bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic significance of obesity in high-grade serous carcinoma of the ovary
Authors: Schlumbrecht M. , Urbauer D. , Gershenson D. , Broaddus R. 
Published: August 2020

e16528 Background: Obesity is an epidemic public health problem in the United States. In gynecologic oncology, obesity is an established risk factor for endometrial cancer. However, its role in the pathogenesis and survival in ovarian cancer is debated. Recent studies have attempted to elucidate a possible relationship, but variations in design and heterogeneity in patient characteristics make it difficult to draw definitive conclusions. The purpose of our study was to determine if body mass index at the time of treatment initiation for high grade serous ovarian carcinoma has an effect on patient outcome. Methods: Nine-hundred four patients treated for ovarian cancer at M.D. Anderson Cancer Center were identified between 2002 and 2007. Patients were excluded for low grade or non-serous histology, neoadjuvant treatment, or if presenting with recurrent disease. Clinicopathologic data were extracted by retrospective chart review. Patients were stratified by body mass index (BMI) as normal (BMI<25), overweight (BMI 25-<30), or obese (BMI>30). All were treated with primary cytoreduction and standard platinum/taxane chemotherapy. Chemotherapy was dosed using adjusted body weights. Outcomes included time to recurrence, overall survival, success of surgical debulking, and chemotherapeutic toxicities. Statistical analysis was performed using Fisher's exact test, Wilcoxon test, and Kaplan-Meier estimates. Results: A total of 127 patients were included for analysis. Patients were followed for a mean of 37 months (range 3–86 months). Twenty-one patients were obese (16.5%), and 35 were overweight (27.5%). Diabetes was more prevalent in the obese cohort (p = 0.0038). There was a trend towards greater likelihood of suboptimal debulking in obese patients, but this did not reach statistical significance (p = 0.06). BMI had no effect on recurrence-free survival (HR 0.69 [CI 0.39–1.23], p = 0.21) or overall survival (HR 0.95 [CI 0.68–2.43], p = 0.91). There was no difference in chemotherapy side effects or chemoresistance across BMI strata. Conclusions: Body mass index has no effect on survival in women with high grade serous ovarian cancer. Effectively managing comorbidities and ensuring adequate chemotherapy dosing in the obese patient is crucial for optimizing outcome. No significant financial relationships to disclose.
Sequential or combination therapy in the management of recurrent ovarian carcinoma: Clinical experience beyond clinical trials
Authors: Gueth U. , Wight E. 
Published: August 2020

e16530 Background: There is a vast amount of literature on the effect of systemic therapy in patients with recurrent ovarian carcinoma (ROC) enrolled in clinical trials. However, there are only a few reports that focus on the treatment during the entire course of disease and its changes and development over time. Methods: We investigated the entire treatment course (all agents administered, number of treatment lines, cumulative time of therapy in relation to survival time) in a population-based cohort of 133 ROC patients. In study group A (n = 63), ROC was diagnosed between 1998 to 2006; in group B, ROC was diagnosed between 1990 to 1997 (n = 70). Results: 7.9% of the patients in group A and 8.6% in group B did not receive any chemotherapy in the palliative setting. Comparison between sub-study groups A and B showed similar overall survival (recurrent disease-specific survival): 19 months (A) vs. 18 months (B); p = 0.549. Compared to group B, the patients in the more recent subgroup A received significantly fewer combination therapies (12% vs. 24.1%, p = 0.0057) but more therapy lines (≥3 lines in 56.1% vs. 31.1%, p = 0.005) and also had significantly longer times of treatment in relation to survival time (mean ratio 57.5% vs. 47.5%, p = 0.014). The distribution of the main agents administered in the course of disease was as follows (A vs. B): carboplatin 31.0% vs. 34.7%; pegylated liposomal doxorubicin (PLD): 19.7% vs. 2.0%; gemcitabine 19.2% vs. 3.0%; paclitaxel: 10.7% vs. 14.6%; topotecan: 9.1% vs. 2.5%; others: 10.3% vs. 43.2%. Conclusions: In the current study group, a similar outcome could be achieved with less aggressive treatment regimens, i.e. with fewer combination therapies and with longer treatment periods. Currently, in a palliative treatment setting, the primary goals of surveillance of ROC patients are maintenance and/or an enhancement of quality of life, which can be achieved using less toxic agents such as gemcitabine and PLD. No significant financial relationships to disclose.
The predictive and prognostic value of serum CA 125 kinetics and CA 125 nadir during paclitaxel/platinum based chemotherapy in patients with advanced ovarian carcinoma
Authors: Tibau A. , Ojeda B. , Nadal R. , Pérez Altozano J. , Boguña I. , Artigas V. , Gallardo A. , Pérez C. , Lopez J. , Barnadas A. 
Published: August 2020

