ◽  
Agnė Ožalinskaitė ◽  
Vilius Rudaitis
Keyword(s):  
Ovarian Cancer ◽  
Confidence Interval ◽  
Cytoreductive Surgery ◽  
Residual Disease ◽  
Advanced Ovarian Cancer ◽  
Optimal Cytoreduction ◽  
Entire Cohort ◽  
Kaplan Meier ◽  
Upper Abdominal ◽  
A Prospective Study

Background. Diaphragmatic peritoneal metastasis by advanced epi­thelial ovarian cancer is a very common holdback precluding optimal cytoreduction. The aim of this study was to determine the rate of dia­phragmatic peritonectomy during optimal cytoreductive surgery and its role in postoperative morbidity and survival in patients with advanced ovarian cancer. Materials and methods. 100 consecutive patients with advanced epithelial ovarian cancer underwent cytoreductive surgery and were followed up prospectively (January 2009 – March 2014). Characteristics of surgery, rate of diaphragmatic peritonectomy and post operative complications were assessed. The Kaplan-Meier method was used for survival analysis. Results. The median age of the entire cohort at the time of primary cytoreduction was 58.5 years (23–83). Optimal cytoreduction was achieved in 73 cases out of 100 patients. From 73 patients in 30 cases (41.1%) upper abdominal procedures, specifically diaphragmatic peritonectomy, was performed to achieve the main goal of cytoreduction  –  no visible or palbable disease at the end of cytoreduction. Non-optimal cytoreduction was achieved in 27 cases. According to the Clavien-Dindo complication grading system grade I and grade II complications occurred more often in patients that underwent diaphragmatic surgery. The median overall survival from the time of diagnosis to the last follow-up or death was 28 months (range 0–63 months). The factors associated with the longest survival after primary cytoreductive surgery were the disease free interval from the primary cytoreduction of more than 19 months (n = 51) versus less than 19 months (n = 49) (95% confidence interval, 51.7–59.5; P = 0.013) and no visible or palpable residual disease at the end of cytoreduction (n = 73) versus visible or palpable residual di­sease (n = 27) (95% confidence interval, 52.7–61.2; P = 0.03). Conclusions. Based on our prospective analysis of advanced ovarian cancer patients, diaphragmatic peritonectomy is feasible and safe, ensures better rates of optimal cytoreduction and should not be an obstacle towards better survival.

Tumor infiltrating lymphocytes (TIL) assessment in muscle invasive bladder cancer (MIBC) patients treated with cisplatin-based neoadjuvant chemotherapy (NAC) and surgery.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 547-547
Author(s):  
Nieves Martinez Chanza ◽  
Anis Hamid ◽  
Roberto Salgado ◽  
Thomas Gevaert ◽  
Marion Maetens ◽  
...  
Keyword(s):  
Residual Disease ◽  
Cohort Analysis ◽  
Predictive Biomarkers ◽  
Tumor Infiltrating Lymphocytes ◽  
Complete Response ◽  
Kaplan Meier ◽  
Retrospective Cohort Analysis ◽  
Muscle Invasive ◽  
Infiltrating Lymphocytes ◽  
Free Rate

547 Background: Cisplatin-based NAC followed by surgery is the gold standard treatment of non-metastatic MIBC. However, predictive biomarkers have not been established yet. Here, we addressed the relevance of TILs for NAC response and prognosis in MIBC patients (pts). Methods: We conducted a single center, retrospective cohort analysis of consecutive MIBC pts treated with cisplatin-based NAC followed by surgery. Pts with pathological complete response (pCR; ypT0/isN0) were grouped as responders, pts with pathological residual disease as non responders. TIL stromal count were assessed pre- and post-NAC. Next Generation Sequencing of selected genes was performed on pre-NAC samples. We catalogued the 3-years(y) relapse free rate and 3-y overall survival rate (OS, Kaplan Meier) for the overall cohort and by subgroups. Results: Of the 25 pts who received cisplatin-gemcitabine NAC, a total of 14 (56%) pts achieved a pCR and 11 (44%) had residual disease. NAC was discontinued in 17 (65%) after completing treatment; and in 8 (32%) pts after 2 cycles due to toxicity. Median follow-up was 54.2 months(mos). At baseline, median TIL count was 60% in the overall cohort. Numerically higher TIL count was observed among responders (80%) compared to non-responders (50%) ( p=0.22). Median TIL count post-NAC in residual samples was 40%, not significantly different to matched pre-NAC samples ( p=0.93). Overall, 3-y relapse free rate was 74.7% (95%CI 51.7-87.9); 3-y OS rate was 79.6% (95%CI 57.6-91) with 6 deaths of which 4 were related to metastatic disease. Table reports subset analyses. Most frequently altered genes were PIK3CA and TP53 in the overall cohort (each 20%) and in the responders subgroup (each 29%). Conclusions: In our study, pts who achieved pCR had numerically greater TIL infiltrate in baseline samples and pCR was associated with reduced risk of recurrence. TILs did not increase in residual tumors after NAC. The independent predictive value of TILs warrants assessment in large cohorts.[Table: see text]

