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.

International Federation of Gynecology and Obstetrics Staging Classification for Cancer of the Ovary, Fallopian Tube, and Peritoneum: Estimation of Survival in Patients With Node-Positive Epithelial Ovarian Cancer

2015 ◽  
Vol 25 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Augusto Pereira ◽  
Tirso Pérez-Medina ◽  
Javier F. Magrina ◽  
Paul M. Magtibay ◽  
Ana Rodríguez-Tapia ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Staging System ◽  
Peritoneal Metastases ◽  
International Federation ◽  
Anatomical Location ◽  
Abdominal Lymph Node ◽  
Node Positive ◽  
Figo Staging ◽  
Gynecology And Obstetrics

ObjectiveThe objective of this study was to determine the survival of patients with node-positive epithelial ovarian cancer according to the 2014 International Federation of Gynecology and Obstetrics (FIGO) staging system.Materials and MethodsWe performed a retrospective chart review. Data from all consecutive patients with node-positive epithelial ovarian cancer (stages IIIC and IV) who underwent cytoreductive surgery at the Mayo Clinic from 1996 to 2000 were reassessed to evaluate the prognostic significance of the new FIGO stages. Multivariate Cox regression was performed, and Kaplan-Meier survival curves constructed.ResultsThe distribution of the restaged patients was as follows: IIIA1, 23 patients (IIIA1i, 9 patients; and IIIA1ii, 14 patients); IIIA2, 3 patients; IIIB, 4; IIIC, 67 patients; IVA, 4 patients; and IVB, 15 patients. In the univariate analysis, the relative risk for positive nodes greater than 10 mm on the longer axis was 2.57 and 3.00 for patients with microscopic peritoneal disease, compared with patients with microscopic positive nodes. However, the difference was not statistically significant. Moreover, the univariate analyses revealed statistically significant differences for 2014 FIGO stages (IIIA, IIIB, IIIC, and IVA-B), anatomical sites of peritoneal metastases, and disease staged at IIIC because of the presence of omental metastases. Multivariate analysis showed that survival was higher in patients restaged to IIIA-B than in those restaged to IIIC and IV (hazard ratios, 2.75 and 3.16, respectively; P = 0.002). The hazard ratio for patients with abdominal peritoneal metastases was 2.76 compared with patients with pelvic peritoneal metastases (P = 0.001).ConclusionsThe current 2014 FIGO staging system for ovarian cancer successfully correlates survival, anatomical location of peritoneal metastases, and extra-abdominal lymph node metastases.

scholarly journals Clinical Outcome of Patients With High-Risk Endometrial Carcinoma After Treatment With Chemotherapy Only

2018 ◽  
Vol 28 (9) ◽  
pp. 1789-1795 ◽  
Author(s):  
Elisabeth Smogeli ◽  
Milada Cvancarova ◽  
Yun Wang ◽  
Ben Davidson ◽  
Gunnar Kristensen ◽  
...  
Keyword(s):  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Recurrence Rate ◽  
Total Population ◽  
Standard Treatment ◽  
International Federation ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iiic ◽  
Gynecology And Obstetrics

ObjectivesAdjuvant treatment of high-risk endometrial cancer (EC) is still controversial. Several studies have tried to clarify the best treatment strategy, and guidelines have been made, but no study to date has shown a survival benefit for radiation over chemotherapy. We aimed to evaluate the outcome of high-risk EC patients treated with adjuvant chemotherapy only in a population where the routine administration of adjuvant radiotherapy was omitted.MethodsThis is a retrospective study including 230 EC patients with International Federation of Gynecology and Obstetrics stage I type II, stage Ib type I/G3, stage II, and IIIc treated at Oslo University Hospital between 2005 and 2012. Standard treatment was hysterectomy, bilateral salpingo-oophorectomy and at least pelvic lymphadenectomy followed by adjuvant chemotherapy.ResultsOf the 230 high-risk patients, standard treatment was given to 146 patients (63.5%): 60 patients in stage I, 10 patients in stage II, and 76 patients in stage IIIc. Only 10% of patients with stage I disease relapsed, with 3.3% locoregional relapses and 6.7% distant relapses. Recurrence rate in stage IIIc was 39.5%, with 7.9% isolated vaginal and 31.6% distant relapses. The 3-year disease-free survival was 92% for stage I, 80% for stage II, and 60% for stage IIIc disease. In the total population, 55 patients had International Federation of Gynecology and Obstetrics stage Ia, 43 Ib, 42 stage II, and 90 stage IIIc disease. Recurrence rate in the total population was 29.6%, with 9.6% isolated vaginal recurrences, 1.7% recurrences located in the pelvis, and 18.3% distant recurrences.ConclusionsPatients with high-risk EC have acceptable vaginal/pelvic control rates after adjuvant chemotherapy. However, prognosis remains poor for patients with stage IIIc disease, also after chemotherapy.

