Correlation of differential ascites volume with primary cytoreductive surgery outcome, lymph node involvement, and disease recurrence in advanced ovarian cancer

Abstract

ObjectiveHigh-grade serous ovarian cancer accounts for a disproportionate number of deaths from gynecologic malignancies. It typically presents at an advanced stage and with a high volume of ascites a common presenting feature. The aims of this study is to evaluate the association between ascites volume at the time of primary surgery for advanced stage ovarian cancer with surgical outcomes and patterns of recurrence.MethodsA retrospective review of stage III/IV high-grade serous ovarian cancer patients who underwent primary surgery at two centers between March 2003 to June 2016. Patients were categorized as low-volume ascites (≤ 200 mL) vs high-volume (≥ 1 L). Patients with an unknown volume of ascites or neoadjuvant chemotherapy were excluded. Patients' characteristics were compared for the two groups. Probability of recurrence over time and the HR from a proportional hazards model for sub-distribution were calculated.ResultsA total of 210 patients were included, 90 (42.9%) patients in the low-volume and 120 (57.1%) patients in the high-volume group. Patients in the low-volume group were older with a median age of 60.2 years vs 56.8 years in the high-volume group and had lower serum CA-125 levels (mean 223 vs 971.5 U/mL). The low-volume group had better surgical outcome with suboptimal debulking (> 1 cm residual disease) in only 17.8 % vs 39.2 % in the high-volume group and had longer median time to recurrence (2.8 years in low-volume vs 1.6 years high-volume group). At the time of recurrence, the low-volume group had a less disseminated pattern of recurrence, lower rates of ascites (20 % in the low-volume group vs 37.2 % in the high-volume group), and a trend toward lower serum CA125 levels (mean 352.8 vs 596.9 U/mL).ConclusionsAdvanced stage serous ovarian cancer patients who present with low-volume ascites have lower serum CA125 levels, more optimal cytoreduction rates, and longer disease-free interval. The low-volume group had less ascites, less disseminated disease, and a trend toward lower serum CA125 levels at the time of recurrence.

Oncolytic adenovirus inhibits malignant ascites of advanced ovarian cancer by reprogramming the ascitic immune microenvironment

“… 7 Ascites could be an independent prognostic indicator, considering that more than 90% of ovarian cancer patients with malignant ascites are diagnosed with stage III and IV cancer. 8 , 9 Immune cells and cytokines are important components of malignant ascites and are associated with disease progression. 6 Previous studies have shown that the immunoreactive phenotype is consistent with lower ascites volume.…”

Development and external validation of nomograms for predicting individual survival in patients with ovarian clear cell carcinoma

“…More than one‐third of ovarian cancer patients developed ascites at initial diagnosis and ascites is likely to further cause chemoresistance, widespread metastasis, and decreased surgical resectability 19–22 . A recent study showed that HGSC patients with ascites <200 mL have lower serum CA125 levels, more optimal cytoreduction rates, and longer disease‐free intervals than those with large ascites 23 . However, most ascites research focuses on HGSC, and determining the importance of ascites in the progression of rare EOC subtypes, such as OCCC, is currently difficult.…”

“… 19 , 20 , 21 , 22 A recent study showed that HGSC patients with ascites <200 mL have lower serum CA125 levels, more optimal cytoreduction rates, and longer disease‐free intervals than those with large ascites. 23 However, most ascites research focuses on HGSC, and determining the importance of ascites in the progression of rare EOC subtypes, such as OCCC, is currently difficult. The present study revealed that survival analysis showed ascites (>400 mL) as an independent OS‐ and PFS‐related factors for patients with OCCC.…”

The Impact of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Epithelial Ovarian Cancer

“…Patients were defined as optimally cytoreduced as ≤1cm of residual disease. Malign high-volume ascites were described as serous fluid (>200 mL) in the peritoneal cavity (7). Lymphovascular Space Invasion (LVSI) was diagnosed when endothelial-lined spaces with or without intraluminal red cells or lymphocytes were observed in tumor tissue.…”