e16534 Background: The tumor marker CA 125 is an accurate and reliable marker for monitoring the response to treatment and detecting early relapse in epithelial ovarian cancer (EOC). The aim of this retrospective study is to analyze the predictive and prognostic value of CA 125 kinetics and the implications of the different levels of CA 125 within the normal range after chemotherapy (CT). Methods: Between 1996 and 2008, 127 patients (pts) were treated with standard CT regimen for FIGO stage IIb-IV EOC. Median age was 64 years (24–87). Tumors were classified: 70 (55%) serous, 24 (19%) poorly differentiated, 14 (11%) endometrioid and 19 (15%) clear cell carcinoma. FIGO stage: 12 (9%) II; 95 (75%) III; and 20 (16%) IV. Tumor grade: 1 (1%) G1; 11 (9%) G2; and 115 (90%) G3. Residual disease after initial surgery: 52 (41%) optimal <2cm and 39 (31%) suboptimal. After surgery, 117 (92%) of the pts received a median of 6 cycles/patient with platinum based (cisplatin or carboplatin) CT in combination with paclitaxel. Median follow-up was 31 months. 93 (73%) pts achieved levels <35 U/ml after CT. Survival analyses for disease-free survival (DFS) and overall survival (OS) used univariate (Kaplan-Meier) and multivariate (Cox) model. Results: For 127 stage IIb-IV pts, 88 (69%) relapsed and 60 (47%) died from EOC. The median DFS for 3 groups 1, 2 and 3, was 34, 20, 14 months, respectively (p < 0.0001). The median OS for 3 groups was 7.5, 3 and 3 years, respectively (p < 0.0001). Pre-CT Ca 125 (p < 0.002), and time to negativization (p < 0.043) all had a univariate prognostic value for DFS and OS. In Cox models, FIGO stage (p < 0.0001) and nadir concentration (p < 0.0001) were the most powerful prognostic factors for DFS and OS. We found no differences in DFS and OS related to time to nadir. Conclusions: Serum CA 125 kinetics during early CT has a strong predictive and prognostic relevance for patients with advanced EOC. Within normal range, the differences between CA 125 levels could add prognostic information, stratify pts according to the risk of progression and would be a useful tool when performing consolidation CT in future clinical trials. No significant financial relationships to disclose.
Pegylated liposomal doxorubicin in recurrent serous carcinoma of the uterus
Authors: Dizon D. S. , Stuckey A. , Schwartz J. 
Published: August 2020

e16538 Background: Serous carcinoma of the uterus behaves in a much more aggressive fashion than endometrioid tumors of the uterus with risks almost equivalent to ovarian cancers. Given this, we were interested in seeing if pegylated liposomal doxorubicin had a differential benefit in serous cancers of the uterus when compared to endometrioid carcinomas. Methods: Patients with recurrent serous and endometrioid uterine cancer treated with pegylated liposomal doxorubicin between 1999 and 2007 were identified. Demographics, stage, grade, and prior lines of chemotherapy were collected. The primary objectives were to determine progression-free (PFS) and overall survivals (OS) in these subsets of women with recurrent endometrial cancer. Results: Twenty-three patients with recurrent serous histology and 24 with endometrioid histology were identified. The median age at diagnosis in the serous group was 70 (45–89) and 62 (37–94) in the endometrioid cohort. The majority of patients in both groups were Caucasian. There was no difference between the serous and endometrioid cohorts by stage with advanced disease in 65% and 73%, respectively (p = 0.95). The majority of patients had 2 prior lines of treatment. The most common prior chemotherapy was carboplatin and paclitaxel. The median number of pegylated liposomal doxorubicin cycles was 4 in both groups. The median PFS was 4.6 months in the serous cohort and 4.7 months in the endometrioid group (p = 0.47). The median overall survival in the serous group was 9.8 months and in the endometrioid group it was 9.6 months (p > 0.5). Conclusions: We did not find a difference in survival endpoints in women with serous versus endometrioid histologies. While pegylated liposomal doxorubicin appears to be equally active in these groups, survival is uniformly poor in the context of recurrent disease. No significant financial relationships to disclose.
Role of an EpCAM auto-antibody in ovarian cancer patients with special regard to disseminated tumor cells in bone marrow
Authors: Heubner M. , Kasimir-Bauer S. , Errico D. , Herlyn D. , Kimmig R. , Wimberger P. 
Published: August 2020