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

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.

scholarly journals An update on preoperative assessment of the resectability of advanced ovarian cancer

2019 ◽  
Vol 41 (3) ◽  
Author(s):  
Philippe Kadhel ◽  
Aurélie Revaux ◽  
Marie Carbonnel ◽  
Iptissem Naoura ◽  
Jennifer Asmar ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cytoreductive Surgery ◽  
Residual Disease ◽  
Advanced Ovarian Cancer ◽  
Preoperative Assessment ◽  
Complete Cytoreduction ◽  
Sufficient Information ◽  
Positron Emission ◽  
Composite Models ◽  
Improving Accuracy

AbstractThe best prognosis for advanced ovarian cancer is provided by no residual disease after primary cytoreductive surgery. It is thus important to be able to predict resectability that will result in complete cytoreduction, while avoiding unnecessary surgery that may leave residual disease. No single procedure appears to be sufficiently accurate and reliable to predict resectability. The process should include a preoperative workup based on clinical examination, biomarkers, especially tumor markers, and imaging, for which computed tomography, as well as sonography, magnetic resonance imaging and positron-emission tomography, can be used. This workup should provide sufficient information to determine whether complete cytoreduction is possible or if not, to propose neoadjuvant chemotherapy which is preferable in this case. For the remaining patients, laparoscopy is broadly recommended as an ultimate triage step. However, its modalities are still debated, and several scores have been proposed for standardization and improving accuracy. The risk of false negatives requires a final assessment of resectability as the first stage of cytoreductive surgery by laparotomy. Composite models, consisting of several criteria of workup and, sometimes, laparoscopy have been proposed to improve the accuracy of the predictive process. Regardless of the modality, the process appears to be accurate and reliable for predicting residual disease but less so for predicting complete cytoreduction and thus avoiding unnecessary surgery and an inappropriate treatment strategy. Overall, the proposed procedures are heterogeneous, sometimes unvalidated, or do not consider advances in surgery. Future techniques and/or models are still needed to improve the prediction of complete resectability.

Efficacy of liposomal-irinotecan (nal-IRI) plus 5-fluorouracil/folinic acid (5-FU/LV) versus oxaliplatin plus fluoropyrimidines in previous gemcitabine treated pancreatic adenocarcinoma (PAC) patients (pts).

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 383-383
Author(s):  
Markus Kieler ◽  
Matthias Unseld ◽  
Daniela Bianconi ◽  
Werner Scheithauer ◽  
Gerald W. Prager
Keyword(s):  
Randomized Trials ◽  
Treatment Options ◽  
Cohort Analysis ◽  
Progression Free Survival ◽  
Line Treatment ◽  
Free Survival ◽  
Median Progression Free Survival ◽  
Kaplan Meier ◽  
Retrospective Cohort Analysis ◽  
Liposomal Irinotecan

