Chemotherapy is not necessary for early-stage serous and endometrioid ovarian cancer after undergoing comprehensive staging surgery

Early Stage ◽

Number Of Patients ◽

Staging Surgery ◽

Abstract In order to investigate whether adjuvant chemotherapy is essential for patients with early-stage serous and endometrioid epithelial ovarian cancer, the present study collected data from the US Surveillance, Epidemiology and End Results database between 2004 and 2015. All subjects underwent comprehensive staging surgery and were diagnosed as stages IA-IIA, grade 1-2. A total of 2,644 patients were enrolled in the present study, among which 1,589 patients received platinum-based chemotherapy. Comparisons of categorical data were performed via χ2 tests. Variables with P<0.05 in univariate analyses were further analyzed using multiple logistic regression. Selection bias from the heterogeneity of demographic and clinical characteristics was avoided using propensity score matching. Cox proportional hazards models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), investigating the association between variables and 5-year overall survival. After the propensity score matching, there was an equal number of patients with or without chemotherapy (n=925). The results of the present study indicated that those aged ≥65 years were at an increased risk of ovarian cancer, and the age was associated with poor prognosis (HR, 1.486; CI, 1.208-1.827; P<0.001). Endometrioid carcinoma was associated with improved 5-year overall survival compared with serous cystadenocarcinoma (HR, 0.697; CI, 0.584-0.833; P<0.001). Chemotherapy could not prolong the 5-year overall survival of patients with early-stage serous and endometrioid ovarian cancer (HR, 1.092; CI, 0.954-1.249; P=0.201). These results demonstrated that adjuvant chemotherapy was unnecessary for patients with early-stage serous and endometrioid ovarian cancer after they underwent comprehensive staging surgery.

Chemotherapy is not Necessary for Early-Stage Serous and Endometrioid Ovarian Cancer After Undergoing Comprehensive Staging Surgery

10.21203/rs.3.rs-35362/v1 ◽

2020 ◽

Author(s):

Shuqing Li ◽

Zhiling Zhu

Keyword(s):

Ovarian Cancer ◽

Overall Survival ◽

Adjuvant Chemotherapy ◽

Propensity Score ◽

Early Stage ◽

Univariate Analysis ◽

Staging Surgery ◽

Abstract Background: To investigate whether adjuvant chemotherapy was essential for patients with early-stage serous and endometrioid epithelial ovarian cancer，we collected data from the US Surveillance, Epidemiology, and End Results database between 2004 and 2015. All subjects underwent comprehensive staging surgery and their pathological diagnoses were stage IA-IIA, grade 1-2. Ultimately, a total of 2,644 patients were enrolled in the study, among which 1,589 patients received platinum-based chemotherapy. Comparisons of categorical data were done by chi-square tests. Variables with P < 0.05 in univariate analysis were further analyzed using multiple logistic regression. Selection bias from the heterogeneity of demographic and clinical characteristics were avoided by propensity score matching. Cox proportional hazards models were applied to estimate hazard ratios (HR) and 95% confidence intervals (CI), exploring the relationship between variables and 5-year overall survival.Results: After propensity score matching, patients with or without chemotherapy were equal number (n=925). Our results indicated that 65 years of age or older increased the hazard and was related to poor prognostic (HR = 1.486, CI = 1.208- 1.827, P < 0.001). Endometrioid carcinoma was associated with better 5-year overall survival than serous cystadenocarcinoma (HR = 0.697, CI = 0.584-0.833, P < 0.001). Chemotherapy could not prolong 5-year overall survival of early-stage serous and endometrioid ovarian cancer patients (HR = 1.092, CI = 0.954-1.249, P = 0.201).Conclusions: These results demonstrated that adjuvant chemotherapy was unnecessary for patients with early-stage serous and endometrioid ovarian cancer after they underwent comprehensive staging surgery.

