Journal of Clinical Medicine

Editorial

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Open AccessEditorial

Ovarian Cancer: Latest Advances and Prospects

by Ludivine Dion and Vincent Lavoué

J. Clin. Med. 2021, 10(24), 5919; https://doi.org/10.3390/jcm10245919 - 17 Dec 2021

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Abstract

The landscape of ovarian cancer therapeutics is experiencing an increase in new opportunities [...] Full article

(This article belongs to the Special Issue Ovarian Cancer: Latest Advances and Prospects)

Research

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11 pages, 1768 KiB

Open AccessArticle

Does Time-to-Chemotherapy after Primary Complete Macroscopic Cytoreductive Surgery Influence Prognosis for Patients with Epithelial Ovarian Cancer? A Study of the FRANCOGYN Group

by Grégoire Rocher, Thomas Gaillard, Catherine Uzan, Pierre Collinet, Pierre-Adrien Bolze, Marcos Ballester, Sofiane Bendifallah, Lobna Ouldamer, Cyril Touboul, Cyrille Huchon, Vincent Lavoue, Yohann Dabi, Cherif Akladios, Charles Coutant, Emilie Raimond, Alexandre Bricou, Geoffroy Canlorbe and Henri Azaïs

J. Clin. Med. 2021, 10(5), 1058; https://doi.org/10.3390/jcm10051058 - 4 Mar 2021

Cited by 9 | Viewed by 1819

Abstract

To determine if the time-to-chemotherapy (TTC) after primary macroscopic complete cytoreductive surgery (CRS) influences recurrence-free survival (RFS) and overall survival (OS) in patients with epithelial ovarian cancer (EOC). We conducted an observational multicenter retrospective cohort analysis of women with EOC treated from September [...] Read more.

To determine if the time-to-chemotherapy (TTC) after primary macroscopic complete cytoreductive surgery (CRS) influences recurrence-free survival (RFS) and overall survival (OS) in patients with epithelial ovarian cancer (EOC). We conducted an observational multicenter retrospective cohort analysis of women with EOC treated from September 2006 to November 2016 in nine institutions in France (FRANCOGYN research group) with maintained EOC databases. We included women with EOC (all FIGO stages) who underwent primary complete macroscopic CRS prior to platinum-based adjuvant chemotherapy. Two hundred thirty-three patients were included: 73 (31.3%) in the early-stage group (ESG) (FIGO I-II), and 160 (68.7%) in the advanced-stage group (ASG) (FIGO III-IV). Median TTC was 43 days (36–56). The median OS was 77.2 months (65.9–106.6). OS was lower in the ASG when TTC exceeded 8 weeks (70.5 vs. 59.3 months, p = 0.04). No impact on OS was found when TTC was below or above 6 weeks (78.5 and 66.8 months, respectively, p = 0.25). In the whole population, TTC had no impact on RFS or OS. None of the factors studied were associated with an increase in TTC. Chemotherapy should be initiated as soon as possible after CRS. A TTC greater than 8 weeks is associated with poorer OS in patients with advanced stage EOC. Full article

(This article belongs to the Special Issue Ovarian Cancer: Latest Advances and Prospects)

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11 pages, 1383 KiB

Open AccessArticle

Assessment of Lymph Node Involvement with PET-CT in Advanced Epithelial Ovarian Cancer. A FRANCOGYN Group Study

by Antoine Tardieu, Lobna Ouldamer, François Margueritte, Lauranne Rossard, Aymeline Lacorre, Nicolas Bourdel, Guillaume Lades, Camille Sallée, Jacques Monteil and Tristan Gauthier

J. Clin. Med. 2021, 10(4), 602; https://doi.org/10.3390/jcm10040602 - 5 Feb 2021

Cited by 6 | Viewed by 1895

Abstract

The objective of our study is to evaluate the diagnostic performance of positron emission tomography/computed tomography (PET-CT) for the assessment of lymph node involvement in advanced epithelial ovarian, fallopian tubal or peritoneal cancer (EOC). This was a retrospective, bicentric study. We included all [...] Read more.

