N de Gregorio

Age-dependent differences in borderline ovarian tumours (BOT) regarding clinical characteristics and outcome: results from a sub-analysis of the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) ROBOT study

BACKGROUND Approximately one-third of all borderline ovarian tumours (BOT) are diagnosed in patients with child-bearing potential. Detailed information regarding their specific characteristics and prognostic factors is limited. METHODS Clinical parameters of BOT patients treated between 1998 and 2008 in 24 German centres were retrospectively investigated. Central pathology review and prospective follow-up were carried out. Patients <40 versus ≥40 years were analysed separately and then compared regarding clinico-pathological variables and prognosis. RESULTS A total of 950 BOT patients with a median age of 49.1 (14.1-91.5) years were analysed [280 patients <40 years (29.5%), 670 patients ≥40 years (70.5%)]. Fertility-preserving surgery was carried out in 53.2% (149 of 280) of patients <40 years with preservation of the primarily affected ovary in 32 of these 149 cases (21.5%). Recurrence was significantly more frequent in patients <40 years (19.0% versus 10.1% 5-year recurrence rate, P < 0.001), usually in ovarian tissue, whereas disease-specific overall survival did not differ between the subgroups. In case of recurrent disease, malignant transformation was less frequent in younger than in older patients (12.0% versus 66.7%, P < 0.001), mostly presenting as invasive peritoneal carcinomatosis. Multivariate analysis for patients <40 years identified advanced International Federation of Gynecology and Obstetrics (FIGO) stage and fertility-sparing approach as independent prognostic factors negatively affecting progression-free survival (PFS) while, for patients ≥40 years, higher FIGO stage and incomplete staging was associated with impaired PFS. CONCLUSIONS Despite favourable survival, young BOT patients with child-bearing potential are at higher risk for disease recurrence. However, relapses usually remain BOT in the preserved ovaries as opposed to older patients being at higher risk for malignant transformation in peritoneal or distant localisation. Therefore, fertility-sparing approach can be justified for younger patients after thorough consultation.BACKGROUND Approximately one-third of all borderline ovarian tumours (BOT) are diagnosed in patients with child-bearing potential. Detailed information regarding their specific characteristics and prognostic factors is limited. METHODS Clinical parameters of BOT patients treated between 1998 and 2008 in 24 German centres were retrospectively investigated. Central pathology review and prospective follow-up were carried out. Patients <40 versus ≥40 years were analysed separately and then compared regarding clinico-pathological variables and prognosis. RESULTS A total of 950 BOT patients with a median age of 49.1 (14.1-91.5) years were analysed [280 patients <40 years (29.5%), 670 patients ≥40 years (70.5%)]. Fertility-preserving surgery was carried out in 53.2% (149 of 280) of patients <40 years with preservation of the primarily affected ovary in 32 of these 149 cases (21.5%). Recurrence was significantly more frequent in patients <40 years (19.0% versus 10.1% 5-year recurrence rate, P < 0.001), usually in ovarian tissue, whereas disease-specific overall survival did not differ between the subgroups. In case of recurrent disease, malignant transformation was less frequent in younger than in older patients (12.0% versus 66.7%, P < 0.001), mostly presenting as invasive peritoneal carcinomatosis. Multivariate analysis for patients <40 years identified advanced International Federation of Gynecology and Obstetrics (FIGO) stage and fertility-sparing approach as independent prognostic factors negatively affecting progression-free survival (PFS) while, for patients ≥40 years, higher FIGO stage and incomplete staging was associated with impaired PFS. CONCLUSIONS Despite favourable survival, young BOT patients with child-bearing potential are at higher risk for disease recurrence. However, relapses usually remain BOT in the preserved ovaries as opposed to older patients being at higher risk for malignant transformation in peritoneal or distant localisation. Therefore, fertility-sparing approach can be justified for younger patients after thorough consultation.