e16557 Background: EpCAM is a tumor associated antigen which is frequently expressed in ovarian cancer. Recently, an autoantibody (AAB) against EpCAM has been identified in ovarian cancer patients. Autoantibodies are immunogene factors and might be of prognostic importance. We showed that disseminated tumor cells (DTC) in bone marrow carry the EpCAM antigen on their surface and correlate with poorer progression free survival (PFS). Here, we evaluated whether EpCAM-AABs have an impact on clinical parameters or the presence of DTC in ovarian cancer patients. Methods: EpCAM-AABs were determined in sera of 28 healthy voluntary age matched females and 62 patients with primary epithelial ovarian cancer before and after platinum-based chemotherapy using a recombinant EpCAM-epitope for antibody- detection by ELISA technique. Mean follow up time was 13 months. DTC in BM were detected by immunocytochemistry applying the pan cytokeratin antibody A45-B/B3. All samples exceeding the mean antibody titer of healthy controls plus 2 standard deviations were considered positive. Results: The antibody titer of healthy controls was 0.061 + 0.015. Using a cut-off value of 0.091, we found 9/62 (15%) ovarian cancer patients to be positive for EpCAM-AABs after first-line treatment. Interestingly, no positive AAB-titers were seen before therapy. Using the paired T-Test, we noted a significant posttherapeutic increase of AABs (CI 0.95, p < 0.0001). Analysis of PFS, FIGO stage, resection status, grading, age, sensitivity to platinum based chemotherapy and DTC did not reveal significant associations with positive EpCAM-AAB titers. Conclusions: The clinical course of ovarian cancer patients and the prevalence of DTC were not altered by EpCAM-AABs. Interestingly, we observed an increase of antibody-levels after first-line treatment. For further validation, we intend to extend our patient collective. In future, it might also be interesting to investigate the impact of AABs on response to targeted therapies against EpCAM. No significant financial relationships to disclose.
Impact of malnutrition on surgical outcome of patients with ovarian cancer: Results of a prospective study
Authors: Skowronek P. , Kuhberg M. , Chen F. , Schwarz J. , Lichtenegger W. , Sehouli J. 
Published: August 2020

e16564 Background: The purpose of this study was to examine an influence of poor nutritional status on surgical outcome in patients with ovarian cancer. Methods: Data from 152 consecutive patients with histologically confirmed ovarian cancer were prospectively analyzed. Overall 79 suffered from primary and 73 from recurrent disease. All patients received a systematic nutritional assessment prior to cytoreductive surgery and postoperative all complications were analyzed in detail. The Nutritional Risk Score (NRS-2002) was used to identify patients at high nutritional risk (NRS≥3). Intraoperatively, a standardized documentation script (IMO) was applied including tumor localization, surgical interventions, and postoperative residual tumor mass. Results: 29 patients (19%) were classified as malnourished, including 19 (24%) with primary and 10 (14%) with recurrent disease. These patients showed a significantly poorer performance status preoperatively compared to patients with NRS<3 (p < 0.05), which was assessed according to the American Society of Anesthesiologists (ASA). Also an intra-operatively documented tumor spread was significantly more extended in group with NRS≥3 than among patients with NRS<3 (p < 0.05). In malnourished patients complete resection rate was significantly decreased (31% vs. 69%, p < 0.001) and they required more often a colo- or ileostoma (17% vs. 6%, p = 0.041). Malnourished patients suffered more often from post-operative complications (62% vs. 37%, p < 0.05), especially infectious like pneumonia or sepsis. All postoperative mortality events (3 cases) occurred in the malnourished group. Conclusions: Malnourished ovarian cancer patients have significantly more often post-operative complications. They suffer from more extended tumor spread and were less frequently postoperatively tumor-free. Based on our results further prospective trials of preoperative nutritional therapy to improve surgical outcome are warranted. No significant financial relationships to disclose.
A second peritoneal cytology instead of the initial cytology as a prognostic factor in epithelial ovarian cancer
Authors: Sirop S. , Saha S. , Soni M. , Chkravarty B. , Korant A. , Dutt N. , Wilson D. , Ng P. , Arora M. , Singh T. 
Published: August 2020

