Can we replace adjuvant chemotherapy with surveillance for stage IA-C immature ovarian teratomas of any grade? an international multicenter analysis
| Autor: | Dee Short, Giorgia Mangili, Gabriella Ferrandina, Adrian Lim, Giovanna Scarfone, Xianne Aguiar, Alice Bergamini, Michael J. Seckl, Sandro Pignata, Naveed Sarwar, Cristina Camnasio, Baljeet Kaur, Gennaro Cormio, Philip Savage |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
0301 basic medicine Cancer Research medicine.medical_specialty medicine.medical_treatment Ovarian immature teratomas Disease Young Adult 03 medical and health sciences 0302 clinical medicine Interquartile range Internal medicine medicine Humans Female germ cell tumors Ovarian Teratoma Stage (cooking) Neoplasm Staging Ovarian Neoplasms Pregnancy Chemotherapy Surveillance business.industry Hazard ratio Teratoma Middle Aged medicine.disease Stage I Adjuvant chemotherapy Settore MED/40 - GINECOLOGIA E OSTETRICIA 030104 developmental biology Oncology Chemotherapy Adjuvant 030220 oncology & carcinogenesis Female Neoplasm Grading Ovarian cancer business |
| Zdroj: | European Journal of Cancer. 137:136-143 |
| ISSN: | 0959-8049 |
| Popis: | Background The role of surveillance after surgery for stage IA-C grade 2 (G2) or grade 3 (G3) immature teratomas (ITs) is controversial with many guidelines advocating adjuvant chemotherapy. Here, we investigate the safety of surveillance in stage IA-C G1-3 ITs. Methods Clinicopathological data were analysed on postpubertal patients with stage I pure ITs in Multicenter Italian Trials in Ovarian Cancer centres and at Charing Cross Hospital, UK, between January 1985 and January 2018. Results Of 108 stage I patients, 66 (61.1%), 3 (2.8%) and 39 (36.1%) were International Federation of Gynecology and Obstetrics IA, IB, IC, respectively, with 31 (28.7%), 41 (38%) and 36 (33.3%) having grade 1 (G1), 2 and 3 disease, respectively. After surgery, 27 patients (25%) had adjuvant chemotherapy and 81 (75%) surveillance. There was no significant increase in the risk of malignant (G2-3 IT) relapse (9/81 vs 2/27; p = 0.72) or in disease-free survival (DFS) or overall survival in the surveillance vs chemotherapy groups. The median time to relapse was 17.8 months (range: 3–47) with no significant difference between surveillance or chemotherapy groups. The median follow-up was 64.3 months (Interquartile range (IQR) 22.2–101.7). Chemotherapy induced cures in all except for one patient who did not follow the surveillance protocol due to pregnancy and died of disease. Univariate and multivariate analyses revealed that only tumour grade (hazard ratio [HR] = 3.11; p = 0.02) and complete surgical staging (HR = 0.2; p = 0.01) were independent prognostic factors for decreased DFS. Conclusion The present study suggests that in the adult setting careful surveillance appears to be an acceptable alternative to adjuvant chemotherapy for stage IA-C ITs of any grade, properly staged and with negative postoperative tumour markers. |
| Databáze: | OpenAIRE |
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