Surgical staging and prognosis in serous borderline ovarian tumours (BOT): A subanalysis of the AGO ROBOT study

Background:Incomplete surgical staging is a negative prognostic factor for patients with borderline ovarian tumours (BOT). However, little is known about the prognostic impact of each individual staging procedure.Methods:Clinical parameters of 950 patients with BOT (confirmed by central reference pathology) treated between 1998 and 2008 at 24 German AGO centres were analysed. In 559 patients with serous BOT and adequate ovarian surgery, further recommended staging procedures (omentectomy, peritoneal biopsies, cytology) were evaluated applying Cox regression models with respect to progression-free survival (PFS).Results:For patients with one missing staging procedure, the hazard ratio (HR) for recurrence was 1.25 (95%-CI 0.66–2.39; P=0.497). This risk increased with each additional procedure skipped reaching statistical significance in case of two (HR 1.95; 95%-CI 1.06–3.58; P=0.031) and three missing steps (HR 2.37; 95%-CI 1.22–4.64; P=0.011). The most crucial procedure was omentectomy which retained a statistically significant impact on PFS in multiple analysis (HR 1.91; 95%-CI 1.15–3.19; P=0.013) adjusting for previously established prognostic factors as FIGO stage, tumour residuals, and fertility preservation.Conclusion:Individual surgical staging procedures contribute to the prognosis for patients with serous BOT. In this analysis, recurrence risk increased with each skipped surgical step. This should be considered when re-staging procedures following incomplete primary surgery are discussed.

Prognose nach isoliertem Lokalrezidiv beim Vulvakarzinom – eine Subgruppenanalyse der AGO-CaRE-1 Studie

Hintergund/Zielsetzung: Abhangig vom Lymphknotenstatus entwickeln 15 – 40% der Patientinnen mit Vulvakarzinom ein Lokalrezidiv. Ein isoliertes Rezidiv im Bereich der Vulva gilt dabei als wenig relevant fur die weitere Prognose. Methoden: Die AGO-CaRE-1 Studie ist eine retrospektive Datensammlung zu Behandlungsstrategien und Prognosefaktoren des Vulvakarzinoms. Insgesamt wurden 1618 Patientinnen mit vulvarem Plattenepithelkarzinom FIGO Stadium ≥1B, behandelt an 29 deutschen Zentren 1998 – 2008, erfasst. Diese Subgruppenanalyse untersucht Patientinnen, die im Krankheitsverlauf ein isoliertes Lokalrezidiv entwickelten. Ergebnisse: 1249/1618 (77,2%) Patientinnen erhielten ein operatives Staging der Leiste und hatten einen bekannten Nodalstatus. Die meisten zeigten lokal begrenzte Primartumore [1124/1249 (90,0%) pT1b/pT2], die R0 reseziert wurden [1022/1249 (81,8%)]. 447/1249 (35,8%) Patientinnen waren nodalpositiv. Bei 324 (25,9%) wurde eine adjuvante Therapie durchgefuhrt. Das mediane Follow-up betrug 39,4 Monate. 360 Patientinnen (28,8%) entwickelten ein Rezidiv; davon 193 (53,6%) isoliert im Bereich der Vulva nach medianen 17,1 Monaten. Initial erhielten 38 (19,7%) dieser Patientinnen eine Radiotherapie der Vulva. Die Therapie des Lokalrezidives umfasste die alleinige Operation in 104 (53,9%), eine Operation und Radiotherapie in 40 (20,7%) und eine Radio(chemo)therapie in 14 (7,3%) Fallen [19 (9,8%) erhielten keine Rezidivtherapie und bei 16 (8,3%) war die Therapie unbekannt]. 58 (30,1%) entwickelten ein zweites Rezidiv in den folgenden Lokalisationen: 40 (20,7%) Vulva, 15 (7,8%) Leiste, 7 (3,6%) Becken, 12 (6,2%) Fernmetastasen, 2 (1,0%) unbekannt (multiple Nennung moglich). Die 1-Jahres-Rezidivfreie-Uberlebensrate nach Lokalrezidiv lag bei 58,5%. Das 3- und 5-Jahres-Gesamtuberleben betrug 76,7% bzw. 66,9% verglichen mit 85,9% und 80,6% bei Patientinnen ohne Lokalrezidiv. Zusammenfassung: Entgegen der allgemeinen Annahme zeigen AGO-CaRE-1 Patientinnen mit Lokalrezidiv eine beeintrachtigte Prognose. Ein wesentlicher Anteil der Betroffenen entwickelt ein Zweitrezidiv nach initial isoliertem Lokalrezidiv.