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Contemporary primary treatment of women with stage II-IV low-grade serous ovarian/peritoneal cancer (LGSOC): Determinants of relapse and disease-free survival

Published:September 19, 2022DOI:https://doi.org/10.1016/j.ygyno.2022.09.005

      Highlights

      • Following contemporary primary therapy, 98% of women with stage II-IV LGSOC who relapsed did so within 5 years of diagnosis.
      • Fifty-one percent of women who received contemporary primary therapy had not relapsed at time of analysis.
      • This study delineates several clinicopathologic factors that may be associated with patient outcomes.

      Abstract

      Objective

      The purpose of the present study is to describe a cohort who received contemporary primary treatment for stage II-IV low-grade serous ovarian/peritoneal cancer (LGSOC), including patient characteristics and determinants of relapse and disease-free survival.

      Methods

      The study included 99 patients: 1) with pathologically confirmed stage II-IV LGSOC of the ovary or peritoneum, 2) who underwent primary treatment consisting of cytoreductive surgery and either a) platinum/taxane chemotherapy followed by aromatase inhibitor maintenance therapy or b) aromatase inhibitor monotherapy, and 3) for whom there was availability of clinical data. Descriptive statistics were used to characterize clinicodemographic features. Subgroups were compared for PFS and OS. Multivariable Cox regression analyses were performed.

      Results

      Median PFS for the entire cohort was 56.8 months (95% CI, 41.3-NE), and median OS was 130.7 months (95% CI, 115.0–146.4). Forty-nine of 99 (49.5%) patients have relapsed to date. For these 49 patients, median time from diagnosis to relapse was 29.6 months (95% CI, 24.6–33.1) (range, 5.4–69.1 months). Only 1/49 (2%) patients who relapsed did so >5 years from diagnosis. Fifty (50.0%) patients have not experienced disease progression or relapse. Median follow-up time for these 50 patients is 86.2 months (range, 25.3–169.0). Thirty-three of the 50 (66.0%) have been followed for >5 years from diagnosis. On regression analyses, factors associated with improved patient outcomes—either PFS, OS, or both–included no gross residual disease, normal serum CA 125 at diagnosis, primary peritoneal site, and presence of extensive psammomatous calcifications.

      Conclusions

      This is the first report to describe the clinicopathologic features and outcomes of women with stage II-IV LGSOC who received contemporary primary therapy.

      Keywords

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      Linked Article

      • Low grade serous ovarian cancer: Unpicking drivers of outcome
        Gynecologic OncologyVol. 167Issue 2
        • Preview
          Low grade serous ovarian cancer (LGSOC) was first recognised as a separate entity almost two decades ago. In the first ten years since then, the number of dedicated LGSOC studies was low, reporting data from only a small number of specialist institutions. However, over the last 5 years there has been a wider, more concerted research effort that has driven substantial progress in uncovering the biological and clinical nuances of this unique disease type. This has included retrospective studies demonstrating the value of endocrine therapy [1,2] which have informed clinical guidelines and first-line trial design [3], randomised phase III trials demonstrating the value of MEK inhibitors in the relapsed disease setting [4,5] and most recently, a number of investigations that have painted a more detailed picture of the molecular landscape in LGSOC [6–9].
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