Clinical Practice of Adjuvant Chemotherapy in Patients with Early-Stage Epithelial Ovarian Cancer

Chemotherapy ◽

10.1159/000445024 ◽

2016 ◽

Vol 61 (6) ◽

pp. 287-294

Author(s):

Lindy M.J. Frielink ◽

Brenda M. Pijlman ◽

Nicole P.M. Ezendam ◽

Johanna M.A. Pijnenborg

Keyword(s):

Ovarian Cancer ◽

Clinical Practice ◽

Adjuvant Chemotherapy ◽

Epithelial Ovarian Cancer ◽

Early Stage ◽

Figo Stage ◽

Selective Treatment ◽

Grade 3 ◽

Practice Methods

Background: Adjuvant platinum-based chemotherapy improves survival in women with early-stage epithelial ovarian cancer (EOC). Yet, there is a wide variety in clinical practice. Methods: All patients diagnosed with FIGO I and IIa EOC (2006-2010) in the south of the Netherlands were analyzed. The percentage of patients that received adjuvant chemotherapy was determined as well as the comprehensiveness of staging and outcome. Results: Forty percent (54/135) of the patients with early-stage EOC received adjuvant chemotherapy. Treatment with adjuvant chemotherapy was associated with FIGO stage, clear-cell histology and nonoptimal staging. Optimal staging was achieved in 50%, and nonoptimal staging was associated with advanced age, comorbidity and treatment in a non-referral hospital. Overall, there was no difference in outcome between patients with and without adjuvant chemotherapy. Yet, in grade 3 tumors, adjuvant chemotherapy seems beneficial. Conclusions: Selective treatment of patients with early-stage EOC might reduce adjuvant chemotherapy without compromising outcome.

Comparison of adjuvant chemotherapy, chemoradiation, and chemotherapy followed by chemoradiation for resected stage I-II pancreatic cancer.

10.1200/jco.2019.37.4_suppl.372 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 372-372

Author(s):

Sung Jun Ma ◽

Gregory Hermann ◽

Kavitha M Prezzano ◽

Lucas M Serra ◽

Austin J Iovoli ◽

...

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Adjuvant Chemotherapy ◽

Propensity Score ◽

Multivariable Analysis ◽

Cox Proportional Hazards ◽

Stage I ◽

Concurrent Chemoradiation ◽

Forest Plot

372 Background: Prior National Cancer Database (NCDB) studies have demonstrated an overall survival (OS) benefit for adjuvant concurrent chemoradiation (CRT) compared to chemotherapy alone. Given the more recent adoption of postoperative chemotherapy followed by concurrent chemoradiation (C+CRT), this NCDB analysis evaluates the clinical outcomes of C+CRT compared to CRT alone or adjuvant chemotherapy alone (C) for resected pancreatic cancer. Methods: The NCDB was queried for primary stage I-II, cT1-3N0-1M0, resected pancreatic adenocarcinoma treated with adjuvant C, CRT, or C+CRT (2004-2015). Patients treated with C+CRT were compared with those treated with C (cohort C) or with CRT (cohort CRT). The primary endpoint was overall survival (OS). Baseline patient, tumor, and treatment characteristics were examined. Kaplan-Meier analysis, multivariable Cox proportional hazards method, forest plot, and propensity score matching were used. Results: Among 5667 patients (n = 3031 for C, n = 1307 for CRT, n = 1329 for C+CRT), median follow-up was 34.7 months, 45.2 months, and 39.7 months for the C, CRT, and C+CRT cohorts, respectively. In the multivariable analysis for all patients, C (HR 1.31, p < 0.001) and CRT (HR 1.24, p < 0.001) were associated with worse mortality compared to C+CRT. Treatment interactions were seen among pathologically node positive disease. C+CRT was favored in 1-3 (HR 0.74, p < 0.001) and 4+ (HR 0.75, p < 0.001) positive lymph node disease when compared to C or CRT alone, but none of the treatment options were significantly favored in node negative disease (HR 0.96, p = 0.67). Using 1:1 propensity score matching, 2152 patients for cohort C and 1774 patients for cohort CRT were matched. C+CRT remained significant for improved OS for both cohort C (median OS 23.3 vs 20.0 months, p < 0.001) and cohort CRT (median OS 23.4 vs 20.8 months, p < 0.001). Conclusions: This NCDB study using propensity score matched analysis demonstrates an OS benefit for C+CRT compared to C or CRT alone following surgical resection of pancreatic cancer. Most of this benefit is in patients with positive lymph nodes.

The effect of complete surgical staging and adjuvant chemotherapy on survival in stage I, grade 1 and 2 endometrioid ovarian carcinoma

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2021-003112 ◽

2021 ◽

pp. ijgc-2021-003112

Author(s):

Brenna E Swift ◽

Allan Covens ◽

Victoria Mintsopoulos ◽

Carlos Parra-Herran ◽

Marcus Q Bernardini ◽

...

