J Gynecol Oncol.  2019 Jan;30(1):e4. 10.3802/jgo.2019.30.e4.

The detrimental effect of adopting interval debulking surgery in advanced stage low-grade serous ovarian cancer

• Bogani G
• Leone Roberti Maggiore U
• Paolini B
• Diito A
• Martinelli F
• Lorusso D
• Raspagliesi F

• KMID: 2429573
• DOI: http://doi.org/10.3802/jgo.2019.30.e4

Abstract

OBJECTIVE
To examine outcomes of patients having treatments for newly diagnosed advanced stage low-grade serous ovarian cancer (LGSC).
METHODS
We conducted a retrospective case series of women affected by advanced stage (stage IIIB or more) LGSC undergoing surgery in a single oncologic center between January 2000 and December 2017. Survival outcomes were assessed using Kaplan-Meier and Cox models.
RESULTS
Data of 72 patients were retrieved. Primary cytoreductive surgery was attempted in 68 (94.4%) patients: 19 (27.9%) had residual disease (RD) >1 cm after primary surgery. Interval debulking surgery (IDS) was attempted in 15 of these 19 (78.9%) patients and the remaining 4 patients having not primary debulking surgery. Twelve out of 19 (63.1%) patients having IDS had RD. After a mean (±standard deviation) follow-up was 61.6 (±37.2) months, 50 (69.4%) and 22 (30.5%) patients recurred and died of disease, respectively. Via multivariate analysis, non-optimal cytoreduction (hazard ratio [HR]=2.79; 95% confidence interval [CI]=1.16-6.70; p=0.021) and International Federation of Obstetrics and Gynecologists (FIGO) stage IV (HR=3.15; 95% CI=1.29-7.66; p=0.011) were associated with worse disease-free survival. Via multivariate analysis, absence of significant comorbidities (HR=0.56; 95% CI=0.29-1.10; p=0.093) and primary instead of IDS (HR=2.95; 95% CI=1.12-7.74; p=0.027) were independently associated with an improved overall survival.
CONCLUSION
LGSC is at high risk of early recurrence. However, owing to the indolent nature of the disease, the majority of patients are long-term survivors. Further prospective studies and innovative treatment modalities are warranted to improve patients care.

Keyword

Ovarian Neoplasms; Drug Therapy; Neoplasm Metastasis; Gynecologic Surgical Procedures; Cytoreduction Surgical Procedures

MeSH Terms

Comorbidity
Cytoreduction Surgical Procedures
Disease-Free Survival
Drug Therapy
Female
Follow-Up Studies
Gynecologic Surgical Procedures
Humans
Multivariate Analysis
Neoplasm Metastasis
Obstetrics
Ovarian Neoplasms*
Proportional Hazards Models
Prospective Studies
Recurrence
Retrospective Studies
Survivors