The objective of our study is to evaluate the diagnostic performance of positron emission tomography/computed tomography (PET-CT) for the assessment of lymph node involvement in advanced epithelial ovarian, fallopian tubal or peritoneal cancer (EOC). This was a retrospective, bicentric study. We included all patients over 18 years of age with a histological diagnosis of advanced EOC who had undergone PET-CT at the time of diagnosis or prior to cytoreduction surgery with pelvic or para-aortic lymphadenectomy. We included 145 patients with primary advanced EOC. The performance of PET-CT was calculated from the data of 63 patients. The sensitivity of PET-CT for preoperative lymph node evaluation was 26.7%, specificity was 90.9%, PPV was 72.7%, and NPV was 57.7%. The accuracy rate was 60.3%, and the false-negative rate was 34.9%. In the case of primary cytoreduction (n = 16), the sensitivity of PET-CT was 50%, specificity was 87.5%, PPV was 80%, and NPV was 63.6%. The accuracy rate was 68.8%, and the false negative rate was 25%. After neoadjuvant chemotherapy (n = 47), the sensitivity of PET-CT was 18.2%, specificity was 92%, PPV was 66.7%, and NPV was 56.1%. The accuracy rate was 57.5%, and the false negative rate was 38.3%. Due to its high specificity, the performance of a preoperative PET-CT scan could contribute to the de-escalation and reduction of lymphadenectomy in the surgical management of advanced EOC in a significant number of patients free of lymph node metastases. Full article

(This article belongs to the Special Issue Ovarian Cancer: Latest Advances and Prospects)

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13 pages, 1540 KiB

Open AccessArticle

Microscopic Peritoneal Residual Disease after Complete Macroscopic Cytoreductive Surgery for Advanced High Grade Serous Ovarian Cancer

by Henri Azaïs, Anne-Sophie Vignion-Dewalle, Marine Carrier, Jeremy Augustin, Elisabeth Da Maïa, Alix Penel, Jérémie Belghiti, Marianne Nikpayam, Clémentine Gonthier, Laurine Ziane, Serge Mordon, Pierre Collinet, Geoffroy Canlorbe and Catherine Uzan

J. Clin. Med. 2021, 10(1), 41; https://doi.org/10.3390/jcm10010041 - 25 Dec 2020

Cited by 16 | Viewed by 2665

Abstract

Background: Epithelial ovarian cancers (EOC) are usually diagnosed at an advanced stage and managed by complete macroscopic cytoreductive surgery (CRS) and systemic chemotherapy. Peritoneal recurrence occurs in 60% of patients and may be due to microscopic peritoneal metastases (mPM) which are neither eradicated [...] Read more.

Background: Epithelial ovarian cancers (EOC) are usually diagnosed at an advanced stage and managed by complete macroscopic cytoreductive surgery (CRS) and systemic chemotherapy. Peritoneal recurrence occurs in 60% of patients and may be due to microscopic peritoneal metastases (mPM) which are neither eradicated by surgery nor controlled by systemic chemotherapy. The aim of this study was to assess and quantify the prevalence of residual mPM after complete macroscopic CRS in patients with advanced high-grade serous ovarian cancer (HGSOC). Methods: A prospective study conducted between 1 June 2018 and 10 July 2019 in a single referent center accredited by the European Society of Gynecological Oncology for advanced EOC management. Consecutive patients presenting with advanced HGSOC and eligible for complete macroscopic CRS were included. Up to 13 peritoneal biopsies were taken from macroscopically healthy peritoneum at the end of CRS and examined for the presence of mPM. A mathematical model was designed to determine the probability of presenting at least one mPM after CRS. Results: 26 patients were included and 26.9% presented mPM. There were no differences in characteristics between patients with or without identified mPM. After mathematical analysis, the probability that mPM remained after complete macroscopic CRS in patients with EOC was 98.14%. Conclusion: Microscopic PM is systematically present after complete macroscopic CRS for EOC and could be a relevant therapeutic target. Adjuvant locoregional strategies to conventional surgery may improve survival by achieving microscopic CRS. Full article

(This article belongs to the Special Issue Ovarian Cancer: Latest Advances and Prospects)