e16572 Background: Ovarian cancer (OvCa) is the most common gynecological malignancy causing death. Positive (+ve) peritoneal cytology is an important prognostic factor. The role of a repeat peritoneal washing after resection of the tumor at the time of surgery has not been evaluated in the past. Methods: A retrospective analysis of our prospective cohort database was undertaken. Patients (pts) diagnosed with OvCa between 2001–2007 were included in the study. All pts underwent debulking surgery with two peritoneal washings during surgery: one before and one after resection of the tumor. The primary outcome was overall survival. Exclusion criteria included second malignancy, refusal of chemotherapy, or non-surgical candidates. Only stage III andIV pts were included in the follow-up analysis. Results: Forty three pts were included in our study. Of these, 8 (gp A) had both peritoneal washings +ve for malignancy, 16 (gp B) had the first washing +ve and the second one negative (-ve) for malignancy, and 19 (gp C) had both washings -ve for malignancy. There was no significant difference in the demographics and grade of disease (Table). There was more serous histology in gp B as compared to gp A and gp C. The median length of stay was 13.2, 10.9, 9 days and the median CA 125 level at the time of diagnosis was 651, 440 and 445 in gp A, B and C respectively. Bowel was involved and required radical resection in 75%, 41.7%, and 26.3% in gp A, B, and C, however the rates of optimal cytoreduction were 75%, 84.6% and 90.9% respectively. The minimum follow-up was 12 months. The percentage of pts with persistent or recurrent disease was 62.5%, 41.7%, and 36.4% in gpA, B and C respectively. There was improved survival in gp C as compared to gp B and gp A. (42 months vs 23.5 months vs 13 months respectively). Conclusions: While preliminary, our study shows that at the time of debulking surgery of OvCa, a -ve peritoneal washing after resection of the tumor following an initial +ve washing is a possible independent prognostic factor. [Table: see text] No significant financial relationships to disclose.
Low-dose methotrexate and cyclophosphamide in recurrent ovarian cancer
Authors: Scheusan R. , Curescu S. , Stanculeanu D. , Curescu P. 
Published: August 2020

e16574 Background: Ovarian cancer continues to be the leading cause of death secondary to gynecologic cancers among women. Despite the fact that new chemotherapeutic drugs have been found effective, the prognosis of these women continues to be poor. Metronomic chemotherapy, chronic administration of chemotherapy at relatively low, minimally toxic doses on a frequent schedule with no prolonged drug-free breaks, is a potentially novel approach to the control of advanced cancer disease. It is thought to work primarily through antiangiogenic mechanisms and has, as an advantage, the property of significantly reducing toxic side-effects. Purpose: to evaluate the efficacy and toxicity of metronomic chemotherapy using low dose methotrexate and cyclophosphamide in patients with refractory pretreated ovarian cancer. Methods: From May 2007 to July 2008, 11 patients with refractory pretreated ovarian adenocarcinoma were included. Patient's characteristics: median age 51 years (range 41–64), ECOG 0–2, progression after more than two lines of chemotherapy for recurrent disease. Treatment: low-dose oral methotrexate 2.5 mg bd on days 1 and 2 each week and cyclophosphamide 50 mg/day administered continuously until disease progression. Follow-up: every month clinical examination, ECOG, blood test; every two months CA-125; every four months CT-scan. Results: All patients were evaluable for response and toxicity. There was no complete response; 2 pts (18.18%) - partial response and the overall clinical benefit rate was 54.54%. The median time to progression was 4.4 month. Main toxicities according to WHO criteria were: grade 1–2 gastrointestinal toxicities (nausea, vomiting) 4 pts (36.36%), grade 1–2 anemia 4 pts (36.36%), grade 1–2 neutropenia 2 pts (18.18%). No grade 3–4 toxicities was observed. Conclusions: Metronomic metotrexate-cyclophosphamide is minimally toxic and effective in heavily pretreated recurrent ovarian cancer. In conclusion, metronomic regimen could represent a potentially significant palliative treatment for these patients. A better understanding of mechanism of actions would help determine the optimal dose and schedule for metronomic chemotherapy regimens as antiangiogenic therapy. No significant financial relationships to disclose.
Surgical and immunohistochemical (IC) risk factors for metastatic disease in stage IB1 cervical cancer (CC)
Authors: De La Mota J. , Thomas B. , Fengwei W. , Micaily B. , Yajue H. , Hernandez E. 
Published: August 2020

