Giulia Dondi

Two possible entities of endometriosis-associated ovarian cancer: correlated or incidental?

This study aimed to describe 2 types of endometriosis-associated ovarian cancer: those with transitional elements (atypical endometriosis and borderline tumors) termed endometriosis-correlated or incidental benign endometriosis vs ovarian cancer cases not associated with endometriosis. This was a prospective, observational, monocentric study conducted from November 2021 to December 2023. Patients with ovarian cancer eligible for surgery were enrolled and classified into endometriosis-correlated ovarian carcinoma, endometriosis-incidental ovarian carcinoma, or ovarian carcinoma without endometriosis groups based on the presence or not of endometriosis and transitional lesions. Clinical, sonographic, surgical and pathological data and progression-free survival were recorded. Logistic regression models for accurate patient classification were developed from pre-surgical variables. Of the 170 patients included, 83 (48.82%) had ovarian carcinoma without endometriosis, 39 (22.94%) had endometriosis-incidental ovarian carcinoma, and 48 (28.24%) had endometriosis-correlated ovarian carcinoma. Patients with endometriosis-incidental ovarian carcinoma and endometriosis-correlated ovarian carcinoma were diagnosed at younger ages (p = .002) and had lower post-menopausal rates than patients with ovarian carcinoma without endometriosis (p = .011). Patients with endometriosis-correlated ovarian carcinoma had fewer pregnancies (p < .001) and higher CA-19.9 levels (p = .002) presented with unilateral and multilocular solid lesions than patients with ovarian carcinoma without endometriosis (p < .001). Patients with endometriosis-incidental ovarian carcinoma showed intermediate lesion morphology. Endometriosis-correlated ovarian carcinoma was mostly diagnosed at early Federation of Gynecology and Obstetrics stages (range; I-II) compared with endometriosis-incidental ovarian carcinoma and ovarian carcinoma without endometriosis (p < .001), had less extensive disease (p < .001), and a higher likelihood of complete cytoreduction (p = .035). Endometriosis-correlated ovarian carcinoma was more likely to include clear cell, endometrioid, and mesonephric-like adenocarcinomas, whereas serous histotype predominated in the other groups (p < .001). Logistic regression models accurately identified patients with endometriosis-correlated ovarian carcinoma vs patients with endometriosis-incidental ovarian carcinoma (area under the curve [AUC] = 0.926) and ovarian carcinoma without endometriosis (AUC = 0.968) but could not reliably differentiate endometriosis-incidental ovarian carcinoma from ovarian carcinoma without endometriosis (AUC = 0.668). The 2-year progression-free survival rates were 91% in endometriosis-incidental ovarian carcinoma, 80% in endometriosis-correlated ovarian carcinoma, and 59% in ovarian carcinoma without endometriosis (p = .024). Our study indicates that ovarian cancer associated with endometriosis consists of 2 clinical entities, with endometriosis-incidental ovarian carcinoma emerging as a bridging group between endometriosis-correlated ovarian carcinoma and ovarian carcinoma without endometriosis.

Optimal number of neoadjuvant chemotherapy cycles prior to interval debulking surgery in advanced epithelial ovarian cancer: a systematic review and meta-analysis of progression-free survival and overall survival

Neoadjuvant chemotherapy (NACT) represents a treatment option in patients with advanced epithelial ovarian cancer (AEOC) who are not good candidates for primary debulking surgery. Usually, 3 cycles of chemotherapy before surgery have been considered the best option for patient survival, although quite often some patients receive more than 3 cycles. The aim of this systematic review and meta-analysis was to identify the optimal number of NACT cycles reporting better survival in AEOC patients. PubMed, Cochrane Library, and Scopus were searched for original articles that analyzed the relationship between the number of chemotherapy cycles and clinical outcomes in AEOC patients before interval debulking surgery (IDS). The main outcomes were progression-free survival (PFS) and overall survival (OS). A total of 22 studies comprising 7,005 patients diagnosed with AEOC were included in our analysis. In terms of survival, the reviewed studies dividing the patients in ≤3 NACT cycles vs. >3, showed a trend for a decrease in PFS and a significant reduction in OS with an increasing number of cycles, while a difference in both PFS and OS was revealed if early IDS included patients with 4 NACT cycles. These results should be interpreted with caution due to the complex characteristics of AEOC patients. In conclusion, our review and meta-analysis revealed that there is not enough evidence to determine the optimal number of NACT treatments before surgery. Further research in the form of well-designed randomized controlled trials is necessary to address this issue. PROSPERO Identifier: CRD42022334959.

Mesonephric-like adenocarcinoma of the ovary: features of a rare and aggressive entity associated with endometriosis.

Mesonephric-like adenocarcinoma is a rare, aggressive ovarian cancer subtype, newly classified by the World Health Organization in 2020. This study examines the clinical, ultrasound, pathological features, and survival outcomes of ovarian mesonephric-like adenocarcinoma. This observational, prospective, single-center study included patients with ovarian mesonephric-like adenocarcinoma treated between January 2020 and December 2023. Clinical data and ultrasound findings were collected. Ultrasound examinations were performed according to the International Ovarian Tumor Analysis guidelines and qualitatively described in correlation with pathological findings. Histopathological evaluation was conducted based on the 2020 World Health Organization classification. Progression-free survival and overall survival were calculated from the time of diagnosis to recurrence or death. Among 467 patients with ovarian cancer treated at our center, 14 (3.0%) were diagnosed with ovarian mesonephric-like adenocarcinoma, with a mean age of 60 ± 8 years. Ultrasound commonly showed unilateral solid lesions (57.2%) with moderate-to-strong blood flow, heterogeneous echogenicity, and hyperechoic "cotton candy" regions. Most patients (57.1%) had International Federation of Gynecology and Obstetrics stage III to IV disease; 78.5% underwent upfront surgery, achieving complete cytoreduction in 92.8%. Pathology revealed mesonephric-like adenocarcinoma alone in 44.4% and mixed histotypes in 55.6% (endometrioid, mucinous, or high-grade serous components), with endometriosis in 64.2%. K-RAS mutations were present in all cases. Median progression-free survival was 17.5 months (IQR 13.5-35.9), with 57.1% experiencing recurrence, mostly as peritoneal metastases. Median overall survival was not reached, with one death recorded. Mesonephric-like adenocarcinoma is a rare yet aggressive ovarian cancer strongly associated with endometriosis and characterized by K-RAS mutation. Unique ultrasound features, such as "cotton candy" hyperechoic regions, may assist in early recognition and pre-surgical diagnosis.