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14 pages, 1779 KiB

Open AccessArticle

Impact on Prognosis of the Surgical Route, Laparoscopy or Laparotomy, for the Surgical Staging of Early Stage Ovarian Cancer—A Study from the FRANCOGYN Group

by Margaux Merlier, Yohan Kerbage, Adeline Pierache, Nassima Ramdane, Geoffroy Canlorbe, Pierre-Adrien Bolze, Marcos Ballester, Sofiane Bendifallah, Lobna Ouldamer, Cyril Touboul, Cyrille Huchon, Vincent Lavoue, Yohann Dabi, Cherik Akladios, Charles Coutant, Emilie Raimond, Alexandre Bricou, Jerôme Phalippou, Pierre Collinet and Henri Azaïs

J. Clin. Med. 2020, 9(11), 3528; https://doi.org/10.3390/jcm9113528 - 31 Oct 2020

Cited by 12 | Viewed by 4357

Abstract

Background and objective: according to the latest ESMO−ESGO recommendations, laparotomy is the standard surgical approach to treat and stage patients with presumed early stage epithelial ovarian cancer (EOC). A few studies have investigated the efficacy and the safety of laparoscopy for the staging [...] Read more.

Background and objective: according to the latest ESMO−ESGO recommendations, laparotomy is the standard surgical approach to treat and stage patients with presumed early stage epithelial ovarian cancer (EOC). A few studies have investigated the efficacy and the safety of laparoscopy for the staging of early stage EOC, and this question is still in the center of debates. Recurrence-free survival (RFS) and overall survival (OS) benefits of the minimally invasive surgery (MIS) have still to be specified. The aim of this multicenter and retrospective study is to assess the survival outcomes of laparoscopic staging in comparison with laparotomic staging for patients presenting with an early stage EOC. Methods: data of patients with early stage EOC (FIGO I-IIA) who underwent primary surgery between 2000 and 2018 were extracted from the FRANCOGYN database. OS and RFS of these two groups, constituted according to the surgical route, were compared using Log rank test. Results: of the 144 patients included, 107 patients underwent laparotomy and 37 underwent laparoscopy for a staging purpose. The median follow-up was 36.0 months (18.0 to 58.0). For the laparoscopy and the laparotomy group, the median follow-up period was 24 (11.0 to 50.0) and 42.0 (24.0 to 66.0) months, respectively, (p < 0.001). Tumor recurrence occurred in 33 (23%) patients: 2 (5.4%) in the laparoscopy group and 31 (29%) in the laparotomy group (p = 0.08). The OS rate at 5 years was 97.3% after laparoscopy and 79.8% after laparotomy (p = 0.19). Conclusions: there is no difference associated with the laparoscopic approach for the staging of early stage EOC on RFS and OS in comparison with laparotomy. MIS may be proposed as a safe and adequate alternative to laparotomy when performed by well-trained surgeons. Full article

(This article belongs to the Special Issue Ovarian Cancer: Latest Advances and Prospects)

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14 pages, 3928 KiB

Open AccessArticle

H2A Histone Family Member X (H2AX) Is Upregulated in Ovarian Cancer and Demonstrates Utility as a Prognostic Biomarker in Terms of Overall Survival

by Sayeh Saravi, Eriko Katsuta, Jeyarooban Jeyaneethi, Hasnat A. Amin, Matthias Kaspar, Kazuaki Takabe, George Pados, Fotios Drenos, Marcia Hall and Emmanouil Karteris

J. Clin. Med. 2020, 9(9), 2844; https://doi.org/10.3390/jcm9092844 - 2 Sep 2020

Cited by 8 | Viewed by 2993

Abstract

Background: H2AX can be of prognostic value in breast cancer, since in advanced stage patients with high levels, there was an association with worse overall survival (OS). However, the clinical relevance of H2AX in ovarian cancer (OC) remains to be elucidated. Methods [...] Read more.

