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Stage IC grade 1 endometrioid adenocarcinoma of the ovary: assessment of post-operative chemotherapy de-escalation
  1. Sabrina M Woll1,2,
  2. Matthew W Lee1,
  3. Monica K Neuman1,
  4. Christian Pino1,
  5. Maximilian Klar3,
  6. Lynda D Roman1,
  7. Jason D Wright4 and
  8. Koji Matsuo1
    1. 1 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
    2. 2 Keck School of Medicine University of Southern California, Los Angeles, California, USA
    3. 3 Department of Obstetrics and Gynecology, University of Freiburg Faculty of Medicine, Freiburg, Germany
    4. 4 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, USA
    1. Correspondence to Professor Dr Koji Matsuo; koji.matsuo{at}med.usc.edu

    Abstract

    Objective Given limited real-world practice data evaluating the National Comprehensive Cancer Network clinical practice guidelines for possible post-operative chemotherapy omission as a treatment option for patients with stage IC grade 1 endometrioid ovarian carcinoma, this population-based study examined the association between post-operative chemotherapy and overall survival in this tumor group.

    Methods The National Cancer Institute’s Surveillance, Epidemiology, and End Results program was retrospectively queried. The study population was 1207 patients with stage IC grade 1–3 endometrioid ovarian carcinoma who received primary cancer-directed surgery from 2007 to 2020. Overall survival was assessed with multivariable Cox proportional hazard regression model.

    Results The median age was 52, 54, and 55 years for grade 1, 2, and 3 groups, respectively (p=0.02). Grade 1 and 2 tumors were more common than grade 3 tumors (n=508 (42.1%), n=493 (40.8%), and n=206 (17.1%), respectively). Chemotherapy use rate for grade 1 tumors was lower compared with grade 2–3 tumors (67.9%, 76.5%, and 78.6%, respectively, p<0.001). When nodal evaluation was performed for grade 1 tumors, among patients who did not receive post-operative chemotherapy and among those who did, 5-year overall survival rate exceeded 90% (93.3% and 96.0%, respectively), with statistically non-significant hazard estimates (adjusted hazard ratio (aHR) 1.54, 95% CI 0.63 to 3.73). In contrast, post-operative chemotherapy omission for patients who did not undergo nodal evaluation was associated with decreased overall survival (5-year rates 82.3% vs 96.0%, aHR 5.41, 95% CI 1.95 to 15.06). Results were similar for node-evaluated grade 2 tumors (5-year overall survival rates, 94.6% and 94.4% for node-evaluated post-operative chemotherapy omission and administration, respectively), but not in grade 3 tumors.

    Conclusion The results of this population-based study may partially support the current clinical practice guidelines for post-operative chemotherapy omission as a possible option for patients with stage IC grade 1 endometrioid adenocarcinoma of the ovary for those who had lymph node evaluation. Observed data were also supportive for node-evaluated grade 2 tumors, warranting further evaluation.

    • Ovarian Cancer

    Data availability statement

    Data are available in a public, open access repository. The data on which this study is based are the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program (https://seer.cancer.gov/).

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    Data availability statement

    Data are available in a public, open access repository. The data on which this study is based are the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program (https://seer.cancer.gov/).

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    Footnotes

    • SMW and MWL contributed equally.

    • Presented at 2024 Annual Meeting on Women’s Cancer, San Diego, CA, March 16-18, 2024.

    • Contributors Conceptualization: KM, MNK. Data curation: KM. Formal analysis: KM. Funding acquisition: KM, LDR. Investigation: all authors. Methodology: KM. Project administration: KM. Resources: MK, JDW, LDR. Software: KM. Supervision: MK, JDW, LDR. Validation: KM. Visualization: KM. Writing - original draft: SW, MWL, KM. Writing - review and editing: all authors. KM is guarantor and accepts full responsibility for the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

    • Funding Ensign Endowment for Gynecologic Cancer Research (KM). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication

    • Competing interests Consultant, AstraZeneca, CooperSurgical, Immunogen, and KLS Martin (MK); research grant, Merck, royalties, UpToDate, honorarium, American College of Obstetrics and Gynecology (JDW); consultant, Cardiff Oncology, Nutcracker, participation in the Steering Committee for the Global Coalition of Adaptive Research (LDR); none for others.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Author note The manuscript’s corresponding authors affirm that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. The National Cancer Institute’s Surveillance, Epidemiology, and End Results Program is the source of the de-identified data used; race/ethnicity was grouped by the program; and the program has not verified and is not responsible for the statistical validity of the data analysis or the conclusions derived by the study team.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.