Surgical Implications of Advanced Low-Grade Serous Ovarian Cancer: Analysis of the Database of the Tumeurs Malignes Rares Gynécologiques Network

Bonsang-Kitzis, Hélène; Panchbhaya, Nabilah; Bats, Anne‐Sophie; Pujade-Lauraine, Éric; Pautier, Patricia; Ngô, Charlotte; Frère‐Belda, Marie‐Aude Le; Kalbacher, Elsa; Floquet, Anne; Berton‐Rigaud, Dominique; Lefeuvre-Plesse, Claudia; Fabbro, Michel; Ray‐Coquard, Isabelle; Lécuru, Fabrice

doi:10.3390/cancers14092345

Cited by 5 publications

(7 citation statements)

References 25 publications

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“…In the PDS group, relative survival was best following surgery with no macroscopic residual disease and in the IDS group, this applied to patients without macroscopic or ≤1 cm residual disease, in line with other studies 10,36–38 . Better survival following PDS than after neo‐adjuvant chemotherapy followed by IDS was found, which is in accordance with two recent studies, but this was not confirmed in another cohort of stage II–IV LGSC patients 38–40 . It is important to note that these differences might be caused not by the surgery itself but rather by the extent of disease 13 .…”

Section: Discussionsupporting

confidence: 81%

Stage, treatment and survival of low‐grade serous ovarian carcinoma in the Netherlands: A nationwide study

Decker

Wenzel

Bart

et al. 2023

Acta Obstet Gynecol Scand

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Introduction Serous ovarian carcinomas constitute the largest group of epithelial ovarian cancer (60%–75%) and are further classified into high‐ and low‐grade serous carcinoma. Low‐grade serous carcinoma (LGSC) is a relatively rare subtype (approximately 5% of serous carcinomas) and epidemiologic studies of large cohorts are scarce. With the present study we aimed to report trends in stage, primary treatment and relative survival of LGSC of the ovary in a large cohort of patients in an effort to identify opportunities to improve clinical practice and outcome of this relatively rare disease. Material and Methods Patients diagnosed with LGSC between 2000 and 2019 were identified from the Netherlands Cancer Registry (n = 855). Trends in FIGO stages and primary treatment were analyzed with the Cochran–Armitage trend test, and differences in and trends of 5‐year relative survival were analyzed using multivariable Poisson regression. Results Over time, LGSC was increasingly diagnosed as stage III (39.9%–59.0%) and IV disease (5.7%–14.4%) and less often as stage I (34.6%–13.5%; p < 0.001). Primary debulking surgery was the most common strategy (76.2%), although interval debulking surgery was preferred more often over the years (10.6%–31.1%; p < 0.001). Following primary surgery, there was >1 cm residual disease in only 15/252 patients (6%), compared with 17/95 patients (17.9%) after interval surgery. Full cohort 5‐year survival was 61% and survival after primary debulking surgery was superior to the outcome following interval debulking surgery (60% vs 34%). Survival following primary debulking surgery without macroscopic residual disease (73%) was better compared with ≤1 cm (47%) and >1 cm residual disease (22%). Survival following interval debulking surgery without macroscopic residual disease (51%) was significantly higher than after >1 cm residual disease (24%). Except FIGO stage II (85%–92%), survival did not change significantly over time. Conclusions Over the years, LGSC has been diagnosed as FIGO stage III and stage IV disease more often and interval debulking surgery has been increasingly preferred over primary debulking in these patients. Relative survival did not change over time (except for stage II) and worse survival outcomes after interval debulking surgery were observed. The results support the common recommendation to perform primary debulking surgery in patients eligible for primary surgery.

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Section: Discussionsupporting

confidence: 81%

Stage, treatment and survival of low‐grade serous ovarian carcinoma in the Netherlands: A nationwide study

Decker

Wenzel

Bart

et al. 2023

Acta Obstet Gynecol Scand

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“…A systematic review of the literature identified 8 studies (eFigure 5 and eTable 6 in Supplement 1 ). 6 , 8 , 12 , 13 , 14 , 15 , 16 , 17 Of those, 3 studies provided HRs for OS. Together with the NCDB cohort in the current study, a total of 4 studies were evaluated in our meta-analysis (eFigure 4 in Supplement 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…The most prevalent histologic subtype of epithelial ovarian cancer is high-grade serous carcinomas, and clear cell, low-grade serous, and mucinous carcinomas represent less common histologic subtypes in the US (2%-7%) . Due to their rarity, the use and survival outcomes associated with NACT in these less common epithelial carcinomas have been relatively understudied . Even with the available data, limited sample size and lack of comparator groups make their findings difficult to interpret and adopt.…”

Section: Introductionmentioning

confidence: 99%

“… 11 Due to their rarity, the use and survival outcomes associated with NACT in these less common epithelial carcinomas have been relatively understudied. 6 , 8 , 12 , 13 , 14 , 15 , 16 , 17 Even with the available data, limited sample size and lack of comparator groups make their findings difficult to interpret and adopt.…”