Background: H2AX can be of prognostic value in breast cancer, since in advanced stage patients with high levels, there was an association with worse overall survival (OS). However, the clinical relevance of H2AX in ovarian cancer (OC) remains to be elucidated. Methods: OC H2AX expression studied using the TCGA/GTEX datasets. Subsequently, patients were classified as either high or low in terms of H2AX expression to compare OS and perform gene set enrichment. qRT-PCR validated in-silico H2AX findings followed by immunohistochemistry on a tissue microarray. The association between single nucleotide polymorphisms in the area of H2AX; prevalence and five-year OC survival was tested in samples from the UK Biobank. Results: H2AX was significantly overexpressed in OCs compared to normal tissues, with higher expression associated with better OS (p = 0.010). Gene Set Enrichment Analysis demonstrated gene sets involved in G2/M checkpoint, DNA repair mTORC1 signalling were enriched in the H2AX highly expressing OCs. Polymorphisms in the area around the gene were associated with both OC prevalence (rs72997349-C, p = 0.005) and worse OS (rs10790282-G, p = 0.011). Finally, we demonstrated that H2AX gene expression correlated with γ-H2AX staining in vitro. Conclusions: Our findings suggest that H2AX can be a novel prognostic biomarker for OC. Full article

(This article belongs to the Special Issue Ovarian Cancer: Latest Advances and Prospects)

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18 pages, 3442 KiB

Open AccessArticle

Intraoperative Clinical Examination for Assessing Pelvic and Para-Aortic Lymph Node Involvement in Advanced Epithelial Ovarian Cancer: A Systematic Review and Meta-Analysis

by Camille Mimoun, Jean Louis Benifla, Arnaud Fauconnier and Cyrille Huchon

J. Clin. Med. 2020, 9(9), 2793; https://doi.org/10.3390/jcm9092793 - 29 Aug 2020

Cited by 7 | Viewed by 2206

Abstract

After the publication of the Lymphadenectomy in Ovarian Neoplasms (LION) trial results, lymphadenectomy in advanced epithelial ovarian cancer with primary complete cytoreductive surgery is considered indicated only for women with suspicious lymph nodes. The aim of this meta-analysis was to evaluate the diagnostic [...] Read more.

After the publication of the Lymphadenectomy in Ovarian Neoplasms (LION) trial results, lymphadenectomy in advanced epithelial ovarian cancer with primary complete cytoreductive surgery is considered indicated only for women with suspicious lymph nodes. The aim of this meta-analysis was to evaluate the diagnostic accuracy of intraoperative clinical examination for detecting lymph node metastases in patients with advanced epithelial ovarian cancer during primary complete cytoreductive surgery. MEDLINE, EMBASE, Web of Science and the Cochrane Library were searched for January 1990 to May 2019 for studies evaluating the diagnostic accuracy of intraoperative clinical examination for detecting lymph node metastases in patients with advanced epithelial ovarian cancer during primary complete cytoreductive surgery, with histology as the gold standard. Methodological quality was assessed by using the QUADAS-2 tool. Pooled diagnostic accuracy was calculated, and hierarchical summary receiver operating curve was constructed. The potential sources of heterogeneity were analyzed by meta-regression analysis. Deek’s funnel plot test for publication bias and Fagan’s nomogram for clinical utility were also used. This meta-analysis included five studies involving 723 women. The pooled sensitivity of intraoperative clinical examination for detecting lymph node metastases was 0.79, 95% CI (0.67–0.87), and its specificity 0.85, 95% CI (0.67–0.94); the area under the hierarchical summary receiver operating curve was 0.86, 95% CI (0.83–0.89). In the meta-regression analysis, patient sample size, mean age, and type of cancer included were significant covariates explaining the potential sources of heterogeneity. Deek’s funnel plot test showed no evidence of publication bias (p = 0.25). Fagan’s nomogram indicated that intraoperative clinical examination increased the post-test probability of lymph node metastases to 79% when it was positive and reduced it to 16% when negative. This meta-analysis shows that the diagnostic accuracy of intraoperative clinical examination during primary complete cytoreductive surgery for detecting lymph node metastases in advanced epithelial ovarian cancer is good. Full article

(This article belongs to the Special Issue Ovarian Cancer: Latest Advances and Prospects)

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17 pages, 1181 KiB

Open AccessArticle

Impact of Lymphadenectomy on Survival of Patients with Serous Advanced Ovarian Cancer After Neoadjuvant Chemotherapy: A French National Multicenter Study (FRANCOGYN)

by Virginie Bund, Lise Lecointre, Michel Velten, Lobna Ouldamer, Sofiane Bendifallah, Martin Koskas, Pierre-Adrien Bolze, Pierre Collinet, Geoffroy Canlorbe, Cyril Touboul, Cyrille Huchon, Charles Coutant, Emilie Faller, Thomas Boisramé, Justine Gantzer, Martin Demarchi, Jean-Jacques Baldauf, Marcos Ballester, Vincent Lavoué and Chérif Akladios

J. Clin. Med. 2020, 9(8), 2427; https://doi.org/10.3390/jcm9082427 - 29 Jul 2020

Cited by 14 | Viewed by 2436

Abstract

Background: The population of interest to this study comprised individuals with advanced-stage ovarian carcinoma who were exposed to neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS). Those who had not received systematic lymphadenectomy (SL; Group 1) were compared to those who had [...] Read more.

