Prognostic implications of histological tumor regression (Böhm's score) in patients receiving neoadjuvant chemotherapy for high grade serous tubal & ovarian carcinoma.

OBJECTIVE: Primary objective of this study was to determine prognostic significance of Bohm's histopathological regression score in patients who received neoadjuvant chemotherapy (NACT) for treatment of high grade serous (HGS) tubal & ovarian carcinoma. METHODS: This was a retrospective cohort study of patients who received NACT between 2010 and 2015. The 3 point histopathological regression score of Böhm was used to classify chemotherapy response. Survival outcomes between the 3 different subgroups was analysed and compared with standard clinico-pathological variables using the Cox proportional hazards model and log-rank test. RESULTS: Study cohort comprised 111 patients. Chemotherapy response score (CRS) 3 was observed in 47 (42.4%) and CRS 1and CRS 2 in 22 (19.8%) and 42 (37.8%) women respectively. Women with CRS score of 1 and 2 combined showed a three-fold increased risk of progression on both univariate and multivariate assessment (HR 3.54; C.I 2.19-5.72, p < 0.001). The median overall survival for patients with CRS 1 was 34 months, CRS 2 was 30 months and 47 months for CRS 3. CRS 1 and 2 combined was the only variable that held significance in prediction of reduced overall survival on multivariate assessment (HR 3.26, C.I 1.91-5.54, p 0.0006). CRS 1 and 2 were also associated with 5.15-fold increased risk of relapse within 6 months of completion of chemotherapy (Odds ratio OR 5.15, C.I 0.07-0.47, p - 0.002). CONCLUSION: CRS is an independent prognosticator of survival and reliable predictor of relapse within 6 months in advanced high grade serous tubal and ovarian carcinoma patients receiving NACT.

Gynae-Oncology Surgeons' Preparedness to Undertake Colorectal Procedures during Cytoreductive Surgery for Ovarian Cancer: A Cross Sectional Survey.

Cytoreductive surgery for advanced ovarian cancer commonly involves bowel resection. Although UK gynaecological oncologists are trained in bowel surgery, the degree to which they perform bowel surgery independently varies nationally. A recent joint policy statement from the British Gynaecological Cancer Society (BGCS) emphasises the need for formalised colorectal support. An anonymous, online survey was emailed to BGCS members to assess the status of multidisciplinary working between UK gynaecological oncology and colorectal/general surgical teams. A total of 46 members responded (8.2% response rate). There was a large variety in the involvement of colorectal/general surgical teams in preoperative planning. A total of 13% of respondents had no formalised agreement for intraoperative support, 72.1% of respondents independently performed rectal peritoneal stripping and 60.5% independently performed small bowel resection. This was reduced to 27.9% for right hemicolectomy with primary anastomosis and 16.3% for left hemicolectomy with primary anastomosis. Respondents often involved colorectal support for post-operative complications. The majority of UK gynaecological oncologists involve colorectal/general surgical teams in bowel procedures, more commonly for large bowel procedures compared to small bowel and for left colon compared to right colon procedures. A total of 16.3% of respondents independently performed all surveyed bowel procedures. Future research should examine training and experience within these groups to address this disparity.

Advanced stage (IIIC/IV) endometrial cancer: Role of cytoreduction and determinants of survival.

OBJECTIVE: Primary aim of this study was to assess the impact of optimal cytoreduction in women who had surgical treatment of advanced stage (IIIC/IV) endometrial cancer. Secondary objective was to define demographic and surgico-pathologic variables that exerted a significant influence on survival outcomes. STUDY DESIGN: Records of 45 patients with stage IIIC/IV Endometrial cancer who underwent surgery with cytoreductive intent between 2010 and 2016 were analysed. Data on disease distribution, surgical procedures, adjuvant therapy and survival times was collated. Survival curves were plotted by Kaplan Meier method and median survival estimates were compared using log rank test. Cox proportional hazards model was used to identify independent variables predictive of survival. RESULTS: 28 women (62.2%) had undergone primary surgery and 17 (37.8%) received neoadjuvant chemotherapy prior to delayed primary surgery. Optimal cytoreduction to 1 cm residual disease (p = 0.02). Median overall survival was 29 months in patients who had optimal cytoreduction and 17.5 months in women who had bulky residual disease (p=0.002). Only poor performance status (p = 0.035), presence of bowel disease (p = 0.05) and suboptimal cytoreduction (p = 0.006) retained significance as predictors of poor survival on multivariate analyses. Suboptimal cytoreduction surgery, compared to optimal cytoreduction, showed a 3.55-fold increased risk of death independent of performance status and anatomic region with disease (Hazard Ratio 3.55 (95% confidence interval 1.44-8.73) p = 0.006). CONCLUSION: Survival analyses demonstrate significantly better progression free survival and overall survival when optimal cytoreduction is achieved. A prospective, multicentre study is recommended to establish conclusive evidence.