Lucia Genovesi

Continuing chemotherapy beyond 6 cycles increases the chances of complete cytoreduction surgery in patients with advanced ovarian cancer

To evaluate the impact of receiving more than 6 cycles of NACT on survival outcomes and chemotherapy-related toxicity in patients with advanced epithelial ovarian cancer (AOEC) ineligible for primary debulking surgery. This retrospective, monocentric, observational study analyzed AEOC patients who received at least 6 cycles of NACT followed by IDS. They were grouped by number of NACT cycles (6 vs ≥ 7) and cytoreduction rate (CC0 vs CC ≥ 1), with a non-surgical group for comparison. A total of 335 patients were evaluated over a 20-year period. Pre-surgical variables were similar across groups, except for older age (p < 0.001) and higher Peritoneal Cancer Index (PCI) (p = 0.04) in the non-surgery cohort. Chemotherapy-related toxicities led to delays in subsequent NACT cycles, mainly in the non-surgery group (p = 0.02). After a median follow-up of 67.7 months, patients with CC0 demonstrated the longest median progression-free survival (PFS): 22 months (NACT=6) vs 21 months (NACT≥7). In CC ≥ 1 patients, PFS was 15 months (NACT=6) and 19 months (NACT≥7), while the non-surgery group had 10 months. CC0 was the primary predictor of overall survival (OS). Patients with CC0-NACT=6 had a median OS of 59 months, compared to 40 months for CC0-NACT≥7 group (p = 0.4), while patients with CC≥1, both NACT=6 and NACT≥7 presented a median OS of 27 months. Achieving CC0 after NACT≥7 significantly improved survival compared to NACT=6-CC≥1 (HR = 1.71, p = 0.019 for PFS; HR = 2.1, p = 0.009 for OS). Extending NACT beyond 6 cycles may benefit selected patients by enhancing cytoreduction rates and survival without increasing toxicity.

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.