Keyword(s):

Ovarian Cancer ◽

Overall Survival ◽

Adjuvant Chemotherapy ◽

Stage I ◽

Low Grade ◽

Recurrence Free Survival ◽

Free Survival ◽

Stage Ia ◽

ObjectivesTo assess the effect of complete surgical staging and adjuvant chemotherapy on survival in stage I, low grade endometrioid ovarian cancer.MethodsThis retrospective study was conducted at two cancer centers from July 2001 to December 2019. Inclusion criteria were all stage I, grade 1 and 2 endometrioid ovarian cancer patients. Patients with mixed histology, concurrent endometrial cancer, neoadjuvant chemotherapy, and patients who did not undergo follow-up at our centers were excluded. Clinical, pathologic, recurrence, and follow-up data were collected. Cox proportional hazard model evaluated predictive factors. Recurrence-free survival and overall survival were calculated using the Kaplan-Meier method.ResultsThere were 131 eligible stage I patients: 83 patients (63.4%) were stage IA, 5 (3.8%) were stage IB, and 43 (32.8%) were stage IC, with 80 patients (61.1%) having grade 1 and 51 (38.9%) patients having grade 2 disease. Complete lymphadenectomy was performed in 34 patients (26.0%), whereas 97 patients (74.0%) had either partial (n=22, 16.8%) or no (n=75, 57.2%) lymphadenectomy. Thirty patients (22.9%) received adjuvant chemotherapy. Median follow-up was 51.5 (95% CI 44.3 to 57.2) months. Five-year recurrence-free survival was 88.0% (95% CI 81.6% to 94.9%) and 5 year overall survival was 95.1% (95% CI 90.5% to 99.9%). In a multivariable analysis, only grade 2 histology had a significantly higher recurrence rate (HR 3.42, 95% CI 1.03 to 11.38; p=0.04). There was no difference in recurrence-free survival (p=0.57) and overall survival (p=0.30) in patients with complete lymphadenectomy. In stage IA/IB, grade 2 there was no benefit of adjuvant chemotherapy (p=0.19), and in stage IA/IB, low grade without complete surgical staging there was no benefit of adjuvant chemotherapy (p=0.16). Twelve patients (9.2%) had recurrence; 3 (25%) were salvageable at recurrence and are alive with no disease.ConclusionsPatients with stage I, low grade endometrioid ovarian cancer have a favorable prognosis, and adjuvant chemotherapy and staging lymphadenectomy did not improve survival.

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

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 ◽

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.

Socioeconomic status based on race in early-stage anal squamous cell carcinoma undergoing locoregional therapy.

10.1200/jco.2020.38.15_suppl.4056 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 4056-4056

Author(s):

Suleyman Yasin Goksu ◽

Muhammet Ozer ◽

Muhammad Shaalan Beg ◽

Syed Mohammad Ali Kazmi ◽

Aravind Sanjeevaiah ◽

...

Keyword(s):

At Risk ◽

Overall Survival ◽

Propensity Score ◽

Squamous Cell ◽

Early Stage ◽

Private Insurance ◽

Locoregional Therapy ◽

Black Patients ◽

White Patients

4056 Background: Anal Squamous Cell Cancer (ASCC) is a highly curable cancer. Underserved and vulnerable populations are particularly at risk of developing this disease. We aimed to study racial disparities and overall survival (OS) in patients with ASCC who received radiation therapy (RT) or chemo-RT (CRT) using the National Cancer Database. Methods: We identified adult patients with early-stage (stage I-II) ASCC diagnosed between 2004-2016 who underwent RT or CRT. We compared the clinical and treatment characteristics of white and black patients. The chi-square test was used for categorical variables. Kaplan-Meier and Cox regression method performed for survival analyses. We used 1:1 nearest neighbor propensity score matching to eliminate selection bias. Results: A total of 10,014 patients; 90.2% were white and 9.8% were black. White patients were more likely to be female, older age, have higher rate high-school education, private insurance, higher income, and travel a longer distance (all p < .001). Black patients were more likely to be higher comorbidity score and be treated at an academic/research facility. White patients had a higher rate of CRT and significantly better overall survival (OS) as compared to black patients (5-year survival 76% vs. 70%, p < .001) which persisted after propensity score matching (5-year survival 76% vs. 70%, p = .002). This difference continued after adjusting for clinically important factors, including HPV status (unmatched p < .03, matched p = .008). In the patients who received CRT, white patients were associated with improved OS versus black patients (unmatched 77% vs. 71%, p < .001; matched 77% vs. 71%, p = .011), and even after multivariate Cox analysis (unmatched p < .001; matched .014) (Table). Conclusions: White patients had significantly better OS as compared to black patients with early-stage ASCC as well as in the patients who received CRT. White patients were associated with high education level, higher income, and private insurance. The rate of HPV positive was similar among groups. Further investigations are needed to enlighten these disparities and target the increase education of the population at risk. [Table: see text]

