Impact of incomplete surgery and adjuvant chemotherapy for the intraoperative rupture of capsulated stage I epithelial ovarian cancer : a multi-institutional study with an in-depth subgroup analysis
(2021) In Journal of gynecologic oncology 32(5).- Abstract
OBJECTIVE: The aim of the present study was to examine the effects of incomplete surgery and adjuvant chemotherapy on the prognosis of patients with intraoperative rupture of capsulated stage I epithelial ovarian cancer (OvCa). METHODS: A regional retrospective study was conducted between 1986 and 2019. Among 4,730 patients with malignant ovarian tumors, 534 women with International Federation of Gynecology and Obstetrics stage IA and IC1 epithelial OvCa were eligible. Differences in survival outcomes were examined between patients with stage IA and IC1 tumors and the effects of uterine preservation, complete-staging lymphadenectomy, and adjuvant chemotherapy were investigated by an in-depth subgroup analysis. To analyze therapeutic... (More)
OBJECTIVE: The aim of the present study was to examine the effects of incomplete surgery and adjuvant chemotherapy on the prognosis of patients with intraoperative rupture of capsulated stage I epithelial ovarian cancer (OvCa). METHODS: A regional retrospective study was conducted between 1986 and 2019. Among 4,730 patients with malignant ovarian tumors, 534 women with International Federation of Gynecology and Obstetrics stage IA and IC1 epithelial OvCa were eligible. Differences in survival outcomes were examined between patients with stage IA and IC1 tumors and the effects of uterine preservation, complete-staging lymphadenectomy, and adjuvant chemotherapy were investigated by an in-depth subgroup analysis. To analyze therapeutic effects, baseline imbalances were adjusted using propensity score (PS). RESULTS: The prognosis of patients with stage IC1 tumors was worse than those with stage IA. Surgical spill did not affect the site of recurrence. In the PS-adjusted subgroup analysis, uterine preservation (hazard ratio [HR]=1.669; 95% confidence interval [CI]=1.052-2.744), incomplete-staging lymphadenectomy (HR=1.689; 95% CI=1.211-2.355), and the omission of adjuvant chemotherapy (HR=3.729; 95% CI=2.090-6.653) significantly increased the HR of recurrence for patients with stage IC1 tumors compared to those with stage IA tumors. Adjuvant chemotherapy decreased the impact of rupture with uterine preservation (HR=0.159; 95% CI=0.230-1.168) or incomplete-staging lymphadenectomy (HR=0.987; 95% CI=0.638-1.527). CONCLUSION: The present results suggest intraoperative rupture of capsulated stage I epithelial OvCa is associated with a poor prognosis. When chemotherapy is given for patients receiving incomplete surgery, there is no longer an increased risk of recurrence observed with the rupture.
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- author
- Yoshihara, Masato ; Tamauchi, Satoshi ; Iyoshi, Shohei ; Kitami, Kazuhisa ; Uno, Kaname LU ; Mogi, Kazumasa and Kajiyama, Hiroaki
- organization
- publishing date
- 2021-09
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Adjuvant Chemotherapy, Fertility Effect, Lymph Node Excision, Ovarian Cancer, Rupture, Spontaneous
- in
- Journal of gynecologic oncology
- volume
- 32
- issue
- 5
- article number
- e66
- publisher
- Korean Society of Gynecologic Oncology and Colposcopy
- external identifiers
-
- pmid:34378361
- scopus:85113852547
- ISSN
- 2005-0399
- DOI
- 10.3802/jgo.2021.32.e66
- language
- English
- LU publication?
- yes
- id
- ac3a6a18-1994-4e1e-acce-2177261be005
- date added to LUP
- 2021-09-17 15:34:22
- date last changed
- 2024-09-08 00:30:42
@article{ac3a6a18-1994-4e1e-acce-2177261be005, abstract = {{<p>OBJECTIVE: The aim of the present study was to examine the effects of incomplete surgery and adjuvant chemotherapy on the prognosis of patients with intraoperative rupture of capsulated stage I epithelial ovarian cancer (OvCa). METHODS: A regional retrospective study was conducted between 1986 and 2019. Among 4,730 patients with malignant ovarian tumors, 534 women with International Federation of Gynecology and Obstetrics stage IA and IC1 epithelial OvCa were eligible. Differences in survival outcomes were examined between patients with stage IA and IC1 tumors and the effects of uterine preservation, complete-staging lymphadenectomy, and adjuvant chemotherapy were investigated by an in-depth subgroup analysis. To analyze therapeutic effects, baseline imbalances were adjusted using propensity score (PS). RESULTS: The prognosis of patients with stage IC1 tumors was worse than those with stage IA. Surgical spill did not affect the site of recurrence. In the PS-adjusted subgroup analysis, uterine preservation (hazard ratio [HR]=1.669; 95% confidence interval [CI]=1.052-2.744), incomplete-staging lymphadenectomy (HR=1.689; 95% CI=1.211-2.355), and the omission of adjuvant chemotherapy (HR=3.729; 95% CI=2.090-6.653) significantly increased the HR of recurrence for patients with stage IC1 tumors compared to those with stage IA tumors. Adjuvant chemotherapy decreased the impact of rupture with uterine preservation (HR=0.159; 95% CI=0.230-1.168) or incomplete-staging lymphadenectomy (HR=0.987; 95% CI=0.638-1.527). CONCLUSION: The present results suggest intraoperative rupture of capsulated stage I epithelial OvCa is associated with a poor prognosis. When chemotherapy is given for patients receiving incomplete surgery, there is no longer an increased risk of recurrence observed with the rupture.</p>}}, author = {{Yoshihara, Masato and Tamauchi, Satoshi and Iyoshi, Shohei and Kitami, Kazuhisa and Uno, Kaname and Mogi, Kazumasa and Kajiyama, Hiroaki}}, issn = {{2005-0399}}, keywords = {{Adjuvant Chemotherapy; Fertility Effect; Lymph Node Excision; Ovarian Cancer; Rupture, Spontaneous}}, language = {{eng}}, number = {{5}}, publisher = {{Korean Society of Gynecologic Oncology and Colposcopy}}, series = {{Journal of gynecologic oncology}}, title = {{Impact of incomplete surgery and adjuvant chemotherapy for the intraoperative rupture of capsulated stage I epithelial ovarian cancer : a multi-institutional study with an in-depth subgroup analysis}}, url = {{http://dx.doi.org/10.3802/jgo.2021.32.e66}}, doi = {{10.3802/jgo.2021.32.e66}}, volume = {{32}}, year = {{2021}}, }