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The effect of complete surgical staging and adjuvant chemotherapy on survival in stage I, grade 1 and 2 endometrioid ovarian carcinoma
  1. Brenna E Swift1,
  2. Allan Covens1,2,
  3. Victoria Mintsopoulos3,
  4. Carlos Parra-Herran4,5,
  5. Marcus Q Bernardini1,6,
  6. Sharon Nofech-Mozes4,7 and
  7. Liat Hogen1,6
  1. 1Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Toronto, Toronto, Ontario, Canada
  2. 2Gynecologic Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  3. 3Faculty Of Medicine, University Of Toronto, Toronto, Ontario, Canada
  4. 4Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  5. 5Department of Anatomic Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
  6. 6Gynecologic Oncology, University Health Network, Toronto, Ontario, Canada
  7. 7Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Liat Hogen, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Toronto, Toronto, ON M5S 1A1, Canada; liat.hogen{at}uhn.ca

Abstract

Objectives To assess the effect of complete surgical staging and adjuvant chemotherapy on survival in stage I, low grade endometrioid ovarian cancer.

Methods This retrospective study was conducted at two cancer centers from July 2001 to December 2019. Inclusion criteria were all stage I, grade 1 and 2 endometrioid ovarian cancer patients. Patients with mixed histology, concurrent endometrial cancer, neoadjuvant chemotherapy, and patients who did not undergo follow-up at our centers were excluded. Clinical, pathologic, recurrence, and follow-up data were collected. Cox proportional hazard model evaluated predictive factors. Recurrence-free survival and overall survival were calculated using the Kaplan-Meier method.

Results There were 131 eligible stage I patients: 83 patients (63.4%) were stage IA, 5 (3.8%) were stage IB, and 43 (32.8%) were stage IC, with 80 patients (61.1%) having grade 1 and 51 (38.9%) patients having grade 2 disease. Complete lymphadenectomy was performed in 34 patients (26.0%), whereas 97 patients (74.0%) had either partial (n=22, 16.8%) or no (n=75, 57.2%) lymphadenectomy. Thirty patients (22.9%) received adjuvant chemotherapy. Median follow-up was 51.5 (95% CI 44.3 to 57.2) months. Five-year recurrence-free survival was 88.0% (95% CI 81.6% to 94.9%) and 5 year overall survival was 95.1% (95% CI 90.5% to 99.9%). In a multivariable analysis, only grade 2 histology had a significantly higher recurrence rate (HR 3.42, 95% CI 1.03 to 11.38; p=0.04). There was no difference in recurrence-free survival (p=0.57) and overall survival (p=0.30) in patients with complete lymphadenectomy. In stage IA/IB, grade 2 there was no benefit of adjuvant chemotherapy (p=0.19), and in stage IA/IB, low grade without complete surgical staging there was no benefit of adjuvant chemotherapy (p=0.16). Twelve patients (9.2%) had recurrence; 3 (25%) were salvageable at recurrence and are alive with no disease.

Conclusions Patients with stage I, low grade endometrioid ovarian cancer have a favorable prognosis, and adjuvant chemotherapy and staging lymphadenectomy did not improve survival.

  • ovarian cancer
  • gynecologic surgical procedures

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Presented at This work was presented as an Abstract at the Society of Gynecologic Oncology Annual Meeting 2021 and Oral Presentation at the Society of Gynecology Oncology of Canada Annual Meeting 2021.

  • Contributors BES: data curation, Investigation, methodology, visualization, writing – original draft. AC: conceptualization, visualization, writing – review and editing. VM: investigation, writing – review and editing. CP-H: investigation, writing – Review and editing. MQB: visualization, writing – review and editing. SN-M: investigation. LH: Guarantor, conceptualization, methodology, visualization, writing – review and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

  • 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.

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