Chemotherapy is not necessary for early-stage serous and endometrioid ovarian cancer after undergoing comprehensive staging surgery

Journal of Ovarian Research ◽

10.1186/s13048-020-00694-9 ◽

2020 ◽

Vol 13 (1) ◽

Author(s):

Shuqing Li ◽

Zhiling Zhu

Keyword(s):

Ovarian Cancer ◽

Early Stage ◽

Staging Surgery ◽

Propensity score matching analysis of ovarian cancer patients with multiple primary malignant neoplasms using multicenter real-world data.

10.1200/jco.2021.39.15_suppl.e17501 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e17501-e17501

Author(s):

Qing-lei Gao ◽

Xiaofei Jiao ◽

Ruyuan Li ◽

Shaoqing Zeng ◽

Yingjun Zhao ◽

...

Keyword(s):

Breast Cancer ◽

Ovarian Cancer ◽

Overall Survival ◽

Propensity Score ◽

Cancer Patients ◽

Cox Regression ◽

Malignant Neoplasms ◽

Cox Regression Analysis ◽

Multiple Primary

e17501 Background: Multiple primary malignant neoplasms (MPMNs) in patients with ovarian cancer is rare and has not attracted enough attention. It is unclear how the MPMNs affect the prognosis of ovarian cancer (OC) patients. Methods: This is a multicenter retrospective analysis of 5, 268 ovarian cancer patients from six centers who was diagnosed with ovarian cancer from January 1, 1989 to August 21, 2020. Propensity score matching was used to balance the baseline characteristics between patients with and without MPMNs. Cox regression analysis was utilized to analyze the influence of MPMNs on overall survival (OS). Results: After excluding unqualified medical record, totally 4, 848 patients were analyzed and 240 were concurrent at least one MPMNs other than OC. Ten patients had two MPMNs and one patient had three. The most common concurrent cancer was breast cancer (111/240, 46.25%), followed by endometrial cancer (37/240, 15.42%), and cervical cancer (30/240, 12.50%). Patients with MPMNs were elder than those without MPMNs (52 vs. 51, P = 0.03) when ovarian cancer was diagnosed. And the proportion of early-stage cases was lower in patients with MPMNs (25.8% vs. 27.2%, P < 0.001). Patients with breast cancer had a higher proportion of high-grade serous ovarian cancer (HGSOC) than those without MPMNs. After using the propensity score matching method adjusting age, pathological type, grade, and stage, concurrent MPMNs, including breast cancer, had no effect on OS of ovarian cancer patients. Among 240 patients with MPMNs, patients with breast cancer shared similar age and stage compared with the rest patients, while their proportion of HGSOC was higher than patients with other cancer (68.4% vs. 51.1%, P = 0.028). However, the median OS of those two groups were similar (27.3 m vs.27.1 m, P = 0.744). In addition, 94 patients were diagnosed with breast cancer prior to ovarian cancer, seven diagnosed posteriorly to ovarian cancer, four diagnosed simultaneously, and six had no precise diagnosed dates. There was no remarkable difference in clinical characteristics between the prior and posterior groups, however, the median OS of those seven patients was significantly longer than the prior group (76.0 m vs. 25.4 m, P = 0.002). Conclusions: The MPMNs showed no influence on the overall survival of ovarian cancer patients. The order of diagnosis of ovarian cancer and breast cancer might affect the prognosis.

