"The impact of debulking surgery in patients with node-positive epithelial ovarian cancer: Analysis of prognostic factors related to overall survival and progression-free survival after an extended long-term follow-up period".

OBJECTIVE: to estimate the prognostic factors associated with survival and progression free survival (PFS) in patients with node-positive epithelial ovarian cancer (EOC) after an extended long-term follow-up period. METHODS: Data was provided by the Tumor Registry of the Mayo Clinic, Scottsdale, Arizona on 116 node-positive EOC patients who underwent primary cytoreductive surgery observed over the period 1996-2014. RESULTS: At censoring date, 21 patients were alive (18%), 95 dead (82%), 18 without evidence of disease (NED) (15 alive, 3 dead) and 76 with evidence of disease (ED) (2 alive, 74 dead). Twenty-nine ED patients (38.2%) experienced a recurrence within 2 years, 53 patients (69.7%) before 5 years. No recurrences were recorded after 10 years. The median follow-up in alive patients was 169.8 months (1.20-207.9 months), 34.9 months (0.30-196.2 months) in dead patients, 128.4 months for NED patients (72.8-202.5 months) and 34.6 months (0.1-106.9 months) in ED patients. Multivariate analysis showed an increased risk of dead in patients with age ≥ 60 years (HR: 3.20; p < 0.002), stage IVA/B (compared with stage IIIA1/2, HR: 4.31; p < 0.001 and stage IIIB/C, HR: 5.31; p < 0.010) and incomplete surgery (compared with complete surgery, HR: 3.10; 95% CI, 1.41-6.77; p < 0.003) and a decreased PFS in stage IVA/B (compared with stages IIIB/C; p = 0.003 and stage IIIA; p = 0.000) and residual volume after surgery >0.6 cm (compared with residual disease <0.5 cm; p < 0.023). CONCLUSIONS: prognostic factors for an extended long-term PFS are similar as those for survival, because after 17-year follow-up period, the majority of alive patients are NED patients.

International Federation of gynecology and obstetrics staging classification for cancer of the ovary, fallopian tube, and peritoneum: estimation of survival in patients with node-positive epithelial ovarian cancer.

OBJECTIVE: The objective of this study was to determine the survival of patients with node-positive epithelial ovarian cancer according to the 2014 International Federation of Gynecology and Obstetrics (FIGO) staging system. MATERIALS AND METHODS: We performed a retrospective chart review. Data from all consecutive patients with node-positive epithelial ovarian cancer (stages IIIC and IV) who underwent cytoreductive surgery at the Mayo Clinic from 1996 to 2000 were reassessed to evaluate the prognostic significance of the new FIGO stages. Multivariate Cox regression was performed, and Kaplan-Meier survival curves constructed. RESULTS: The distribution of the restaged patients was as follows: IIIA1, 23 patients (IIIA1i, 9 patients; and IIIA1ii, 14 patients); IIIA2, 3 patients; IIIB, 4; IIIC, 67 patients; IVA, 4 patients; and IVB, 15 patients. In the univariate analysis, the relative risk for positive nodes greater than 10 mm on the longer axis was 2.57 and 3.00 for patients with microscopic peritoneal disease, compared with patients with microscopic positive nodes. However, the difference was not statistically significant. Moreover, the univariate analyses revealed statistically significant differences for 2014 FIGO stages (IIIA, IIIB, IIIC, and IVA-B), anatomical sites of peritoneal metastases, and disease staged at IIIC because of the presence of omental metastases. Multivariate analysis showed that survival was higher in patients restaged to IIIA-B than in those restaged to IIIC and IV (hazard ratios, 2.75 and 3.16, respectively; P = 0.002). The hazard ratio for patients with abdominal peritoneal metastases was 2.76 compared with patients with pelvic peritoneal metastases (P = 0.001). CONCLUSIONS: The current 2014 FIGO staging system for ovarian cancer successfully correlates survival, anatomical location of peritoneal metastases, and extra-abdominal lymph node metastases.

Occult transitional cell carcinoma and Lynch syndrome incidentally revealed after laparoscopic hysterectomy and cystoscopy during staging for endometrial cancer.

► Lynch syndrome involves many rare cancers, such as urothelial carcinoma. ► The case describes incidental urothelial carcinoma associated with Lynch syndrome. ► Clinical suspicion of rare cancers must be maintained in certain patients.

The impact of peritoneal metastases in epithelial ovarian cancer with positive nodes.

OBJECTIVE: The objective of the study was to evaluate the impact of the extent of intraperitoneal disease, presurgical and postsurgical debulking, in patients with epithelial ovarian cancer (EOC) stages IIIC and IV with nodal metastases. METHODS: This was a retrospective chart review of 101 patients with EOC treated at the Mayo Clinic between 1996 and 2000. All patients had positive retroperitoneal lymph nodes (stages IIIC and IV). Patients were divided into complete or incomplete debulking, according to no visible or visible residual disease after debulking. Patients with incomplete debulking were subclassifed into residual disease less than 0.5, 0.6 to 1, 1.1 to 1.5, 1.6 to 2, and more than 2 cm. All patients received adjuvant chemotherapy with platinum-based regimen. RESULTS: The mean patient's age was 61.8 years. The mean length of follow-up was 3.5 years. The 5-year overall survival rates were 52.9% and 38.7% for International Federation of Gynecology and Obstetrics stages IIIC and IV, respectively. Significant prognostic factors were the presence of peritoneal metastases before debulking (P = 0.01), the presence of visible residual tumor after debulking, (P = 0.007), and International Federation of Gynecology and Obstetrics stage (P = 0.049). CONCLUSION: The extent of peritoneal metastases before debulking is a significant factor for survival in patients with node-positive EOC.