Giacomo Guidi

Gliomatosis peritonei with ovarian teratoma: an international multicenter case series

Gliomatosis peritonei (GP) is a rare condition characterized by peritoneal implants of mature glial tissue, macroscopically resembling peritoneal carcinomatosis. It is usually associated with ovarian mature or immature teratoma. To describe the clinical characteristics, treatment, and prognosis of cases with GP. Multi-center retrospective study of patients diagnosed with ovarian teratoma and GP between 2000 and 2023. Non-gynecological GP cases were excluded. Overall, 23 patients were included. Median age was 25 years (range; 10-38). Median ovarian tumor size was 19 cm (range; 6-35). The main symptom was abdominal pain (n = 13). Histology was mature teratoma in 13% (n = 3), and immature teratoma in 87% (n = 20) of cases, of which 90% (n = 18) was pure teratomas and 10% (n = 2) was mixed with yolk sac tumor. Overall, 60% were grade 3. Fertility-sparing surgery was performed in 87% (n = 20, of them 18 underwent unilateral salpingo-oophorectomy and 2 cystectomy ± further biopsies) without macroscopic residual disease in 91% (n = 21), and 78% (n = 18) were diagnosed at stage I. Adjuvant chemotherapy was given in 7 cases, only with grade 2 or more. Twelve women relapsed after a median of 43 months. However, only 2 relapses had immature teratoma components. Three patients had a second relapse after a median of 9 months. Over a median follow-up of 81 months (range; 7-270), the entire cohort remained alive and 3 live births were reported. GP is mostly associated with high-grade early-stage immature teratoma in young patients. Resection of peritoneal implants is crucial for the accurate diagnosis and optimal treatment planning. Relapses are mostly mature, therefore, offering fertility-sparing treatment in pre-menopausal cases could be considered.

Laparoscopic tumor load as an independent prognostic marker in advanced ovarian cancer: a 3-year cohort study

To evaluate the association between pre-operative tumor load, progression-free survival, and overall survival in patients with advanced epithelial ovarian cancer. Patients diagnosed with The International Federation of Gynecology and Obstetrics (FIGO) stage III to IV primary ovarian, tubal, or peritoneal carcinoma, who underwent intraoperative abdominal disease spread assessment using the laparoscopic predictive index value (PIV) at the Gynecologic Oncology Unit of the Policlinico-Agostino Gemelli University Hospital-IRCCS, Rome, from January 2018 to December 2020, were included. Patients were divided into 2 groups based on median laparoscopic PIV at diagnosis in our population: group A (low tumor load) with PIV from 0 to 6, group B (high tumor load), with PIV from 8 to 12, and/or with extensive miliary carcinomatosis and mesentery retraction. During the study period, 817 patients with newly diagnosed advanced epithelial ovarian cancer were included, with a median age of 60 years (range;18-87), a median CA125 level of 584 (range; 5-6262), and ascites presence in 436 cases (54.0%). With a median follow-up of 51.0 months (95% CI 49.5 to 52.5), 571 (69.9%) recurrences and 388 (47.5%) deaths were observed. The median progression-free and overall survival were 22.0 months (95% CI 19.8 to 24.2) and 53.0 months (95% CI 48.7 to 57.3), respectively. A statistically significant correlation between PIV and risk of recurrence or death was observed (p < .001). The median progression-free survival was 27 months for PIV < 8 versus 16 months for PIV ≥ 8 (p < .001). The 5-year survival rate was 54.8 % (95% CI 49.1 to 60.5) for PIV < 8 and 30.4% (95% CI 23.7 to 37.1) for PIV ≥ 8 (p < .001). This correlation was maintained in the subgroup analysis by stage. Specifically, for FIGO stage III, the 5-year survival rate was 57.2 % for the group with PIV < 8 and 26.3 % for the group with PIV ≥ 8; for FIGO stage IV, it was 47.9 % for the group with PIV < 8, and 32.8 % for the group with PIV ≥ 8. In multivariate analysis, PIV was confirmed as an independent prognostic factor for both progression-free and overall survival, along with BRCA status and residual tumor after surgery, as well as ascites for progression-free survival and age for overall survival. This study underscores tumor burden at diagnosis, quantified by PIV, as a key independent prognostic factor in advanced ovarian cancer, irrespective of FIGO stage or BRCA status, even in the era of maintenance therapies.