Background: The population of interest to this study comprised individuals with advanced-stage ovarian carcinoma who were exposed to neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS). Those who had not received systematic lymphadenectomy (SL; Group 1) were compared to those who had received SL (Group 2). Outcome measures included progression-free survival (PFS), overall survival (OS), and surgical complications. Methods: This was a retrospective, multicenter cohort study in nine referral centers of France between January 2000 and June 2017. OS analysis using the multivariate Cox regression model was performed. PFS and surgery-related morbidity were analyzed. Results: Of the 255 patients included, 100 were in Group 1 and 155 in Group 2. Patient majority was, on average, younger and less comorbid, with predominant R0 surgery in Group 2. Dindo–Clavien score was similar between the two groups (p = 0.15). Median OS was 26.8 months in Group 2 and 27.6 months in Group 1. SL was not statistically significant on OS (p = 0.7). Median PFS was 18.3 months in Group 2 and 16.6 months in Group 1. SL had positive impact on PFS (p = 0.005). Conclusions: patients who had received SL (Group 2) had significantly higher PFS regardless of node-positivity status when compared to those who had not received SL (Group 1). Full article

(This article belongs to the Special Issue Ovarian Cancer: Latest Advances and Prospects)

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14 pages, 836 KiB

Open AccessArticle

Management and Survival of Elderly and Very Elderly Patients with Ovarian Cancer: An Age-Stratified Study of 1123 Women from the FRANCOGYN Group

by Yolaine Joueidi, Ludivine Dion, Sofiane Bendifallah, Camille Mimoun, Alexandre Bricou, Krystel Nyangoh Timoh, Pierre Collinet, Cyril Touboul, Lobna Ouldamer, Henri Azaïs, Yohann Dabi, Cherif Akladios, Geoffroy Canlorbe, Pierre-Adrien Bolze, Hélène Costaz, Mathieu Mezzadri, Tristan Gauthier, Frederic Kridelka, Pauline Chauvet, Nicolas Bourdel, Martin Koskas, Xavier Carcopino, Emilie Raimond, Olivier Graesslin, Lise Lecointre, Marcos Ballester, Cyrille Huchon, Jean Levêque and Vincent Lavoué Show full author list Hide full author list

J. Clin. Med. 2020, 9(5), 1451; https://doi.org/10.3390/jcm9051451 - 13 May 2020

Cited by 14 | Viewed by 2888

Abstract

Elderly women with ovarian cancer are often undertreated due to a perception of frailty. We aimed to evaluate the management of young, elderly and very elderly patients and its impact on survival in a retrospective multicenter study of women with ovarian cancer between [...] Read more.

Elderly women with ovarian cancer are often undertreated due to a perception of frailty. We aimed to evaluate the management of young, elderly and very elderly patients and its impact on survival in a retrospective multicenter study of women with ovarian cancer between 2007 to 2015. We included 979 women: 615 women (62.8%) <65 years, 225 (22.6%) 65–74 years, and 139 (14.2%) ≥75 years. Women in the 65–74 years age group were more likely to have serous ovarian cancer (p = 0.048). Patients >65 years had more >IIa FIGO stage: 76% for <65 years, 84% for 65–74 years and 80% for ≥75 years (p = 0.033). Women ≥75 years had less standard procedures (40% (34/84) vs. 59% (104/177) for 65–74 years and 72% (384/530) for <65 years (p < 0.001). Only 9% (13/139) of women ≥75 years had an Aletti score >8 compared with 16% and 22% for the other groups (p < 0.001). More residual disease was found in the two older groups (30%, respectively) than the younger group (20%) (p < 0.05). Women ≥75 years had fewer neoadjuvant/adjuvant cycles than the young and elderly women: 23% ≥75 years received <6 cycles vs. 10% (p = 0.003). Univariate analysis for 3-year Overall Survival showed that age >65 years, FIGO III (HR = 3.702, 95%CI: 2.30–5.95) and IV (HR = 6.318, 95%CI: 3.70–10.77) (p < 0.001), residual disease (HR = 3.226, 95%CI: 2.51–4.15; p < 0.001) and lymph node metastasis (HR = 2.81, 95%CI: 1.91–4.12; p < 0.001) were associated with lower OS. Women >65 years are more likely to have incomplete surgery and more residual disease despite more advanced ovarian cancer. These elements are prognostic factors for women’s survival regardless of age. Specific trials in the elderly would produce evidence-based medicine and guidelines for ovarian cancer management in this population. Full article

