Predictive biomarker for surgical outcome in patients with advanced primary high-grade serous ovarian cancer. Are we there yet? An analysis of the prospective biobank for ovarian cancer.

BACKGROUND: High-grade serous ovarian cancer (HGSOC) is the most common subtype of ovarian cancer and is associated with high mortality rates. Surgical outcome is one of the most important prognostic factors. There are no valid biomarkers to identify which patients may benefit from a primary debulking approach. OBJECTIVE: Our study aimed to discover and validate a predictive panel for surgical outcome of residual tumor mass after first-line debulking surgery. STUDY DESIGN: Firstly, "In silico" analysis of publicly available datasets identified 200 genes as predictors for surgical outcome. The top selected genes were then validated using the novel Nanostring method, which was applied for the first time for this particular research objective. 225 primary ovarian cancer patients with well annotated clinical data and a complete debulking rate of 60% were compiled for a clinical cohort. The 14 best rated genes were then validated through the cohort, using immunohistochemistry testing. Lastly, we used our biomarker expression data to predict the presence of miliary carcinomatosis patterns. RESULTS: The Nanostring analysis identified 37 genes differentially expressed between optimal and suboptimal debulked patients (p < 0.05). The immunohistochemistry validated the top 14 genes, reaching an AUC Ø0.650. The analysis for the prediction of miliary carcinomatosis patterns reached an AUC of Ø0.797. CONCLUSION: The tissue-based biomarkers in our analysis could not reliably predict post-operative residual tumor. Patient and non-patient-associated co-factors, surgical skills, and center experience remain the main determining factors when considering the surgical outcome at primary debulking in high-grade serous ovarian cancer patients.

Incidence and Pattern of Spread of Lymph Node Metastasis in Patients With Low-grade Serous Ovarian Cancer.

BACKGROUND/AIM: Involvement of lymph nodes (LNs) and their surgical resection in low-grade ovarian cancer remains a field of discussion. The aim of this study was to determine the incidence and pattern of distribution of lymph node metastases in patients with low-grade serous ovarian cancer. PATIENTS AND METHODS: A retrospective analysis was carried out in patients with primary low-grade serous ovarian cancer who underwent primary surgery including systematic lymphadenectomy. Analysis of the affected LNs along with pattern of lymphatic spread was performed. RESULTS: Thirty-seven patients who underwent systematic pelvic and para-aortal LN dissection were identified. The median age was 48 years (range=26-76 years). The majority of patients had International Federation of Gynecology and Obstetrics stage III (89.2%). A median of 41 (range=10-97) LNs were resected. LN metastases were found in 27 (72.9%) patients. In 15 (55.5%) patients, both pelvic and para-aortic LNs were affected concomitantly, in isolated para-aortal and pelvic lymph nodes in three (11.1%) and eight (29.6%) patients, respectively. The most frequently affected region was the right obturator fossa, found in 14 (51.8%) patients, followed by the left obturator fossa in 11 (40.7%) patients. CONCLUSION: Low-grade serous ovarian cancer exhibits a high percentage of lymphatic spread, with more confinement to the pelvic compared to the para-aortic region.

Systematic pelvic and paraaortic lymphadenectomy in early high-risk or advanced endometrial cancer.

PURPOSE: Patients with high-risk early or advanced endometrial cancer (EC) are at high risk for lymph node (LN) metastases. However, both the anatomical pattern of the LN metastases and also the therapeutic value of systematic LN dissection remain a field of discussion and controversy. METHODS: We performed an exploratory analysis of patients with high-risk or advanced EC who underwent systematic pelvic and para-aortic lymphadenectomy in two tertiary referral centers for gynecological malignancies. RESULTS: One hundred and twenty-eight completely surgically staged patients underwent systematic pelvic and para-aortic lymphadenectomy for high-risk or advanced EC. A median of 29 and 21.5 LN was harvested in the pelvis and in the para-aortic region, respectively. Overall, 27 patients (21.1 %) had positive LN: 18 % showed positive pelvic LN and 14.8 % positive para-aortic LN; while 3.1 % showed isolated para-aortic LN metastases. Five-year overall survival was 70 versus 30 % in LN-negative versus LN-positive patients (p < 0.01). LN-status was the only factor significantly associated with overall survival [HR: 3.67 (95 % CI 1.48-9.11); p = 0.01] in a multivariate Cox regression model. CONCLUSIONS: Patients with high-risk or advanced EC were at a high-risk for LN metastases. Anatomical distribution of positive LN indicates that lymphadenectomy, when performed, should contain both pelvic and para-aortic areas up to the renal vessels for an accurate assessment of all potential positive LN.