Laparoscopic tumor load as an independent prognostic marker in advanced ovarian cancer: a 3-year cohort study

Abstract

Objective: To evaluate the association between pre-operative tumor load, progression-free survival, and overall survival in patients with advanced epithelial ovarian cancer.

Methods: Patients diagnosed with The International Federation of Gynecology and Obstetrics (FIGO) stage III to IV primary ovarian, tubal, or peritoneal carcinoma, who underwent intraoperative abdominal disease spread assessment using the laparoscopic predictive index value (PIV) at the Gynecologic Oncology Unit of the Policlinico-Agostino Gemelli University Hospital-IRCCS, Rome, from January 2018 to December 2020, were included. Patients were divided into 2 groups based on median laparoscopic PIV at diagnosis in our population: group A (low tumor load) with PIV from 0 to 6, group B (high tumor load), with PIV from 8 to 12, and/or with extensive miliary carcinomatosis and mesentery retraction.

Results: During the study period, 817 patients with newly diagnosed advanced epithelial ovarian cancer were included, with a median age of 60 years (range;18-87), a median CA125 level of 584 (range; 5-6262), and ascites presence in 436 cases (54.0%). With a median follow-up of 51.0 months (95% CI 49.5 to 52.5), 571 (69.9%) recurrences and 388 (47.5%) deaths were observed. The median progression-free and overall survival were 22.0 months (95% CI 19.8 to 24.2) and 53.0 months (95% CI 48.7 to 57.3), respectively. A statistically significant correlation between PIV and risk of recurrence or death was observed (p < .001). The median progression-free survival was 27 months for PIV < 8 versus 16 months for PIV ≥ 8 (p < .001). The 5-year survival rate was 54.8 % (95% CI 49.1 to 60.5) for PIV < 8 and 30.4% (95% CI 23.7 to 37.1) for PIV ≥ 8 (p < .001). This correlation was maintained in the subgroup analysis by stage. Specifically, for FIGO stage III, the 5-year survival rate was 57.2 % for the group with PIV < 8 and 26.3 % for the group with PIV ≥ 8; for FIGO stage IV, it was 47.9 % for the group with PIV < 8, and 32.8 % for the group with PIV ≥ 8. In multivariate analysis, PIV was confirmed as an independent prognostic factor for both progression-free and overall survival, along with BRCA status and residual tumor after surgery, as well as ascites for progression-free survival and age for overall survival.

Conclusions: This study underscores tumor burden at diagnosis, quantified by PIV, as a key independent prognostic factor in advanced ovarian cancer, irrespective of FIGO stage or BRCA status, even in the era of maintenance therapies.

Keywords: Advanced Stages; FIGO Staging; Laparoscopy; Ovarian Cancer; Predictive Index Value.