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

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

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    Abstract

    The surgical specificities of advanced low-grade serous ovarian carcinoma (LGSOC) have been little investigated. Our objective was to describe surgical procedures/complications in primary (PDS) compared to interval debulking surgery (neoadjuvant chemotherapy and interval debulking surgery, NACT-IDS) and to assess the survival (progression-free (PFS) and overall survival (OS)) in patients with advanced LGSOC. We retrospectively analyzed advanced LGSOC from a nationwide registry (January 2000 to July 2017). A total of 127 patients were included (48% PDS and 35% NACT-IDS). Peritoneal carcinomatosis was more severe (p = 0.01 to 0.0001, according to sites), surgery more complex (p = 0.03) and late postoperative morbidity more frequent (p = 0.03) and more severe in the NACT-IDS group. PFS and OS were similar in patients with CC0 and CC1 residual disease after PDS or IDS. Prognosis was poorest for NACT-IDS patients with CC2/CC3 resection (PFS: HR = 2.31, IC95% (1.3–4.58); p = 0.005; OS: HR = 4.98, IC95% (1.59–15.61); p = 0.006). NACT has no benefit in terms of surgical outputs in patients with advanced LGSOC. Patients with complete resection or minimal residual disease (CC0 and CC1) have similar prognoses. On the other hand, patients with CC2 and more residual disease have similar survival rates compared to nonoperated patients. Primary cytoreduction with complete or with minimal residuals should be preferred when feasible.

    Original languageEnglish
    Article number2345
    JournalCancers
    Volume14
    Issue number9
    DOIs
    Publication statusPublished - 1 May 2022

    Keywords

    • advanced stage
    • low-grade serous ovarian cancer
    • neoadjuvant chemotherapy
    • surgery
    • survival

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