Section: Introductionmentioning

confidence: 99%

“…Across the 2 cohorts in this study and 2 previous studies, NACT use for low-grade serous ovarian cancer was associated with worse OS outcomes compared with PDS. 15,17 This survival association was particularly prominent in prognostically more favorable subgroups in general (younger, healthier patients and earlier disease). This age interaction may support a study reporting shorter survival in younger patients with low-grade serous carcinomas.…”

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Uptake and Outcomes of Neoadjuvant Chemotherapy Among US Patients With Less Common Epithelial Ovarian Carcinomas

et al. 2023

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ImportanceRandomized clinical trials examining the effectiveness of neoadjuvant chemotherapy (NACT) for advanced ovarian cancer predominantly included patients with high-grade serous carcinomas. The use and outcomes of NACT in less common epithelial carcinomas are understudied.ObjectiveTo investigate the uptake and survival outcomes in treatment with NACT for less common histologic subtypes of epithelial ovarian cancer.Design, Setting, and ParticipantsA retrospective cohort study and systematic literature review with meta-analysis was conducted using the National Cancer Database from 2006 to 2017 and the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program from 2006 to 2019. Data analysis was performed from July 2022 to April 2023. The evaluation included patients with stage III to IV ovarian cancer with clear cell, mucinous, or low-grade serous histologic subtypes who received multimodal treatment with surgery and chemotherapy.ExposuresExposure assignment per the sequence of treatment: primary debulking surgery (PDS) followed by chemotherapy (PDS group) or NACT followed by interval surgery (NACT group).Main Outcomes and MeasuresTemporal trends and characteristics of NACT use were assessed using multivariable analysis, and overall survival (OS) was assessed with the inverse probability of treatment weighting propensity score.ResultsA total of 3880 patients were examined in the National Cancer Database including 1829 women (median age, 56 [IQR, 49-63] years) with clear cell, 1156 women (median age, 53 [IQR, 42-64] years) with low-grade serous, and 895 women (median age, 57 [IQR, 48-66] years) with mucinous carcinomas. NACT use increased in patients with clear cell (from 10.2% to 16.2%, 58.8% relative increase; P &lt; .001 for trend) or low-grade serous (from 7.7% to 14.2%, 84.4% relative increase; P = .007 for trend) carcinoma during the study period. This association remained consistent in multivariable analysis. NACT use also increased, but nonsignificantly, in mucinous carcinomas (from 8.6% to 13.9%, 61.6% relative increase; P = .07 for trend). Across the 3 histologic subtypes, older age and stage IV disease were independently associated with NACT use. In a propensity score–weighted model, the NACT and PDS groups had comparable OS for clear cell (4-year rates, 31.4% vs 37.7%; hazard ratio [HR], 1.12; 95% CI, 0.95-1.33) and mucinous (27.0% vs 26.7%; HR, 0.90; 95% CI, 0.68-1.19) carcinomas. For patients with low-grade serous carcinoma, NACT was associated with decreased OS compared with PDS (4-year rates, 56.4% vs 81.0%; HR, 2.12; 95% CI, 1.55-2.90). Increasing NACT use and histologic subtype–specific survival association were also found in the Surveillance, Epidemiology, and End Results Program cohort (n = 1447). A meta-analysis of 4 studies, including the current study, observed similar OS associations for clear cell (HR, 1.13; 95% CI, 0.96-1.34; 2 studies), mucinous (HR, 0.93; 95% CI, 0.71-1.21; 2 studies), and low-grade serous (HR, 2.11; 95% CI, 1.63-2.74; 3 studies) carcinomas.Conclusions and RelevanceDespite the lack of data on outcomes of NACT among patients with less common carcinomas, this study noted that NACT use for advanced disease has gradually increased in the US. Primary chemotherapy for advanced-stage, low-grade serous ovarian cancer may be associated with worse survival compared with PDS.

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Trends in the use of neoadjuvant chemotherapy for low-grade serous ovarian cancer in the United States

Silberman

Bercow

Gockley

et al. 2023

Gynecologic Oncology

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Surgical Implications of Advanced Low-Grade Serous Ovarian Cancer: Analysis of the Database of the Tumeurs Malignes Rares Gynécologiques Network

Cited by 5 publications

References 25 publications

Stage, treatment and survival of low‐grade serous ovarian carcinoma in the Netherlands: A nationwide study

Stage, treatment and survival of low‐grade serous ovarian carcinoma in the Netherlands: A nationwide study

Uptake and Outcomes of Neoadjuvant Chemotherapy Among US Patients With Less Common Epithelial Ovarian Carcinomas

Trends in the use of neoadjuvant chemotherapy for low-grade serous ovarian cancer in the United States

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