Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2022; 10(12): 3739-3753
Published online Apr 26, 2022. doi: 10.12998/wjcc.v10.i12.3739
Surgery in platinum-resistant recurrent epithelial ovarian carcinoma
Ling-Qin Zhao, Wen Gao, Ping Zhang, Ying-Li Zhang, Chen-Yan Fang, Hua-Feng Shou
Ling-Qin Zhao, Wen Gao, Ping Zhang, Ying-Li Zhang, Chen-Yan Fang, Department of Gynecologic Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou 310022, Zhejiang Province, China
Hua-Feng Shou, Department of Gynecology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
Author contributions: Zhao LQ and Gao W contributed to conceptualization, data curation, and writing - review & editing; CY Fang, Zhang P contributed to formal analysis and methodology; Zhao LQ, Gao W, YL Zhang, and Shou HF contributed to writing - original draft; Zhao LQ and Gao W contributed equally to this work; all authors read and approved the final manuscript.
Supported by the Medical Science Project of Zhejiang Province, No. 2018KY027.
Institutional review board statement: The research adhered to the principles of the Declaration of Helsinki and Title 45, United States. Code of Federal Regulations, Part 46, Protection of Human Subjects. The present study was approved by the Medical Ethics Committee of Zhejiang Cancer Hospital. The study has obtained informed consent for all individual participants that appear in this manuscript.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this work have nothing to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at shouhuafeng@hmc.edu.cn.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—a checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hua-Feng Shou, MD, Department of Gynecology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, No. 158 Shangtang Road, Xiacheng District, Hangzhou 310014, Zhejiang Province, China. shouhuafeng@hmc.edu.cn
Received: October 1, 2021
Peer-review started: October 1, 2021
First decision: December 10, 2021
Revised: December 24, 2021
Accepted: March 6, 2022
Article in press: March 6, 2022
Published online: April 26, 2022
Abstract
BACKGROUND

Ovarian cancer is one of the three most common malignant tumors of the female reproductive tract and ranks first in terms of mortality among gynecological tumors. Epithelial ovarian carcinoma (EOC) is the most common ovarian malignancy, accounting for 90% of all primary ovarian tumors. The clinical value of cytoreductive surgery in patients with platinum-resistant recurrent EOC remains largely unclear.

AIM

To evaluate the feasibility of secondary cytoreductive surgery for treating platinum-resistant recurrent EOC.

METHODS

This was a retrospective study of the clinical data of patients with platinum-resistant EOC admitted to the Cancer Hospital of the University of Chinese Academy of Sciences between September 2012 and June 2018. Patient baseline data were obtained from clinical records. Routine follow-up of disease progression was performed as follows. CA125 assessment and physical examination were performed every 3 wk during treatment, including gynecological examination. Imaging assessment was carried out every 12 wk by B-mode ultrasound, computed tomography, or magnetic resonance imaging. The primary outcome was progression-free survival (PFS). Secondary outcomes included overall survival (OS), chemotherapy-free interval (CFI), and complications. Follow-up ended on April 15, 2019.

RESULTS

A total of 38 patients were included. R0 resection was achieved in 25 (65.8%) patients and R1/2 in 13 (34.2%). Twenty-five (65.8%) patients required organ resection. Nine (23.7%) patients had operative complications, 36 (94.7%) received chemotherapy, and five (13.2%) had targeted therapy. Median PFS and OS were 10 (95%CI: 8.27-11.73) months and 28 (95%CI: 12.75-43.25) months, respectively; median CFI was 9 (95%CI: 8.06-9.94) months. R0 resection and postoperative chemotherapy significantly prolonged PFS and OS (all P < 0.05), and R0 resection also significantly prolonged CFI (P < 0.05). Grade ≥ 3 complications were observed, including rectovaginal fistula (n = 1), intestinal and urinary fistulas (n = 1), and renal failure-associated death (n = 1). Except for the patient who died after surgery, all other patients with complications were successfully managed. Two patients developed intestinal obstruction and showed improvement after conservative treatment.

CONCLUSION

Secondary cytoreductive surgery is feasible for treating platinum-resistant recurrent EOC. These findings provide important references for the selection of clinical therapeutic regimens.

Keywords: Carcinoma, Ovarian epithelial, Cisplatin, Drug resistance, Neoplasm, Surgical treatment

Core Tip: This retrospective study examined 38 patients with platinum-resistant epithelial ovarian carcinoma (EOC). R0 resection was achieved in 25 (65.8%) and R1/2 in 13 (34.2%). Twenty-five (65.8%) patients required organ resection. Nine (23.7%) patients had operative complications, 36 (94.7%) received chemotherapy, and five (13.2%) had targeted therapy. Median progression-free survival (PFS) and overall survival (OS) were 10 and 28 mo, respectively; median chemotherapy-free interval (CFI) was 9 mo. R0 resection and postoperative chemotherapy significantly prolonged PFS and OS, and R0 resection also significantly prolonged CFI. Overall, these findings indicated secondary cytoreductive surgery is feasible for the treatment of platinum-resistant recurrent EOC.