Prognostic value of miliary versus non-miliary sub-staging in advanced ovarian cancer

Abstract

Objective The presence of miliary disease during initial ovarian cancer debulking may reflect a distinct mode of peritoneal spread independent from size-based tumor staging and may explain variation in response to treatment and survival outcomes. To infer the prevalence, presentation and clinical implications of miliary disease we reviewed existing surgical records. Methods Reports were available for 1008 primary debulking surgeries for ovarian, primary peritoneal or fallopian tube cancer between 2001 and 2015 (685 reports from 2005 to 2015). Clinical outcome data was available for 938 patients. We analyzed a high-stage sub-cohort for survival (N=436). Results Most records were evaluable for miliary disease (761/938); for these, the miliary phenotype was highly prevalent (249/761, 32.7%) and often accompanied by ascites (185/249, 74%). While optimal debulking rates were unaffected by miliary disease, total resection (R0) rates were poorer. Liver, stomach, spleen or bladder appeared to be sporadically involved while the omentum, mesentery, bowel, peritoneum and diaphragm were affected simultaneously (Spearman rho > 0.5). Overall, miliary disease was associated with worse progression free survival, overall survival, and time from relapse to death independent of stage. Survival effects were particularly strong for Stage IV disease where median overall survival varied by over 30 months (log-rank p=0.002). Conclusions Miliary disease is an identifiable surgical phenotype reflecting a distinct clinical trajectory that adds prognostic information to standard disease burden-based staging. These findings should permit further retrospective investigation in a wider cohort and prompt the consideration of prospective structured operative reporting standards and treatment strategies.

Factors that influence survival in high-grade serous ovarian cancer: A complex relationship between molecular subtype, disease dissemination, and operability

“…We reasoned that patients with upper abdominal and miliary disease have similar surgical outcomes and molecular profiles: both are more likely to be MES, and both more often have incomplete resections compared to lower abdominal and pelvic disease. Previous studies have reported on the prognostic significance of miliary disease [20]. However, we observed similar OS between patients with upper abdominal and miliary disease.…”

NECTIN4 (PVRL4) as Putative Therapeutic Target for a Specific Subtype of High Grade Serous Ovarian Cancer—An Integrative Multi-Omics Approach

“…This spread behavior was linked to the putative origin of the cancer, fallopian tube secretory epithelial cells (FTE) or ovarian surface epithelial (OSE) cells [12,13,14]. Patients with miliary spread type and patients with tumors of putative tubal origin have an unfavorable survival outcome [6,8,12,15,16] and would urgently require new targeted therapies. It was also shown that patients with non-miliary tumor spread present with an increased adaptive immune reaction (e.g., CD8 + immune cell tumor infiltration) and immune-checkpoint expression (e.g., PD-L1 on tumor cells) [7], therefore might render good candidates for an additional immune therapy.…”

Clinico pathological features and treatment outcome of malignant epithelial ovarian tumour

“…In this study, multivariate analysis showed histological subtypes (HR-1.862) and histopathological grade (HR-1.145) were independent prognostic factor for DFS but statistically not significant (p-value< .396 & .785 respectively). 4,11,15 In this study, reported that univariate analysis, histopathological types(HR-1.28095% CI) and grade (HR-1.653 95% CI) was independent significant for recurrence and grade was statistically significant (p<.040). This study showed that mucinous (43.8%) and clear cell(50.0%) subtypes had more recurrence when compared with serous (41.9%) histology.…”