383 Background: The chemotherapy regimens nal-IRI plus 5-FU/LV as well as oxaliplatin plus fluoropyrimidines are used after previous gemcitabine based chemotherapy in the 2nd line treatment of metastatic PAC. We aimed to compare the clinical efficacy of these two treatment options. Methods: In this single institutional retrospective cohort analysis all pts with advanced PAC that were treated between 01/2012-08/2018 with nal-IRI plus 5-FU/LV or oxaliplatin plus fluoropyrimidines after previous 1st line gemcitabine based chemotherapy were analysed for clinical parameters, median progression free survival (mPFS) and overall survival (mOS). Survival analyses were performed by Kaplan-Meier method. Results: Characteristics of pts were well matched (Table). mPFS in pts (n=30) that received nal-IRI plus 5-FU/LV in the 2nd line treatment after gemcitabine based chemotherapy was 4.49 months while treatment with oxaliplatin plus fluoropyrimidines (n=31) resulted in a mPFS of 3.44 months (p=0.007, HR 0.47, 95% CI 0.27-0.81). Furthermore, pts with a CA 19-9 level >1000 kU/l at the beginning of 2nd line treatment had a significantly improved mPFS and mOS, when treated with nal-IRI plus 5-FU/LV compared to oxaliplatin plus fluoropyrimidines (mPFS 4.94 months versus 3.44 months, p=0.0186, HR 0.42, 95% CI 0.18-0.98; mOS 9.31 months versus 6.16 months, p=0.0386, HR 0.43, 95% CI 0.18-1.02). Conclusions: The efficacy of nal-IRI plus 5-FU/LV in our study is encouraging and outperforms oxaliplatin-based chemotherapy in the 2nd line treatment setting for PAC pts pretreated with gemcitabine. Prospective randomized trials are urged to validate our observation. [Table: see text]

Sarcopenia as a predictor of survival in patients with epithelial ovarian cancer (EOC) receiving platinum and taxane-based chemotherapy.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17030-e17030 ◽  
Author(s):  
Stuart-Allison Moffat Staley ◽  
Katherine Tucker ◽  
Meredith Newton ◽  
Michelle Ertel ◽  
Yingao Zhang ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Skeletal Muscle ◽  
Lumbar Vertebrae ◽  
Advanced Ovarian Cancer ◽  
Metastatic Breast ◽  
Survival Outcomes ◽  
Muscle Area ◽  
Skeletal Muscle Index ◽  
Kaplan Meier ◽  
Skeletal Muscle Area

e17030 Background: Severe skeletal muscle loss (sarcopenia) is associated with poor cancer outcomes, including reduced survival and increased treatment toxicity. This relationship has recently been demonstrated in women with metastatic breast cancer, but there is a paucity of data regarding this correlation in women with EOC. Thus, our goal was to evaluate if sarcopenia, as assessed by computed tomography (CT) morphometric measurements, was associated with worse survival outcomes in EOC patients undergoing primary platinum and taxane-based chemotherapy. Methods: EOC patients diagnosed between 06/2000 and 02/2017 who received treatment with platinum and taxane-based chemotherapy were included. CT abdominal images closest to the time of diagnosis were retrospectively evaluated for skeletal muscle area at the 3rd lumbar vertebrae. Measurements were obtained with use of TomoVision® radiological software (SliceOmatic – version 5.0, Quebec, Canada). Sarcopenia was defined as Skeletal Muscle Index (SMI = SMA/height2) ≤ 41. Data analysis included Kaplan-Meier plots to assess survival, and descriptive statistics was utilized to describe characteristics between the two groups. Results: 201 EOC patients were evaluated. Sixty-four percent (128/201) met criteria for sarcopenia (SMI ≤ 41) at time of diagnosis. Seventy-six percent of patients were diagnosed with Stage III or IV disease, with high-grade serous as the most common histology (74%). Median age at diagnosis was 61 years. Approximately one third were obese. Body mass index was greater in the SMI > 41 group compared to the SMI ≤ 41 group (31.3 vs 26.3, p < 0.001). There was no difference in the prevalence of chronic conditions, including diabetes, coronary artery disease, hypertension, chronic kidney disease, or tobacco use, between the two groups. The mean overall survival did not differ between patients with SMI > 41 and SMI ≤ 41 (36.5 vs 40.8 months, p = 0.4, respectively). Conclusions: Based on this patient cohort, sarcopenia was not associated with worse survival outcomes in EOC patients receiving first-line platinum and taxane-based chemotherapy. Further prospective studies are needed to explore other diagnostics that may allow us to provide improved accuracy and individualization in the care of women with advanced ovarian cancer.

