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. 2020 Dec 25;10(1):41.
doi: 10.3390/jcm10010041.

Microscopic Peritoneal Residual Disease after Complete Macroscopic Cytoreductive Surgery for Advanced High Grade Serous Ovarian Cancer

Henri Azaïs  1   2 , Anne-Sophie Vignion-Dewalle  2 , Marine Carrier  1 , Jeremy Augustin  3 , Elisabeth Da Maïa  3 , Alix Penel  4 , Jérémie Belghiti  1 , Marianne Nikpayam  1 , Clémentine Gonthier  1 , Laurine Ziane  2 , Serge Mordon  2 , Pierre Collinet  2   5 , Geoffroy Canlorbe  1   6   7 , Catherine Uzan  1   6   7
Affiliations

Microscopic Peritoneal Residual Disease after Complete Macroscopic Cytoreductive Surgery for Advanced High Grade Serous Ovarian Cancer

Henri Azaïs et al. J Clin Med. .

Abstract

Background: Epithelial ovarian cancers (EOC) are usually diagnosed at an advanced stage and managed by complete macroscopic cytoreductive surgery (CRS) and systemic chemotherapy. Peritoneal recurrence occurs in 60% of patients and may be due to microscopic peritoneal metastases (mPM) which are neither eradicated by surgery nor controlled by systemic chemotherapy. The aim of this study was to assess and quantify the prevalence of residual mPM after complete macroscopic CRS in patients with advanced high-grade serous ovarian cancer (HGSOC).

Methods: A prospective study conducted between 1 June 2018 and 10 July 2019 in a single referent center accredited by the European Society of Gynecological Oncology for advanced EOC management. Consecutive patients presenting with advanced HGSOC and eligible for complete macroscopic CRS were included. Up to 13 peritoneal biopsies were taken from macroscopically healthy peritoneum at the end of CRS and examined for the presence of mPM. A mathematical model was designed to determine the probability of presenting at least one mPM after CRS.

Results: 26 patients were included and 26.9% presented mPM. There were no differences in characteristics between patients with or without identified mPM. After mathematical analysis, the probability that mPM remained after complete macroscopic CRS in patients with EOC was 98.14%.

Conclusion: Microscopic PM is systematically present after complete macroscopic CRS for EOC and could be a relevant therapeutic target. Adjuvant locoregional strategies to conventional surgery may improve survival by achieving microscopic CRS.

Keywords: cytoreductive surgery; epithelial ovarian cancer; gynecologic oncology; peritoneal carcinomatosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Anatomopathological examination of primary and peritoneal lesions of high grade serous ovarian carcinoma (HES: Hematein, Eosin, Saffron). (A) Primary cancer × 10. (B) Macroscopic peritoneal metastase × 20. (C) Microscopic peritoneal metastase × 10.
Figure 2
Figure 2
The relative histogram of the number of biopsies with mPM (blue bars) fitted with a Poisson distribution (orange diamonds). The possible values for the number of biopsies with mPM are reported on the x-axis, and the relative frequency of occurrences of these possible values are represented by blue bars on the y-axis. mPM: microscopic peritoneal metastases.
Figure 3
Figure 3
Probabilities that 0, 1, 2, …, or all the 4000 sub-surfaces of the peritoneal surface has an mPM (red bars). (A): Overview. (B): Zoom on the range (0; 200) in which the probabilities are maximal. mPM: microscopic Peritoneal Metastases.
Figure 3
Figure 3
Probabilities that 0, 1, 2, …, or all the 4000 sub-surfaces of the peritoneal surface has an mPM (red bars). (A): Overview. (B): Zoom on the range (0; 200) in which the probabilities are maximal. mPM: microscopic Peritoneal Metastases.
See this image and copyright information in PMC

References

    1. Jayson G.C., Kohn E.C., Kitchener H.C., Ledermann J.A. Ovarian cancer. Lancet. 2014;384:1376–1388. doi: 10.1016/S0140-6736(13)62146-7. - DOI - PubMed
    1. Chang S.-J., Hodeib M., Chang J., Bristow R.E. Survival impact of complete cytoreduction to no gross residual disease for advanced-stage ovarian cancer: A meta-analysis. Gynecol. Oncol. 2013;130:493–498. doi: 10.1016/j.ygyno.2013.05.040. - DOI - PubMed
    1. Collinson F., Qian W., Fossati R., Lissoni A., Williams C., Parmar M.K., Ledermann J., Colombo N., Swart A. Optimal treatment of early-stage ovarian cancer. Ann. Oncol. 2014;25:1165–1171. doi: 10.1093/annonc/mdu116. - DOI - PMC - PubMed
    1. Eisenkop S.M., Spirtos N.M., Lin W.-C.M. “Optimal” cytoreduction for advanced epithelial ovarian cancer: A commentary. Gynecol. Oncol. 2006;103:329–335. doi: 10.1016/j.ygyno.2006.07.004. - DOI - PubMed
    1. Vergote I., Amant F., Kristensen G., Ehlen T., Reed N.S., Casado A. Primary surgery or neoadjuvant chemotherapy followed by interval debulking surgery in advanced ovarian cancer. Eur. J. Cancer. 2011;47:S88–S92. doi: 10.1016/S0959-8049(11)70152-6. - DOI - PubMed

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