Feras Abu Saadeh

SUROVA study: global real-world treatment strategies and mortality risk prediction in advanced ovarian cancer

This study aimed to compare 5-year overall survival between primary debulking surgery and neoadjuvant chemotherapy followed by interval surgery in patients with stage IIIB to IVB epithelial ovarian cancer, using global real-world data. Secondary objectives included evaluation of progression-free survival and the influence of race, post-operative complications, and residual disease. SUROVA is a retrospective, international cohort study involving patients treated between 2018 and 2019 across 174 centers in 55 countries. Patients underwent primary surgery or received neoadjuvant chemotherapy followed by interval surgery, per institutional protocols. Propensity score matching was based on 7 baseline variables: age, race, Eastern Cooperative Oncology Group performance status at diagnosis, CA125 level at diagnosis, FIGO (International Federation of Gynecology and Obstetrics) stage IV disease, presence of ascites, and final tumor grade. Cox regression models with time-dependent effects and interaction terms were applied. A clinical risk calculator was developed and internally validated. A total of 3286 patients had a mean age of 60.0 years (SD 12); 2978 (90.6%) had high-grade serous carcinoma, and 795 (24.7%) presented with FIGO stage IV disease. A total of 1666 patients (50.7%) underwent primary cytoreductive surgery, and 1620 (49.3%) received neoadjuvant chemotherapy. The median follow-up duration was 43.8 months (interquartile range; 22.6-59.3). After propensity score matching (n=1524), overall survival was similar between groups (67.2 vs 65.0 months; HR 1.002, 95% CI 0.85 to 1.18, p=.98). Outcomes differed by ethnicity, residual disease, and post-operative complications. Post-operative complications (28%) significantly worsened survival (66 vs 46 months; HR 1.5, 95% CI 1.2 to 1.9, p<.001), especially among patients undergoing primary surgery (73 vs 46 months; HR 1.85, 95% CI 1.43 to 2.37, p<.001). The most favorable outcomes were observed among patients with primary surgery, complete resection, and no complications, with median overall survival not reached (HR 1.25, 95% CI 1.12 to 1.40, p<.001). Although overall survival was similar between groups, treatment effects differed by ethnicity, residual disease, and complications. Post-operative complications were associated with significantly worse survival, particularly among patients undergoing primary surgery, while the best outcomes were achieved in those who had primary surgery with complete resection and no complications.

A pilot study evaluating the feasibility of enriching and detecting circulating tumour cells from peripheral and ovarian veins in rare epithelial ovarian carcinomas.

Studies on circulating tumour cells (CTCs) in rare epithelial ovarian carcinomas (EOC) are limited, despite their potential as a minimally invasive biomarker for monitoring cancer progression and predicting outcomes. This pilot study aimed to assess the feasibility of enriching and detecting CTCs from both peripheral and ovarian vein blood samples in rare EOC subtypes. Blood samples were collected from the peripheral and ovarian veins of 20 patients with rare EOC. Among the 20 patients, 12 had early-stage disease (I-II), while 8 had advanced disease (III-IV). CTCs were enriched using the Parsortix® system and immunophenotyped via immunofluorescence targeting epithelial markers (EpCAM/pan-cytokeratin) and Hoechst for positive selection, and CD45 for negative selection. CTC status (positive versus negative) was correlated with clinicopathological data. CTCs were successfully detected in 45 % (1-19 CTCs) of baseline peripheral samples and 55 % (1-4776 CTCs) of ovarian vein samples. CTC doublets and clusters were detected in ovarian vein samples (3/11), but not in peripheral samples (0/20). A higher proportion of deaths were observed in CTC+ patients compared to CTC- patients (p = 0.0088). Here we demonstrate the feasibility of enriching and detecting CTCs from both peripheral and ovarian vein blood in patients with rare EOC. The higher CTC yield in ovarian vein blood suggests that tumour-draining blood may play a role in improving CTC detection. This pilot study paves the way for larger studies to investigate the prognostic utility of CTCs and refine their clinical value in these rare understudied EOC.