Yohann Dabi

Impact of lymph node staging on survival in presumed early-stage ovarian cancer: a multicentric retrospective study

This study aimed to assess the impact of comprehensive staging on survival outcomes in this population. Patients who underwent surgery for epithelial ovarian cancer in one of the 14 Francogyn cancer centers between 2000 and 2020 were included in the study. The primary analysis evaluated the impact of lymphadenectomy on overall survival and recurrence-free survival. Lymph node count was analyzed as a continuous variable, and its association with survival, considered as a continuous outcome was assessed using linear regression (secondary analysis). Survival was compared using the log-rank test, and multivariate analysis was performed using a Cox model. A total of 467 patients with presumed early-stage epithelial ovarian cancer were included, of which 198 underwent complete lymphadenectomy and 266 did not. No significant association was found between lymph node staging and survival in the primary analysis, possibly due to limited statistical power and a selection bias, as patients without lymphadenectomy had more favorable disease profiles (p=0.600 and p=0.700, respectively). Complete lymphadenectomy was associated with a significantly higher risk of complications (34.5% vs. 14%, p<0.001). In secondary analysis, the number of para-aortic lymph nodes harvested was identified as an independent predictor of both overall survival and recurrence-free survival (p=0.007 and p=0.002, respectively). Histological characteristics and adjuvant chemotherapy also showed a significant correlation with improved survival outcomes. Extensive para-aortic lymphadenectomy in early-stage epithelial ovarian cancer is associated with better overall and recurrence-free survival but comes with an increased risk of complications.

O-RADS MRI scoring system has the potential to reduce the frequency of avoidable adnexal surgery

To assess the potential impact of the O-RADS MRI score on the decision-making process for the management of adnexal masses. EURAD database (prospective, European observational, multicenter study) was queried to identify asymptomatic women without history of infertility included between March 1st and March 31st 2018, with available surgical pathology or clinical findings at 2-year clinical follow-up. Blinded to final diagnosis, we stratified patients into five categories according to the O-RADS MRI score (absent i.e. non adnexal, benign, probably benign, indeterminate, probably malignant). Prospective management was compared to theoretical management according to the score established as following: those with presumed benign masses (scored O-RADS MRI 2 or 3) (follow-up recommended) and those with presumed malignant masses (scored O-RADS MRI 4 or 5) (surgery recommended). The accuracy of the score for assessing the origin of the mass was of 97.2 % (564/580, CI The use of O-RADS MRI scoring system could drastically reduce the number of asymptomatic patients undergoing avoidable surgery.

Locally advanced cervical cancer and para-aortic lymphadenectomy: impact of the number of removed lymph nodes, a FRANCOGYN group study

Cervical cancer is the fourth most common cancer worldwide among women. Surgical staging by para-aortic lymph node dissection (PALND) is performed when the cancer is locally advanced (LACC). There are no recommendations concerning the number of lymph node that must be removed during this surgery which hasn't prove is effectiveness concerning survival. We conducted a retrospective multicenter descriptive and comparative study with data from FRANCOGYN group. We included 578 patients with LACC (IB3-IVA FIGO 2028) who underwent a PALND, 190 with <10 nodes and 388 with at least 10 nodes. The primary outcome was to evaluate the impact of the number of lymph nodes removed on the positivity of the staging. The secondary outcomes were to evaluate the impact of the number of lymph nodes removed on the treatment, the morbidity and the survival of the patients. There was no significant difference concerning the positivity of the staging between the two groups with 17,4 % and 16,2 % of positive staging (p = 0,8). There were no significant differences concerning the peri and post operative complications, the modification of the stage and treatment or the OS and DFS. It would appear that para-aortic staging with at least 10 or more nodes does not confer any advantage in terms of positivity and survival over staging with fewer than 10 nodes.

Comparison of survival outcomes between laparoscopic and abdominal radical hysterectomy for early-stage cervical cancer: A French multicentric study

A recent randomized controlled trial has reconsidered the use of laparoscopy for treating patients with early-stage cervical cancer with radical hysterectomy (RH). We aimed to evaluate if surgical approach had an impact on surgical and oncological outcomes in these patients in a French setting. Data of 1706 patients with cervical cancer treated between 1996 and 2017 were extracted from maintained databases of 9 French University hospitals. Patients, with FIGO stage IA2 to IIB tumors, treated by radical hysterectomy were selected for further analysis. A propensity score matching was used with a ratio of 2:1 in favor of laparoscopic approach was used. The Kaplan Meier method was used to estimate the survival distribution. 34 patients treated with laparotomy were matched with 61 patients treated by minimally invasive surgery (MIS). There was no difference regarding overall survival (91 % vs 81 %, p > 0.05) or disease-free survival (82 % vs 78 %, p > 0.05). There was no difference regarding surgical outcomes with no excess of postoperative complication in patients with MIS. Hospital stay was significantly longer in patients operated on laparotomy. In our study, there was no evidence of a difference in survival between minimally invasive surgery and laparotomy in patients treated with radical hysterectomy for early-stage cervical cancer.