e16578 Background: Stage IB1 CC is treated with radical abdominal hysterectomy (RH) and pelvic lymph node dissection (LND) because of presumed risk of parametrial and nodal involvement. We sought to identify surgical and IC risk factors for metastatic disease. Methods: Retrospective chart review of all stage IB1 CC patients who underwent RH and LND from 1996–2008. Results: Of the 35 patients identified, 25 (71%) had squamous cell, 9 (26%) adenocarcinoma, and 1 (3%) adenosquamous histology. Median tumor diameter of patients without lymphovascular space involvement (LVI), with LVI, and with positive LN was 1.2, 2.0, and 2.5 cm respectively. Median of 24 LNs was removed. LVI was noted in 13 (37%) patients of whom 5 (38%) had positive LN. None of the 22 patients without LVI had LN involvement. Only 2 of 35 (6%) had parametrial involvement, both of which had positive LN. All patients with positive LN received chemo-radiation. In addition six patients with LVI and deep cervical stromal invasion received adjuvant radiation therapy. Median follow-up was 14 months. Postoperatively 8 (23%) and 4 (11%) patients had early and late complications respectively. There was one (3%) vaginal recurrence in a patient with positive LN. The 5-year progression-free survival and overall survival was 95% and 100%, respectively. Immunohistochemical (IC) staining was performed on 29 cases (10 LVI, 4 positive LN) for bcl-2, p53, Ki-67. There was increased staining for Ki-67 in patients with LVI (61% vs. 44%, p = 0.01), and in those with positive LN (66% vs. 48%, p = 0.04). No correlation was found with p53 or Bcl-2. Conclusions: The rate of LN metastasis in patients with stage IB1 CC is significant (14 %), as is the rate of parametrial involvement (6%). However, it occurred only in patients with LVI. Staining for Ki-67 may help detect high-risk patient. RH followed by adjuvant therapy in high-risk patients resulted in 100% 5-year survival, but is associated with morbidity. No significant financial relationships to disclose.
YKL-40 and CA 125 serum levels in patients with ovarian cancer
Authors: Chudecka-Glaz A. , Zielinska D. , Rzepka-Górska I. 
Published: August 2020

e16579 Background: CA 125 is known and useful marker in diagnosis and follow up of patients with ovarian cancer. But there is only a few study about YKL-40 and its usefulness in these patients. The aim of our study was to compare the serum levels of YKL-40 and CA 125 in patients with active phase of ovarian cancer disease (during diagnosis and recurrence). Methods: We analyzed 58 women with ovarian cancer hospitalized and treatment in period from January 2006 to March 2008. Group I - 42 patients constituted women with actually diagnosed ovarian cancer and group II women with recurrence of ovarian cancer. Results: Mean value of YKL-40 in patients with just diagnosed ovarian cancer was 181 ng/mL (16.42–766.1 ng/ml). Mean value of YKL-40 in patients with the recurrent of ovarian cancer was 122.38 ng/mL (9.47–389.22 ng/mL). CA 125 respectively 729.58 U/mL (10.62–4882.1 U/mL) and 579.15 /mL (5.38–6000 U/mL). When the cut-off level for YKL-40 was set at 130 ng/mL we found elevated serum levels in 50% of group I and 38% of group II. Respectively in group I we found 73% elevated values of YKL-40 and 44% in group II when the cut-off level was set at 61 ng/mL. In patients with diagnosed ovarian cancer percentage of elevated CA 125 serum value was 90% and 55% in recurrent ovarian cancer (cut-off level -35 U/mL). Conclusions: Significance of YKL-40 tumor marker in ovarian cancer diagnosis seems to be less then known CA 125 antigen. No significant financial relationships to disclose.