Negative peritoneal washing cytology during interval debulking surgery predicts overall survival after neoadjuvant chemotherapy for ovarian cancer

Abstract

ObjectiveOptimal debulking in interval debulking surgery (IDS) after neoadjuvant chemotherapy (NAC) has been reported as a prognostic factor for patients with ovarian cancer. However, the identification of microscopic residual disease (MRD) using visualization and palpation is subjective. Peritoneal washing cytology (PWC) during IDS is an easy-to-implement, objective approach for assessing disease status, although its clinical relevance and association with MRD is not known. The aim of this study was to evaluate the efficacy of PWC during IDS.MethodsIn total, 164 patients diagnosed with ovarian cancer at our institution were retrospectively evaluated, including 64 who had received NAC. Seventeen patients had undergone an exploratory laparotomy followed by NAC, while the remaining patients were diagnosed based on imaging, peritoneal cytology, and tumor markers. The PWC was performed before intraperitoneal observation at laparotomy during IDS.ResultsNAC-treated patients had stage III–IV disease. IDS was performed in 78.1% of NAC-treated patients. Seventeen patients (26.6%) were PWC-negative and 33 patients (51.6%) were PWC-positive. Fourteen patients (21.9%) had progressive disease and were ineligible for IDS. The median overall survival of the PWC-negative, PWC-positive, and non-IDS groups was 47, 18, and 5 months, respectively. The differences were significant (p<0.01). PWC was an independent prognostic factor in the multivariate Cox regression analysis (p<0.001).ConclusionPWC during IDS may be a prognostic factor for NAC-treated patients with ovarian cancer. PWC may be more useful than visualization and palpation in IDS for determining the presence of MRD.

Prognostic impact of intraoperative peritoneal cytology in interval debulking surgery for pelvic high‐grade serous carcinoma

“…This careful examination contributed to increased detection rate of positive‐PWC in this study. Compared to the positive‐PWC rate in patients with R0 status (28%‐39%) reported by previous studies, this study showed a PWC‐positive rate of 59%.…”

“…This careful examination contributed to increased detection rate of positive-PWC in this study. Compared to the positive-PWC rate in patients with R0 status (28%-39%) reported by previous studies, 14,15 this study showed a PWCpositive rate of 59%. Using PWC, it was possible to identify those with microscopic residual disease and reduced PFS; therefore, more intensive therapy or a chemotherapy regimen different from neoadjuvant chemotherapy may be considered for improving clinical outcomes.…”

“…Furthermore, only 64% of patients achieved R0 status. In another study, Iura et al reported that negative PWC during IDS was indicative of increased overall survival (HR 0.28, 95% CI 0.089‐0.860) in 50 patients with advanced ovarian cancer, including the 28 HGSC subtype . Multivariate analysis revealed PWC‐negative, optimal debulking status (<1 cm), whereas the serous histology and number of NACT cycles were independent prognostic factors for OS.…”

Prognostic analysis of peritoneal washing cytology during interval debulking surgery in advanced ovarian cancer

“…In this study, we retrospectively analyzed data from 25 patients with advanced ovarian cancer who underwent NAC/IDS at our institution, and we investigated the prognostic signi cance of PWC in NACtreated patients. While previous studies have highlighted the improved prognosis with NAC/IDS and the importance of optimal debulking [1,2,11], our ndings deviate from previous reports [5,6,12] by indicating no signi cant differences in OS and PFS between patients with positive and negative PWC, regardless of RD status. One possible explanation for this difference is the incorporation of adjuvant therapy post-IDS, including BEV or PARPi, which may have improved outcomes by suppressing malignant cell growth and peritoneal metastasis [7,13].…”

Characteristics of Pelvic Cytology in Patients with Gynecologic Malignancies: Comparison of Pre and Post-Neoadjuvant Specimens

“…This system has shown to correlate with progression-free [10, 11] and overall survival [12]. Clinical studies have shown that negative PC specimens collected at IDS are associated with an increased overall survival [13]. Similar cytologic characterization of post NACT specimens has not been performed.…”