Comparison of retroperitoneal and transperitoneal surgical routes in laparoscopic nodal staging for locally advanced cervical cancers (FIGO IB3-IVA)

This study compares morbidity and mortality associated with retroperitoneal and transperitoneal para-aortic lymphadenectomy (PAAL) for pretherapeutic nodal staging of locally advanced cervical cancers (FIGO IB3-IVA). Pre-, per- and postoperative data of patients treated for locally advanced stage cervical cancer between 1999 and 2018 in 12 French referral centers (FRANCOGYN Study Group) were retrospectively collected. The study was conducted using a sample of 448 patients, of whom 223 (49,8%) underwent retroperitoneal (group 1) and 225 (50,2%) had transperitoneal PAAL (group 2). No differences were noted concerning clinical and histological characteristics between the two groups. Among these 448 patients, 23 (5,1%) had an intraoperative complication (9 (2,0%) in group 1 and 14 (3,1%) in group 2, p = 0.28) and 47 (10,5%) had a postoperative complication (22 (4,9%) in group 1 and 25 (5,6%) in group 2, p = 0.44), only one of which required revision surgery but the patient died. The length of hospital stay was significantly shorter in group 1 than in group 2 (3.97 versus 4.88 days, p < 0.001). There was no significant difference in mortality between the two groups; 34 of 223 patients in group 1 (15.3%) and 40 of 225 patients in group 2 (15.6%) died (HR = 0.968, 95% CI [0.591-1.585]). There was no significant difference in recurrence-free or overall survival between the two groups. Retroperitoneal PAAL appears as a valuable and safety surgical route for nodal staging in locally advanced cervical cancer compared with standard transperitoneal PAAL.

Variability of treatment of locally advanced cervical cancer: How French multidisciplinary teams follow European guidelines?

Cervical cancer is a global public health concern. Despite ESGO recommendations and FIGO classification changes, management of locally advanced cervical cancer (LACC) remains debated in France. Our study aimed to review LACC treatment practices and assess adherence to ESGO recommendations among different practitioners. From February 2021 to August 2022, we conducted a survey among gynecologic oncology surgeons, radiation oncologists, and medical oncologists practicing in France and managing LACC (FIGO stages IB3-IVA) according to the 2018 FIGO classification. We analyzed responses against the 2018 ESGO recommendations as a "gold standard." Among 115 respondents (56% radiation oncologists, 30% surgeons, 13% medical oncologists), 48.6% of gynecologic surgeons didn't perform para-aortic lymphadenectomy (PAL) with significant radiologic pelvic involvement. PAL, when indicated by PET-CT, was more common in university hospitals (66.7% of surgeons). Surgeons in university hospitals also followed ESGO recommendations more closely. Overall, compliance with all ESGO recommendations was low: 5.7% of surgeons, 21.5% of radiation oncologists, and 60% of medical oncologists. Prophylactic para-aortic irradiation, per ESGO, was more frequent in comprehensive cancer centers (52% of radiation oncologists). Adherence to ESGO recommendations for LACC treatment appears low in France, particularly in surgery, with limited PAL in cases of lymph node negativity on PET-CT. However, these recommendations are more often followed by surgeons in university hospitals and radiation oncologists in cancer centers. Adherence to these recommendations may impact patient survival and warrants evaluation of care quality, justifying the organization of LACC management in expert centers.

Understanding the low adherence to fertility preservation program in women treated for borderline ovarian tumors.

Borderline ovarian tumors (BOT) account for 10-20 % of malignant ovarian tumors affecting up to one third of young patients. Therefore, fertility sparing surgery (FSS) has gained attention followed by fertility preservation program (FPP) mainly using controlled ovarian stimulation (COS). However, the determinants to accept or to refuse fertility FPP remain unclear raising the issue on shared decision making. From January 2021 to November 2024, a retrospective analysis from a prospective database of patients with BOT eligible for FPP (patients between 18-, and 43-years-old) were identified and interviewed to evaluate the determinants to refuse FPP. For patients accepting FPP, results of COS were analyzed. Among which 66 patients with BOT undergoing FSS, 29 were eligible for FPP, among them 18 refused the procedure. The main determinants to refuse the FPP were an age >35-years-old, the futility of FPP in 50 % of case, the renouncement to future pregnancy in one-third of cases, and the stress of recurrence (two patients). One patient refused to answer. Among the 18 patients refusing FPP, five became pregnant spontaneously. For the 11 accepting the FPP with COS, the median delay between FSS and COS was 6 months (3-13 months), nine underwent 1 COS cycle and the two patients underwent 2 COS cycles. The median number of retrieved oocytes per COS cycle was 11 (5-39) and the median number of cryopreserved oocytes was 7 (0-35). None of the patients undergoing FPP demand to use their cryopreserved oocytes at the time of the study completion. While this represents a moderate cohort of patients, our results demonstrate the low adherence to FPP after FSS for BOT underlining the need of an objective and personalized information for shared decision making to accept FPP.