The Role of Liver Resection at the Time of Secondary Cytoreduction in Patients With Recurrent Ovarian Cancer

2014 ◽  
Vol 24 (1) ◽  
pp. 70-74 ◽  
Author(s):  
Valentin Kolev ◽  
Elena B. Pereira ◽  
Myron Schwartz ◽  
Umut Sarpel ◽  
Sasan Roayaie ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Survival Analysis ◽  
Liver Resection ◽  
Ovarian Carcinoma ◽  
Cytoreductive Surgery ◽  
Residual Disease ◽  
Recurrent Ovarian Cancer ◽  
Kaplan Meier

ObjectiveThe aim of this study is to determine the role of liver metastatectomy in the morbidity and survival of patients with recurrent ovarian carcinoma.MethodsWe retrospectively reviewed the records of all patients who had undergone hepatic resection for liver metastases from ovarian carcinoma at the time of cytoreductive surgery at our institution from 1988 to 2012. The Kaplan-Meier method was used for survival analysis. A total of 76 patients met the inclusion criteria and had undergone liver resection as part of cytoreductive surgery for ovarian carcinoma during the study period. Of these 76 patients, 27 underwent liver resection at the time of secondary cytoreduction, and these patients that are the focus of this analysis.ResultsMedian overall survival for the study group from the time of diagnosis to the last follow-up or death was 56 months (range, 12–249 months). Twenty died of the disease with an overall median survival of 12 months from the time of the liver resection (2–190 months), and 7 patients were alive with the disease at the time of the last follow-up. Based on Kaplan-Meier survival analysis, the factors associated with the longest survival after the liver resection (2–190 months) were the interval from the primary surgery of less than 24 months versus more than 24 months (P= 0.044) and secondary cytoreduction to residual disease of less than 1 cm (P= 0.014).ConclusionsBased on our analysis of a single institution’s series of ovarian cancer patients with hepatic metastasis, liver resection is feasible and safe and should be considered as an option in selected patients at the time of secondary cytoreduction.

scholarly journals A large meta-analysis establishes the role of MRD negativity in long-term survival outcomes in patients with multiple myeloma

2020 ◽  
Vol 4 (23) ◽  
pp. 5988-5999
Author(s):  
Nikhil C. Munshi ◽  
Herve Avet-Loiseau ◽  
Kenneth C. Anderson ◽  
Paola Neri ◽  
Bruno Paiva ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Prognostic Value ◽  
Residual Disease ◽  
Meta Analysis ◽  
Progression Free Survival ◽  
Survival Outcomes ◽  
Term Survival ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Level Data

Abstract The prognostic value of minimal residual disease (MRD) for progression-free survival (PFS) and overall survival (OS) was evaluated in a large cohort of patients with multiple myeloma (MM) using a systematic literature review and meta-analysis. Medline and EMBASE databases were searched for articles published up to 8 June 2019, with no date limit on the indexed database. Clinical end points stratified by MRD status (positive or negative) were extracted, including hazard ratios (HRs) on PFS and OS, P values, and confidence intervals (CIs). HRs were estimated based on reconstructed patient-level data from published Kaplan-Meier curves. Forty-four eligible studies with PFS data from 8098 patients, and 23 studies with OS data from 4297 patients were identified to assess the association between MRD status and survival outcomes. Compared with MRD positivity, achieving MRD negativity improved PFS (HR, 0.33; 95% CI, 0.29-0.37; P &lt; .001) and OS (HR, 0.45; 95% CI, 0.39-0.51; P &lt; .001). MRD negativity was associated with significantly improved survival outcomes regardless of disease setting (newly diagnosed or relapsed/refractory MM), MRD sensitivity thresholds, cytogenetic risk, method of MRD assessment, depth of clinical response at the time of MRD measurement, and MRD assessment premaintenance and 12 months after start of maintenance therapy. The strong prognostic value of MRD negativity and its association with favorable outcomes in various disease and treatment settings sets the stage to adopt MRD as a treatment end point, including development of therapeutic strategies. This large meta-analysis confirms the utility of MRD as a relevant surrogate for PFS and OS in MM.

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