(This article belongs to the Special Issue Ovarian Cancer: Latest Advances and Prospects)

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12 pages, 566 KiB

Open AccessArticle

Ovarian Cancer in the Elderly: Time to Move towards a More Logical Approach to Improve Prognosis—A Study from the FRANCOGYN Group

by Ludivine Dion, Camille Mimoun, Krystel Nyangoh Timoh, Sofiane Bendifallah, Alexandre Bricou, Pierre Collinet, Cyril Touboul, Lobna Ouldamer, Henri Azaïs, Yohann Dabi, Cherif Akladios, Geoffroy Canlorbe, Pierre-Adrien Bolze, Hélène Costaz, Mathieu Mezzadri, Tristan Gauthier, Frederik Kridelka, Pauline Chauvet, Nicolas Bourdel, Martin Koskas, Xavier Carcopino, Emilie Raimond, Olivier Graesslin, Lise Lecointre, Marcos Ballester, Jean Levêque, Cyrille Huchon and Vincent Lavoué Show full author list Hide full author list

J. Clin. Med. 2020, 9(5), 1339; https://doi.org/10.3390/jcm9051339 - 4 May 2020

Cited by 23 | Viewed by 3149

Abstract

Background and objective: Elderly and/or frail women with ovarian cancer are often undertreated. The aim of the study is to compare the effects of age and frailty on surgical approaches, postoperative complications, and prognosis in elderly women with ovarian cancer. Methods: A retrospective [...] Read more.

Background and objective: Elderly and/or frail women with ovarian cancer are often undertreated. The aim of the study is to compare the effects of age and frailty on surgical approaches, postoperative complications, and prognosis in elderly women with ovarian cancer. Methods: A retrospective multicenter study of women ≥70 years were treated for ovarian cancer at seven French university hospitals between 2007 and 2015. Results: Of the 1119 women treated for ovarian cancer during the study period, 147 were ≥70 years and had complete data. Of these women, 65 were aged 70–74 years, and 82 were aged ≥75 years. Overall, 77% of the younger women (49/65) received optimal treatment compared with 51% (40/82) of the older women (p = 0.018). Women ≥75 years underwent fewer bowel resections (32% vs. 67%, p < 0.001) and experienced fewer postoperative complications (22.6% vs. 38.9%, p < 0.001); 53.2% of the women in this age group were treated by primary surgery or surgery only. These women also received more chemotherapy with platinum only (15% [9/56] vs. 2% [1/57], p = 0.007) and less bevacizumab (9% [5/56] vs. 32% [18/57], p = 0.003). Patients with greater frailty (a modified Charlson Comorbidity Index [mCCI] score >3) had a five-year survival rate of 30% versus 62% for those with a score ≤3 (p < 0.001). Conclusions: Surgeons modify their approach to treating ovarian cancer in women ≥75 years probably to reduce immediate postoperative complications. The prognosis is significantly worse in patients with greater frailty. Improvements to the sequence of treatments administered, with priority given to neoadjuvant chemotherapy in patients with greater frailty, could help increase the number of women who receive optimal treatment and improve their prognosis. Full article

(This article belongs to the Special Issue Ovarian Cancer: Latest Advances and Prospects)

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Review

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9 pages, 502 KiB

Open AccessReview

Clinical Impact of Lymphadenectomy after Neoadjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer: A Review of Available Data

by Stephanie Seidler, Meriem Koual, Guillaume Achen, Enrica Bentivegna, Laure Fournier, Nicolas Delanoy, Huyên-Thu Nguyen-Xuan, Anne-Sophie Bats and Henri Azaïs

J. Clin. Med. 2021, 10(2), 334; https://doi.org/10.3390/jcm10020334 - 18 Jan 2021

Cited by 7 | Viewed by 1976

Abstract

Recent robust data allow for omitting lymph node dissection for patients with advanced epithelial ovarian cancer (EOC) and without any suspicion of lymph node metastases, without compromising recurrence-free survival (RFS), nor overall survival (OS), in the setting of primary surgical treatment. Evidence supporting [...] Read more.