scholarly journals Development and Validation of a Nomogram Based on CA125 Levels for Predicting Progression-Free Survival in Patients with Ovarian Cancer

2020 ◽  
Author(s):  
Minjun He ◽  
Chuanbo Xie ◽  
Jun Huang ◽  
Wei Wei ◽  
Yin Wang ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
External Validation ◽  
Progression Free Survival ◽  
Staging System ◽  
Curve Analysis ◽  
Discriminative Ability ◽  
Decision Curve Analysis ◽  
Free Survival ◽  
Figo Staging ◽  
Gynecology And Obstetrics

Abstract Background We aimed to develop and validate a nomogram incorporating CA125 levels after three cycles of chemotherapy for predicting progression-free survival (PFS) in patients with ovarian cancer.Methods The nomogram was developed in a primary cohort of 491 patients with stage II-IV ovarian cancer. Performance was assessed by concordance index (C-index), calibration curve, and decision curve analysis, and compared with the International Federation of Gynecology and Obstetrics (FIGO) staging system. The predictive value of CA125 levels after three cycles of chemotherapy was evaluated. The model was subjected to bootstrap internal validation. An independent cohort of 81 patients was used for external validation.Results CA125 levels after three cycles of chemotherapy were significantly associated with PFS. Five variables, including CA125 levels were selected to develop the nomogram. The nomogram demonstrated adequate discrimination, with a bootstrap-corrected C-index of 0.708, and good calibration. External validation of the nomogram achieved excellent discrimination (C-index, 0.724) and calibration. CA125 levels after three adjuvant chemotherapy cycles showed a marginally significant increment of discrimination to the nomogram in the primary cohort (C-index, 0.708 vs 0.668; P = 0.097). Superior discriminative ability was observed in the nomogram when compared with the FIGO staging system only in the primary cohort (C-index, 0.708 vs 0.578; P < 0.001). Decision curve analysis demonstrated that our nomogram was clinically useful.Conclusion We developed and validated a nomogram incorporating CA125 levels after three chemotherapy cycles for PFS prediction in ovarian cancer. This nomogram showed well-predictive performance and easy clinical application.

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 &gt; 200 U/mL and CEA &lt; 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; &lt;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).

Revised 2018 International Federation of Gynecology and Obstetrics (FIGO) cervical cancer staging: A review of gaps and questions that remain

2020 ◽  
Vol 30 (6) ◽  
pp. 873-878 ◽  
Author(s):  
Gloria Salvo ◽  
Diego Odetto ◽  
Rene Pareja ◽  
Michael Frumovitz ◽  
Pedro T Ramirez
Keyword(s):  
Cervical Cancer ◽  
Early Stage ◽  
Staging System ◽  
Cancer Staging ◽  
International Federation ◽  
Imaging Modalities ◽  
Early Stage Disease ◽  
Figo Staging ◽  
Gynecology And Obstetrics ◽  
Parametrial Involvement

Recently the revised 2018 International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer was published. In this most recent classification, imaging modalities and pathologic information have been added as tools to determine the final stage of the disease. Although there are many merits to this new staging for cervical cancer, including more detailed categorization of early-stage disease as well as information on nodal distribution, the classification falls short in clarifying areas of controversy in the staging system. Many unanswered questions remain and, as such, a number of gaps lead to further debate in the interpretation of relevant clinical data. Factors such as measurement of tumor size, definition of parametrial involvement, ovarian metastases, lower uterine segment extension, lymph node metastasis, and imaging modalities are explored in this review. The goal is to focus on items that deserve further discussion and clarification in the most recent FIGO staging for cervical cancer.

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