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. 2021 Dec 17;10(24):5927.
doi: 10.3390/jcm10245927.

The Uncertain Benefit of Adjuvant Chemotherapy in Advanced Low-Grade Serous Ovarian Cancer and the Pivotal Role of Surgical Cytoreduction

Racheal Louise Johnson  1 , Alexandros Laios  1 , David Jackson  2 , David Nugent  1 , Nicolas Michel Orsi  3 , Georgios Theophilou  1 , Amudha Thangavelu  1 , Diederick de Jong  1
Affiliations

The Uncertain Benefit of Adjuvant Chemotherapy in Advanced Low-Grade Serous Ovarian Cancer and the Pivotal Role of Surgical Cytoreduction

Racheal Louise Johnson et al. J Clin Med. .

Abstract

In our center, adjuvant chemotherapy is routinely offered in high-grade serous ovarian cancer (HGSOC) patients but less commonly as a standard treatment in low-grade serous ovarian cancer (LGSOC) patients. This study evaluates the efficacy of this paradigm by analysing survival outcomes and by comparing the influence of different clinical and surgical characteristics between women with advanced LGSOC (n = 37) and advanced HGSOC (n = 300). Multivariate analysis was used to identify independent prognostic features for survival in LGSOC and HGSOC. Adjuvant chemotherapy was given in 99.7% of HGSOC patients versus in 27% of LGSOC (p < 0.0001). The LGSOC patients had greater surgical complexity scores (p < 0.0001), more frequent postoperative ICU/HDU admissions (p = 0.0002), and higher peri-/post-operative morbidity (p < 0.0001) compared to the HGSOC patients. The 5-year OS and progression-free survival (PFS) was 30% and 13% for HGSOC versus 57% and 21.6% for LGSOC, p = 0.016 and p = 0.044, respectively. Surgical complexity (HR 5.3, 95%CI 1.2-22.8, p = 0.024) and complete cytoreduction (HR 62.4, 95% CI 6.8-567.9, p < 0.001) were independent prognostic features for OS in LGSOC. This study demonstrates no clear significant survival advantage of chemotherapy in LGSOC. It highlights the substantial survival benefit of dynamic multi-visceral surgery to achieve complete cytoreduction as the primary treatment for LGSOC patients.

Keywords: cytoreduction; high-grade serous ovarian cancer (HGSOC); low-grade serous ovarian cancer (LGSOC); surgical complexity; survival.

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Conflict of interest statement

David Jackson; Honoraria and sponsorship—Novartis, Pfizer, Tesaro/GSK. No other author declares any conflicts of interest.

Figures

Figure 1
Figure 1
Inclusion and exclusion criteria for all patients with an advanced stage EOC who had cytoreductive surgery between January 2014 and December 2017. A total of 37 low-grade serous ovarian cancer (LGSOC) and 300 high-grade serous ovarian cancer (HGSOC) patients were included in the study.
Figure 2
Figure 2
Overall (left panel) and progression-free (right panel) survival in patients with advanced-stage serous epithelial ovarian cancer according to grade. Survival is in months (X-axis), and probability of survival is in percentage (Y-axis). The black line represents patients with advanced low-grade serous cancer (LGSOC), and the purple line represents patients with high-grade serous ovarian cancer (HGSOC).
Figure 3
Figure 3
Overall (left panel) and progression-free (right panel) survival in patients with advanced-stage serous epithelial ovarian cancer according to surgical setting. Survival is in months (X-axis), and the probability of survival is in percentage (Y-axis). The black line represents advanced low- and high-grade serous cancer patients who underwent primary debulking surgery (PDS), and the purple line represents advanced low- and high-grade serous cancer patients who underwent interval debulking surgery following neoadjuvant chemotherapy.
Figure 4
Figure 4
The overall (left panel) and progression-free (right panel) survival in patients with advanced-stage serous epithelial ovarian cancer according to completeness of cytoreduction. Survival is in months (X-axis), and the probability of survival is in percentage (Y-axis). Complete cytoreduction is represented by a CC of 0–1, and incomplete cytoreduction is represented by a CC ≥ 2. The green and orange lines represent patients with advanced low-grade serous cancer (LGSOC), and the blue and red lines represent patients with high-grade serous ovarian cancer (HGSOC).
Figure 5
Figure 5
Overall (left panel) and progression-free (right panel) survival in patients with advanced stage serous epithelial ovarian cancer according to surgical complexity score (SCS). Survival is in months (X-axis), and probability of survival is in percentage (Y-axis). Low surgical complexity is represented by SCS 0–3, and medium to high surgical complexity is represented by SCS ≥ 4. The green and orange lines represent patients with advanced low-grade serous cancer (LGSOC), and the blue and red lines represent patients with high-grade serous ovarian cancer (HGSOC).
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