Ji Eun Lee

Prognostic impact of intraoperative rupture in early-stage epithelial ovarian cancer: an ancillary study of GORILLA-3002

To evaluate whether intraoperative rupture affects oncological outcomes in patients with early-stage epithelial ovarian cancer (EOC). A multicenter retrospective study was conducted on patients with early-stage EOC based on surgical and final pathological reports between 2007 and 2021. Oncologic outcomes were compared between the unruptured group (International Federation of Gynaecology and Obstetrics [FIGO] stage IA/IB) and ruptured group (FIGO stage IC1). The primary endpoint was progression-free survival (PFS). Propensity score matching (PSM) was performed to adjust for the imbalance in prognostic factors between the groups. Overall, 197 (58.3 %) patients comprised the unruptured group (FIGO stage IA/IB), and 141 (41.7 %) were in the intraoperatively ruptured group (FIGO stage IC1). No significant difference in the 5-year PFS was observed between the two groups before PSM (92.65 % vs. 92.80 %, P = 0.93). After PSM, the 5-year PFS showed a noticeable decrease in the ruptured group compared to the unruptured group, although this difference showed borderline statistical significance (96.90 % vs. 89.82 %, P = 0.061). This trend was particularly discernible in cases with aggressive tumor characteristics; intraoperative rupture remained an independent prognostic factor for shorter PFS in patients with high-grade histology (adjusted hazard ratio = 14.4, 95 % confidence interval = 2.8-74.1). Although not statistically significant, intraoperative rupture may negatively affect PFS in these patients after PSM. Therefore, rupture during surgery should be avoided as it can cause upstaging and unnecessary chemotherapy.

Preoperative CT image-based assessment for estimating risk of ovarian torsion in women with ovarian lesions and pelvic pain

To define and weight the preoperative CT findings for ovarian torsion and to develop an integrated nomogram for estimating the probability of ovarian torsion in women with ovarian lesion and pelvic pain. This retrospective study included 218 women with surgically resected ovarian lesions who underwent preoperative contrast-enhanced CT for pelvic pain from January 2014 to February 2019. Significant imaging findings for torsion were extracted using regression analyses and a regression coefficient-based nomogram was constructed. The diagnostic performance with sensitivity, specificity, and accuracy of the significant imaging findings and the nomogram were assessed. A total of 255 ovarian lesions (123 lesions with torsion and 132 lesions without torsion) were evaluated. Multivariable regression analysis showed that whirl sign (odds ratio [OR] 11.000; p < 0.001), tubal thickening (OR 4.621; p = 0.001), unusual location of ovarian lesion (OR 2.712; p = 0.020), and hemorrhagic component within adnexal lesion (OR 2.537; p = 0.028) were independent significant parameters predicting ovarian torsion. Tubal thickening showed the highest sensitivity (91.1%) and whirl sign showed the highest specificity (94.7%). When probabilities of ovarian torsion of 0.5 or more in the nomogram were diagnosed as ovarian torsion, sensitivity, specificity, and accuracy of the nomogram were 78.1%, 91.7%, and 85.1%, respectively. The whirl sign, tubal thickening, unusual location of ovarian lesion, and hemorrhagic component within adnexal lesion, and an integrated nomogram derived from these significant findings can be useful for predicting ovarian torsion.