Prognostic impact of microscopic residual disease after neoadjuvant chemotherapy in patients undergoing interval debulking surgery for advanced ovarian cancer.

Oct 14, 2024

Experts: Violante Di Donato,Giuseppe Caruso,Tullio Golia D'Augè,Giorgia Perniola,Innocenza Palaia,Federica Tomao,Ludovico Muzii,Angelina Pernazza,Carlo Della Rocca,Giorgio Bogani,Pierluigi Benedetti Panici,Andrea Giannini

To determine the prognostic impact of microscopic residual disease after neoadjuvant chemotherapy (NACT) in patients undergoing interval debulking surgery (IDS) for advanced epithelial ovarian cancer (AEOC).
Patients affected by FIGO stage IIIC-IV ovarian cancer undergoing IDS between October 2010 and April 2016 were selected. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier analysis.
In total, 98 patients were identified. Four patients (4.1%) were considered inoperable. Overall, 67 patients (out of 94; 71.3%) had macroscopic disease, equating Chemotherapy Response Score (CRS) 1 and 2, 7 (7.4%) had microscopic residuals, equating CRS3, rare CRS2, while 20 (21.3%) had both microscopic and macroscopic disease. Median OS and PFS were, respectively, 44 and 14 months in patients with no macroscopic residual disease (RD = 0) compared to 25 and 6 months, in patients with RD > 0 (OS: p = 0.001; PFS: p = 0.002). The median PFS was 9 months compared to 14 months for patients with more or less than 3 areas of microscopic disease at final pathologic evaluation (p = 0.04). The serum Ca125 dosage after NACT was higher in patients with RD > 0 compared to those without residue (986.31 ± 2240.7 µg/mL vs 215.72 ± 349.5 µg/mL; p = 0.01).
Even in the absence of macroscopic disease after NACT, the persistence of microscopic residuals predicts a poorer prognosis among AEOC patients undergoing IDS, with a trend towards worse PFS for patients with more than three affected areas. Removing all fibrotic residuals eventually hiding microscopic disease during IDS represents the key to improving the prognosis of these patients.

© 2024. The Author(s).

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ABOUT THE EXPERTS

Violante Di Donato,Giuseppe Caruso,Tullio Golia D'Augè,Giorgia Perniola,Innocenza Palaia,Federica Tomao,Ludovico Muzii,Angelina Pernazza,Carlo Della Rocca,Giorgio Bogani,Pierluigi Benedetti Panici,Andrea Giannini

Violante Di Donato

Department of Maternal and Child Health and Urological Sciences, University of Rome Sapienza, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy. violante.didonato@uniroma1.it.

Giuseppe Caruso

Department of Maternal and Child Health and Urological Sciences, University of Rome Sapienza, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.

Tullio Golia D’Augè

Department of Maternal and Child Health and Urological Sciences, University of Rome Sapienza, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.

Giorgia Perniola

Department of Maternal and Child Health and Urological Sciences, University of Rome Sapienza, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.

Innocenza Palaia

Department of Maternal and Child Health and Urological Sciences, University of Rome Sapienza, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.

Federica Tomao

Department of Maternal and Child Health and Urological Sciences, University of Rome Sapienza, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.

Ludovico Muzii

Department of Maternal and Child Health and Urological Sciences, University of Rome Sapienza, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.

Angelina Pernazza

Department of Medical-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Rome, Italy.

Carlo Della Rocca

Department of Medical-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Rome, Italy.

Giorgio Bogani

Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Milan, Italy.

Pierluigi Benedetti Panici

Department of Maternal and Child Health and Urological Sciences, University of Rome Sapienza, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.

Andrea Giannini

Unit of Gynecology, Department of Surgical and Medical Sciences and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy.