Introduction/Background Low-grade epithelial ovarian cancers (EOC) constitute the minority among all epithelial cancers and clinical experience at recurrence is limited. The aim of our study was to investigate the survival in low-grade recurrent EOC and to compare with high-grade disease, as well as in regard to platinum-sensitive and -resistant recurrences.
Methodology This is an exploratory analysis within the North-Eastern German Society of Gynecological Oncology (NOGGO) metadata base including five randomized phase II/III trials comparing different chemotherapy regimens in recurrent EOC. We conducted survival analyses and cox-proportional regression models.
Results Out of 1050 patients with recurrent epithelial cancer, 42 (4%) patients had low-grade and 1008 (96%) patients had high-grade EOC. In the subgroup of platinum-sensitive recurrences, PFS (8.7 m vs 9.7 m , p= 0.7) OS (23.9 m vs 24.8 m, p= 0.9) did not differ between low-grade and high-grade EOC. In platinum-resistant recurrences, patients with low-grade ovarian cancer had significantly better PFS (7.6 m vs 3.6 m, p= 0.03) and OS (41.9 m vs 9.5 m, p= 0.002) in comparison to those with high-grade cancer (figure 1). In low-grade EOC, there were no significant PFS (8.7 m vs 7.6 m, p=0.91) and OS (23.9 m vs 41.9 m, p=0.25) differences between platinum-sensitive and -resistant recurrences. Patients with low-grade non-serous histology had lower PFS (2.8 m vs 11.3 m, p=0.004) with compared to those with low-grade serous histology (figure 2). At cox regression analysis presence of ascites and residual disease after secondary cytoreductive surgery were independent factors associated with poor PFS within low-grade recurrent cancers.
Conclusion Our study indicates, platinum sensitivity according to platinum-free interval does not have any prognostic significance at recurrent low-grade EOC and non-serous histology is associated with poorer outcome at the recurrence. Secondary surgical cytoreduction to no-gross residual disease and ascites are independently associated with disease progression.
Disclosure EIB reports personal fees from Roche Pharma, CLOVIS, Tesaro, AstraZeneca, Incyte, Seattle Genetics, Amgen and grants from Roche Diagnostic outside the submitted work. All remaining authors have declared no conflicts of interest.
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