Recent robust data allow for omitting lymph node dissection for patients with advanced epithelial ovarian cancer (EOC) and without any suspicion of lymph node metastases, without compromising recurrence-free survival (RFS), nor overall survival (OS), in the setting of primary surgical treatment. Evidence supporting the same postulate for patients undergoing complete cytoreductive surgery after neoadjuvant chemotherapy (NACT) is lacking. Throughout a systematic literature review, the aim of our study was to evaluate the impact of lymph node dissection in patients undergoing surgery for advanced-stage EOC after NACT. A total of 1094 patients, included in six retrospective series, underwent either systematic, selective or no lymph node dissection. Only one study reveals a positive effect of lymphadenectomy on OS, and two on RFS. The four remaining series fail to demonstrate any beneficial effect on survival, neither for RFS nor OS. All of them highlight the higher peri- and post-operative complication rate associated with systematic lymph node dissection. Despite heterogeneity in the design of the studies included, there seems to be a trend showing no improvement on OS for systematic lymph node dissection in node negative patients. A well-conducted prospective trial is mandatory to evaluate this matter. Full article

(This article belongs to the Special Issue Ovarian Cancer: Latest Advances and Prospects)

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12 pages, 646 KiB

Open AccessReview

The Landscape and Therapeutic Implications of Molecular Profiles in Epithelial Ovarian Cancer

by Ludivine Dion, Isis Carton, Sylvie Jaillard, Krystel Nyangoh Timoh, Sébastien Henno, Hugo Sardain, Fabrice Foucher, Jean Levêque, Thibault de la Motte Rouge, Susie Brousse and Vincent Lavoué

J. Clin. Med. 2020, 9(7), 2239; https://doi.org/10.3390/jcm9072239 - 15 Jul 2020

Cited by 25 | Viewed by 3535

Abstract

Epithelial ovarian cancer (EOC) affects 43,000 women worldwide every year and has a five-year survival rate of 30%. Mainstay treatment is extensive surgery and chemotherapy. Outcomes could be improved by molecular profiling. We conducted a review of the literature to identify relevant publications [...] Read more.

Epithelial ovarian cancer (EOC) affects 43,000 women worldwide every year and has a five-year survival rate of 30%. Mainstay treatment is extensive surgery and chemotherapy. Outcomes could be improved by molecular profiling. We conducted a review of the literature to identify relevant publications on molecular and genetic alterations in EOC. Approximately 15% of all EOCs are due to BRCA1 or BRCA2 mutations. Four histologic subtypes characterized by different mutations have been described: serous, endometrioid, mucinous, and clear-cell. Between 20–30% of high-grade serous EOCs have a BRCA mutation. Tumors with BRCA mutations are unable to repair double-strand DNA breaks, making them more sensitive to platinum-based chemotherapy and to PolyAdenosine Diphosphate-Ribose Polymerase (PARP) inhibitors. Olaparib is a PARP inhibitor with proven efficacy in BRCA-mutated ovarian cancer, but its effectiveness remains to be demonstrated in tumors with a BRCAness (breast cancer) profile (i.e., also including sporadic tumors in patients with deficient DNA repair genes). A universally accepted molecular definition of BRCAness is required to identify optimal theranostic strategies involving PARP inhibitors. Gene expression analyses have led to the identification of four subgroups of high-grade serous EOC: mesenchymal, proliferative, differentiated, and immunoreactive. These subtypes are not mutually exclusive but are correlated with prognosis. They are not yet used in routine clinical practice. A greater understanding of EOC subtypes could improve patient management. Full article

(This article belongs to the Special Issue Ovarian Cancer: Latest Advances and Prospects)

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