Sublobar resection is associated with decreased survival for patients with early stage large-cell neuroendocrine carcinoma of the lung

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz140 ◽

2019 ◽

Vol 29 (4) ◽

pp. 517-524 ◽

Cited By ~ 1

Author(s):

Waseem Lutfi ◽

Matthew J Schuchert ◽

Rajeev Dhupar ◽

Inderpal Sarkaria ◽

Neil A Christie ◽

...

Keyword(s):

Overall Survival ◽

Survival Rate ◽

Propensity Score ◽

Neuroendocrine Carcinoma ◽

Early Stage ◽

Large Cell ◽

Sublobar Resection ◽

Overall Survival Rate ◽

Kaplan Meier

Abstract OBJECTIVES Sublobar resection (SLR) for early non-small-cell lung carcinoma (NSCLC) has been shown to have a survival rate similar to that of lobectomy. Large-cell neuroendocrine carcinoma (LCNEC) of the lung, although treated like an NSCLC, has a poor prognosis compared to NSCLC. We sought to determine if outcomes are poor in patients with early stage LCNEC treated with SLR versus lobectomy. METHODS We searched for patients with pathological stage I LCNEC ≤3 cm within the National Cancer Database between 2004 and 2014. Propensity score matching was used to compare the 5-year overall survival rate of patients having SLR (wedge or segmentectomy) to that of patients having a lobectomy. Patients were matched for age, node sampling, comorbidity score, tumour size, insurance status and other factors. Patients who received neoadjuvant therapy were excluded. Kaplan–Meier methods were used for analysis. RESULTS A total of 1011 patients met the inclusion criteria: 263 were treated with SLR (223 wedges and 40 segmentectomies) and 748 patients, with lobectomy. Patients who received SLR were older, had more comorbidities and smaller tumours. On unadjusted Kaplan–Meier analysis, patients who had SLR had decreased 5-year overall survival compared to those who had a lobectomy (37.9% vs 56.6%, P < 0.001). Propensity score matching (1:1) across 12 demographic and tumour variables yielded 185 patients per group with 34 segmentectomies and 151 wedge resections in the SLR cohort. On Kaplan–Meier analysis of the matched cohort, patients who had SLR had a worse 5-year overall survival rate compared to those who had a lobectomy (41.5% vs 60.3%; P = 0.001). CONCLUSIONS SLR for early stage LCNEC is associated with a lower 5-year overall survival rate compared to lobectomy on unadjusted and propensity matched analyses.

Adjuvant platinum-based chemotherapy in radically resected adrenocortical carcinoma: a cohort study

British Journal of Cancer ◽

10.1038/s41416-021-01513-8 ◽

2021 ◽

Author(s):

Otilia Kimpel ◽

Sara Bedrose ◽

Felix Megerle ◽

Alfredo Berruti ◽

Massimo Terzolo ◽

...

Keyword(s):

Overall Survival ◽

Cohort Study ◽

Propensity Score ◽

Adrenocortical Carcinoma ◽

Group Analysis ◽

Radical Resection ◽

Immortal Time Bias ◽

Multicentre Cohort Study

Abstract Background After radical resection, patients with adrenocortical carcinoma (ACC) frequently experience recurrence and, therefore, effective adjuvant treatment is urgently needed. The aim of the study was to investigate the role of adjuvant platinum-based therapy. Methods In this retrospective multicentre cohort study, we identified patients treated with adjuvant platinum-based chemotherapy after radical resection and compared them with patients without adjuvant chemotherapy. Recurrence-free and overall survival (RFS/OS) were investigated in a matched group analysis and by applying a propensity score matching using the full control cohort (n = 268). For both approaches, we accounted for immortal time bias. Results Of the 31 patients in the platinum cohort (R0 n = 25, RX n = 4, R1 n = 2; ENSAT Stage II n = 11, III n = 16, IV n = 4, median Ki67 30%, mitotane n = 28), 14 experienced recurrence compared to 29 of 31 matched controls (median RFS after the landmark at 3 months 17.3 vs. 7.3 months; adjusted HR 0.19 (95% CI 0.09–0.42; P < 0.001). Using propensity score matching, the HR for RFS was 0.45 (0.29–0.89, P = 0.021) and for OS 0.25 (0.09–0.69; P = 0.007). Conclusions Our study provides the first evidence that adjuvant platinum-based chemotherapy may be associated with prolonged recurrence-free and overall survival in patients with ACC and a very high risk for recurrence.