Jeongyun Kim

Changes in Epithelial Ovarian Cancer Recurrence and Survival According to Treatment Paradigm Shifts

ABSTRACT Aim To evaluate oncologic outcomes in patients with epithelial ovarian cancer (EOC) amid evolving surgical and systemic therapy paradigms. Methods This retrospective cohort study included patients diagnosed with EOC from June 2003 to December 2020 at a single tertiary center, grouped by diagnosis period. Overall survival (OS) and progression‐free survival (PFS) were analyzed using the Kaplan–Meier and Cox regression analyses. Results A total of 763 patients were classified as 2003–2008 (Group 1, n  = 101), 2009–2013 (Group 2, n  = 207), and 2014–2020 (Group 3, n  = 455), reflecting changes in cytoreductive surgery and targeted therapies (bevacizumab and PARP inhibitors). Early‐stage diagnoses increased over time without statistical significance (Stage I–II: Group 1, 37.6% vs. Group 3, 46.6%; p  = 0.200). Group 2 showed greater use of interval debulking surgery (IDS), higher complete cytoreduction rates, and more first‐line chemotherapy cycles (all p  < 0.001). Group 3 represented the introduction of targeted therapies ( p  < 0.001 for both). IDS with residual (< 1 cm) was associated with poorer outcomes than complete/optimal primary debulking surgery (PDS) (hazard ratio 2.94, 95% confidence interval 1.5–5.8). Despite unchanged PFS, the 5‐year OS improved from 64.0% to 82.5% among patients with advanced‐stage disease ( p  = 0.024). Conclusions Over two decades, with the advent of targeted therapies, complete cytoreduction (especially in PDS) has increased. Although the use of IDS also increased, residual disease (< 1 cm) after IDS was associated with poorer outcomes. While PFS remained unchanged, 5‐year OS significantly improved among patients with advanced‐stage disease diagnosed in the most recent period.

Multimodal Prehabilitation for Gynecologic Cancer Surgery

Surgical treatment is commonly employed to treat patients with gynecologic cancer, although surgery itself may function as a stressor, reducing the patients’ functional capacity and recovery. Prehabilitation programs attempt to improve patients’ overall health and baseline function prior to surgery, thereby enhancing recovery and lowering morbidity. In recent years, prehabilitation has come to primarily refer to multimodal programs that combine physical activity, nutritional support, psychological well-being, and other medical interventions. However, the specific methods of implementing prehabilitation and measuring its effectiveness are heterogeneous. Moreover, high-level evidence regarding prehabilitation in gynecologic cancer surgery is limited. This review provides a summary of multimodal prehabilitation studies in gynecologic oncologic surgery. Enhanced postoperative recovery, lower postoperative complications, lower rate of blood transfusions, and faster gastrointestinal functional recovery have been reported after multimodal prehabilitation interventions. Patients and healthcare professionals should recognize the importance of prehabilitation in the field of gynecologic oncologic treatment, based on the emerging evidence. In addition, there is a need to establish an appropriate target group and construct a well-designed and tailored prehabilitation program.