Cecile Loaec

Is minimally invasive surgical approach a reasonable option in apparent early stage epithelial ovarian cancer restaging? Results from a multicentric retrospective study

To perform surgical staging of early stage ovarian cancer (EOC), conventional laparoscopy (LS) and robot-assisted laparoscopy (RLS) appear to be reliable procedures compared to open surgery. But oncologicals results with long-term follow up are limited in the literature. The objective of this study is to evaluate the surgical and long-term survival for patients managed by minimally invasive surgery (MIS). We conducted a multicentric retrospective study in 6 institutions. All patients referred for epithelial EOC (apparent stage I-IIa) managed with LS and RLS were involved. From December 2008 to December 2017, 140 patients were included (109 in LS group and 31 in RLS group). A total of 27 (19.2 %) patients were upstaged to an advanced ovarian cancer (FIGO stage > IIA), and 73 % of patients received chemotherapy. Mean operative time was 265,8 ± 88,4 min and significantly longer in RLS group (LS = 254,5 ± 86,8; RLS = 305,6 ± 85,5; p = 0,008). Rate of severe post-operative complications (grade 3) was 5,7 %. Thirteen conversion to laparotomy occurred, including one per-operative hemorrhaege. After a mean follow-up of 60,7 months, 29 (20.7 %) patients recurred, with a time to recurrence was >24 months in 51,7 % of cases. Overall survival (OS) was 88.6 % and disease-free survival (DFS) was 79.3 %. Oncologic outcomes were similar between LS and RLS group (OS: p = 0,504 and DFS: p = 0,213). Surgical staging of EOC by LS or RLS approach has long-term equivalent surgical and oncological approach. These results seem to be equivalent to open surgery according to literature review.

Clinical impact of CA-125 ELIMination rate constant K (KELIM) on surgical strategy in advanced serous ovarian cancer patients

The modeled CA-125 elimination constant K (KELIM) is a pragmatic early marker of tumor chemosensitivity in ovarian cancer patients treated with neoadjuvant chemotherapy before interval surgery. The primary objective of this study was to assess the prognostic value of KELIM regarding the feasibility of complete surgery, and secondary objectives were to assess the prognostic value of KELIM for the risk of a platinum resistant relapse, progression free survival, and overall survival. The study was based on a retrospective cohort of 284 patients treated for an advanced serous high grade ovarian cancer, International Federation of Gynecology and Obstetrics (FIGO) stages III-IV, with neoadjuvant chemotherapy, followed by interval surgery, in a comprehensive cancer center. CA-125 concentrations at baseline and during neoadjuvant chemotherapy were collected. The KELIM predictive value regarding the tumor radiological response rate, likelihood of complete surgery, risk of subsequent platinum resistant relapse, progression free survival, and overall survival were assessed with univariate and multivariate tests. In 232 patients, KELIM was an independent and major predictor of the probability of complete surgery and survival. The final logistic regression model, including KELIM (odds ratio (OR) 0.36, 95% confidence interval (CI)0.16 to 0.73, p=0.006) and complete surgery (no vs yes, OR 0.29, 95% CI 0.15 to 0.53, p<0.001), highlighted the complementary impact of chemosensitivity and surgical outcome relative to the complete surgery. In the multivariate analysis, KELIM and complete surgery were significantly associated with a lower risk of early relapse. In the case of an unfavorable KELIM, when surgical efforts allowed complete cytoreduction, median overall survival was similar to that reported in the case of a favorable KELIM (46.3 months (range 34.6-60.3) vs 46.5 months (range 40.6-68.7), respectively). Primary tumor chemosensitivity, assessed by the modeled CA-125 KELIM, calculated during neoadjuvant chemotherapy, is a major parameter to consider for decision making regarding interval surgery. Complementary to the RECIST score and laparoscopy, this non-invasive tool, available online, helps tailor the interval surgery strategy according to patient tumor chemosensitivity.

Surgical approach and maintenance therapy in advanced low-grade serous ovarian cancer: Insights from the French ESME database

Low-grade serous ovarian cancer is a rare sub-type characterized by indolent growth, limited therapeutic options, and relative chemoresistance. This study aimed to describe management patterns, survival outcomes, and the efficacy of systemic therapies in a large cohort of patients with low-grade serous ovarian carcinoma treated across 18 French comprehensive cancer centers. Using data from the Epidemiological Strategy and Medical Economics ovarian cancer database (NCT03275298), patients with International Federation of Gynecology and Obstetrics (FIGO) stage III to IV low-grade serous ovarian carcinoma diagnosed between 2011 and 2024 were examined. Clinical outcomes, overall survival, and progression-free survival were assessed, along with treatment-related factors affecting survival, including surgical management and bevacizumab administration. Univariable and multi-variable analyses were conducted using Kaplan-Meier estimates and Cox proportional hazards models. Among 230 patients with low-grade serous ovarian carcinoma (median age 55.5 years [range; 19.8-88.2]), 171 (74.3%) and 59 (25.7%) had FIGO stage III and IV diseases, respectively. Primary debulking surgery was performed in 128 (55.6%), platinum-based chemotherapy was given to 223 (97%), and bevacizumab was administered to 79 (34.3%) patients. The median follow-up period was 73.6 months (95% confidence interval [CI] 69.9 to 80.0). Patients who underwent primary debulking surgery had the longest median progression-free survival (35.2 months, 95% CI 26.5 to 48.1) and overall survival (146 months, 95% CI 110.4 to not reached). Multi-variable analyses identified FIGO stage and primary debulking surgery as key prognostic factors for overall survival, whereas age and bevacizumab use were not significantly associated with outcomes. This real-world study underscores the prognostic relevance of surgical approach and disease stage in low-grade serous ovarian carcinoma. Continued investigation is warranted to define the optimal integration of emerging systemic therapies and improve outcomes in this rare malignancy.