Malignant Ascites in Ovarian Cancer: Impact of Total Paracentesis on Hemodynamics

Abstract Malignant ascites in peritoneal metastases is a lipid-enriched microenvironment and is frequently involved in the poor prognosis of epithelial ovarian cancer (EOC). However, the detailed mechanisms underlying ovarian cancer (OvCa) cells dictating their lipid metabolic activities in promoting tumor progression remain elusive. Here, we report that two critical fatty acid desaturases, stearoyl-CoA desaturase-1 (SCD1) and acyl-CoA 6-desaturase (FADS2), are aberrantly upregulated, accelerating lipid metabolic activities and tumor aggressiveness of ascites-derived OvCa cells. Lipidomic analysis revealed that the elevation of unsaturated fatty acids (UFAs) is positively associated with SCD1/FADS2 levels and the oncogenic capacities of OvCa cells. In contrast, pharmaceutical inhibition and genetic ablation of SCD1/FADS2 retarded tumor growth, suppressed cancer stem cell (CSC) formation and reduced platinum resistance in OvCa cells. Mechanistically, inhibition of SCD1/FADS2 directly downregulated GPX4 and the GSH/GSSG ratio, causing disruption of the cellular redox balance and subsequent iron-mediated lipid peroxidation in ascites-derived OvCa cells. Hence, combinational treatment with SCD1/FADS2 inhibitors and cisplatin synergistically repressed tumor cell dissemination, providing a promising chemotherapeutic strategy against EOC platinum resistance and peritoneal metastases.

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Autotaxin in malignant ascites promotes invadopodia formation via reactive oxygen species in ovarian cancer

Gynecologic Oncology ◽

10.1016/j.ygyno.2019.04.135 ◽

2019 ◽

Vol 154 ◽

pp. 56

Author(s):

J.A. Choi ◽

H. Cho ◽

D.B. Chay ◽

H. Kwon ◽

G.H. Han ◽

...

Keyword(s):

Reactive Oxygen Species ◽

Ovarian Cancer ◽

Reactive Oxygen ◽

Malignant Ascites ◽

Oxygen Species ◽

Invadopodia Formation

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The role of bevacizumab plus front-line chemotherapy in patients with malignant ascites of ovarian cancer

Annals of Oncology ◽

10.1093/annonc/mdy285.184 ◽

2018 ◽

Vol 29 ◽

pp. viii348

Author(s):

M. Nikolaou ◽

N. Ziras ◽

I. Athanasiadis ◽

A. Ardavanis ◽

M. Vaslamatzis ◽

...

Keyword(s):

Ovarian Cancer ◽

Malignant Ascites ◽

Front Line ◽

Line Chemotherapy

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Bilateral ovarian serous cystadenocarcinoma metastasizing to cervix: a rare case report

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184550 ◽

2018 ◽

Vol 7 (11) ◽

pp. 4789

Author(s):

Arati Mallick ◽

Saubhagya K. Jena ◽

Debasis Kuanar

Keyword(s):

Ovarian Cancer ◽

Poor Prognosis ◽

Malignant Ascites ◽

Lymph Node Involvement ◽

Serous Cystadenocarcinoma ◽

Gynaecologic Cancer ◽

Rare Case Report ◽

Node Involvement ◽

Gynaecologic Malignancy ◽

Metastatic Involvement

Ovarian carcinoma is the second most common gynaecologic cancer and the leading cause of death from gynaecologic malignancy. Two-third of all malignant epithelial ovarian tumors are constituted by serous ovarian cystadenocarcinomas. It is generally observed that ovarian cancer tends to remain intraabdominal even in advanced cases and that dissemination is usually by invasion of adjacent viscera, diffuse intraperitoneal implantation, and metastatic involvement of aortic and pelvic lymph nodes. Metastasizes to the uterine cervix, vagina, or vulva in ovarian cancer is rare. The reverse i.e. ovarian metastasis from cervical tumor is rather more common. Published literature suggest that, patients with cervical metastases had associated malignant ascites, retroperitoneal lymph node involvement, and significant peritoneal carcinomatosis. Cervical metastasis in ovarian malignancies always indicates the advanced stage of tumor and multi-organ involvement, indirectly stating poor prognosis. The median survival in cases of ovarian cancer metastasizing to cervix is 4.4 months. Authors report a case of bilateral ovarian serous cystadenocarcinoma metastasising to posterior lip of cervix resulted in poor prognosis and proved fatal for the patient with review of published literature.

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Real life efficacy and safety data of bevacizumab-based front line treatment in advance or metastatic ovarian cancer patients: Focus on patients with malignant ascites—A phase IV study.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.5562 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 5562-5562

Author(s):

Michail Nikolaou ◽

Nikolaos Ziras ◽

Ilias Athanasiadis ◽

Alexandros Ardavanis ◽

Michael Vaslamatzis ◽

...

Keyword(s):

Ovarian Cancer ◽

Safety Data ◽

Real Life ◽

Standard Of Care ◽

Ethics Committees ◽

Malignant Ascites ◽

Stage Iii ◽

Platinum Compound ◽

Front Line ◽

Practice Methods

5562 Background: The standard of care for Epithelial Ovarian cancer (EOC) is the combination of a taxane plus a platinum compound (TC) whereas the addition of bevacizumab (bev) to this regimen (TC-bev) has been shown to improve the PFS. Patients (pts) with ascites have more aggressive disease and less overall survival. The aim of the study was to evaluate the safety of the TC/bev regimen in the real life clinical practice. Methods: A multi-center observational study, approved by the ethics committees of the participating centers, including 314 pts with stage III/IV EOC, was conducted (11.2011-06.2014) in Greece. Two independent cohorts, with similar clinico-pathologic characteristics, were treated with front-line TC (n = 109) or TC/bev (n = 205) according to the physician’s choice. 83 (40.5%) and 40 (36.7%) in the TC/bev and TC groups presented with ascites. Results: Disease control was achieved in 90.7% and in 78.9% of patients treated with TC/bev and TC, respectively (p = 0.003). Pts with ascites treated with TC/bev experienced a better overall response rate (ORR) (68.7% Vs 55%) and less progression disease (PD) compared to patients receiving TC (13.2% Vs 30.8%). The median PFS in all pts was 21.5mo and 12.4mo (p < 0.001) and median PFS in ascites pts was 18.1mo and 10.3mo in the TC/bev and TC cohort , respectively (p < 0.001). The median OS was not reached in the TC/bev group and it was 36.9mo in the TC group, ( p = 0.059) while in the ascites pts also has not reached and it is 22.5m, respectively ( p = 0.023). The 3 year survival rate in all pts was 59.4% and 50.4% and in ascites pts was 55.3% and 30% in the TC/bev and TC respectively. Neutropenia was the most common grade 3/4 adverse event in 16.6% and 9.1% in TC/bev- and TC- treated patients ( p = 0.072) with no other adverse events > 5%. Conclusions: These real life data demonstrate that the combination of TC/bev represents an active and well tolerated regimen offering survival benefit in patients with stage III/IV EOC and especially in patients with ascites. Additional larger prospective studies are required to confirm these observations. Clinical trial information: NCT01982500.

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Patterns and prognostic factors of malignant ascites in hospitalized patients with advanced stage cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e24141 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e24141-e24141

Author(s):

Shanila Ahmed ◽

Mir Ibrahim Sajid ◽

Risha Fayyaz ◽

Faiza Ilyas ◽

Noreen Nasir

Keyword(s):

Ovarian Cancer ◽

Abdominal Pain ◽

Prognostic Factors ◽

Serum Albumin ◽

Liver Metastases ◽

Malignant Ascites ◽

Baseline Characteristic ◽

Cancer Type ◽

Advanced Stage ◽

Low Serum

e24141 Background: Ascites is a shared pathological manifestation of numerous diseases, the primary (81%) disease being hepatic cirrhosis. Ascites is termed “malignant” when it is associated with cancers. It can manifest as abdominal swelling, abdominal pain, nausea and vomiting, anorexia and fatigue. Our study aimed at identifying baseline characteristic in patients who present to our hospital with malignant ascites as the first sign of advanced stage cancers and the factors that can affect outcomes in such patients. Methods: This is a retrospective study which includes all the patients who had been diagnosed with malignant ascites at our institute between the years 2012 and 2016.The diagnosis was made either on the basis of cytological examination or medical imaging or both. Patients who were younger than 18 years and who developed ascites due to diseases other than malignancy were excluded from the study. A total of 150 patients were shortlisted using these criteria. Results: The mean age of the sample was 56.52 years with 101 (67%) of the patients being female, 54 (36%) diabetic, 55 (37%) hypertensive, 26 (52%) and 12 (8%) had ischemic heart disease. The most prevalent tumor reported was ovarian cancer 47 (31%) with the highest frequency of metastasis reported in the peritoneal region 34 (23%). Among symptoms, the most prevalent were abdominal distension 127 (85%), abdominal pain 99 (66%), 41 (27%) nausea, 44 (29%) vomiting and 32 (21%) reported weight change. Paracentesis was done in 139 (92%) for palliation of symptoms .Surgery was performed on 11 (7%) of the patients, whereas 70 (47%) of the patients were switched to chemotherapy with Carboplatin-Taxol constituting the major chemotherapeutic regimen. Majority 93 (62%) of the patients were discharged in a stable condition. The median survival following diagnosis of ascites was three months. Ovarian cancer favored longer survival while low serum albumin, low serum protein and liver metastases adversely affected survival. The independent prognostic factors for survival were cancer type, liver metastases and serum albumin. Conclusions: The identified independent prognostic factors should be used to select patients for multimodality therapy for adequate palliation.

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