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Objective To assess the diagnostic and prognostic characteristics of borderline ovarian tumours (BOTs) detected during pregnancy, and to establish an inventory of French practices. Materials and methods A retrospective multi-centre case study of 14 patients treated for BOTs, diagnosed during pregnancy between 2005 and 2017, in five French pelvic cancerology expert centres, including data on clinical characteristics, histological tumour characteristics, surgical procedure, adjuvant treatments, follow-up and fertility. Results The mean age of patients was 29.3 [standard deviation (SD) 6.2] years. Most BOTs were diagnosed on ultrasonography in the first trimester (85.7 %), and most of these cases (78.5 %) also underwent magnetic resonance imaging to confirm the diagnosis (true positives 54.5 %). Most patients underwent surgery during pregnancy (57 %), with complete staging surgery in two cases (14.3 %). Laparoscopy was performed more frequently than other procedures (50 %), and unilateral adnexectomy was more common than cystectomy (57.5 %). Tumour size influenced the surgical approach significantly (mean size 7.5 cm for laparoscopy, 11.9 cm for laparoconversion, 14 cm for primary laparotomy; P = 0.08), but the type of resection did not. Most patients were initially diagnosed with International Federation of Gynecology and Obstetrics stage IA (92.8 %) tumours, but many were upstaged after complete restaging surgery (57.1 %). Most BOTs were serous (50 %), two cases had a micropapillary component (28.5 %), and one case had a micro-invasive implant. BOTs were bilateral in two cases (14.2 %). Mean follow-up was 31.4 (SD 14.8) months. Recurrent lesions occurred in two patients (14.2 %) and no deaths have been recorded to date among the study population. Conclusion BOTs remain rare, but this study – despite its small sample size – supports the hypothesis that BOTs during pregnancy have potentially aggressive characteristics.

Resume Introduction Aux urgences gynecologiques, parmi toutes les consultations du premier trimestre de la grossesse necessitant une echographie, 29 % aboutiront au diagnostic de grossesse d’evolutivite indeterminee. Cette question de « l’evolutivite » est donc une situation frequente dans notre pratique, et qui est egalement porteuse d’enjeux humains. En 2014, le CNGOF a edicte des recommandations claires quant a la prise en charge diagnostique et therapeutique des grossesses arretees. Nous avons souhaite evaluer notre adhesion au versant diagnostique de ces recommandations, et verifier si elles avaient ete optimisees depuis leur publication. Materiel et methodes Il s’agit d’une etude retrospective et descriptive, portant sur toutes les grossesses arretees prises en charge aux urgences gynecologiques du CHU de Tours au cours de trois annees non successives. Nous avons considere l’annee 2013 qui precede les recommandations, l’annee 2015 qui les suit et enfin l’annee 2018 afin d’obtenir davantage de recul. Pour chaque annee ont ete evalues les criteres echographiques ayant permis de conclure au diagnostic, le delai de controle echographique le cas echeant, et la raison de l’erreur de prise en charge si une erreur avait ete commise. Secondairement ont ete etudies les therapeutiques pour l’obtention de la vacuite uterine. Resultats Notre population d’etude a inclus 297 femmes. La non-adherence aux recommandations concernait 20 % des femmes en 2013, 12 % en 2015, et 15 % en 2018 (p = 0,25 si l’on compare avant et apres les recommandations). L’erreur la plus frequemment commise chaque annee est le controle echographique trop precoce, bien qu’il soit de moins en moins pratique (p = 0,03). Les echographistes les moins experimentes ont plutot tendance a etre prudents, avec plus de controles inutiles et plus de delais de controle excessifs. Seuls 13 % des traitements medicamenteux ont permis d’obtenir la vacuite uterine. En cas d’echec des prostaglandines en premiere ligne, l’administration d’une nouvelle dose n’a permis a aucune femme de sursoir a la chirurgie. Conclusion L’adhesion aux recommandations concernant la prise en charge des grossesses d’evolutivite indeterminee n’est pas optimale. Nos prises en charge ont fait l’objet d’ameliorations partielles depuis la publication des recommandations, cependant des erreurs sont encore commises avec pour risque principal de mettre fin a une grossesse evolutive. La mise en place de scores de qualite concernant les cliches echographiques serait interessante a discuter.

INTRODUCTION: Recommendations for the management of patients with gynecological cancer during the COVID-19 pandemic period. MATERIAL AND METHOD: Recommendations based on the consensus conference model. RESULTS: In the case of a COVID-19 positive patient, surgical management should be postponed for at least 15 days. For cervical cancer, the place of surgery must be re-evaluated in relation to radiotherapy and Radio-Chemotherapy-Concomitant and the value of lymph node staging surgeries must be reviewed on a case-by-case basis. For advanced ovarian cancers, neo-adjuvant chemotherapy should be favored even if primary cytoreduction surgery could be envisaged. It is lawful not to offer hyperthermic intraperitoneal chemotherapy during a COVID-19 pandemic. In the case of patients who must undergo interval surgery, it is possible to continue the chemotherapy and to offer surgery after 6 cycles of chemotherapy. For early stage endometrial cancer, in case of low and intermediate preoperative ESMO risk, hysterectomy with bilateral annexectomy associated with a sentinel lymph node procedure should be favored. It is possible to consider postponing surgery for 1 to 2 months in low-risk endometrial cancers (FIGO Ia stage on MRI and grade 1-2 endometrioid cancer on endometrial biopsy). For high ESMO risk, it ispossible to favor the MSKCC algorithm (combining PET-CT and sentinel lymph node biopsy) in order to omit pelvic and lumbar-aortic lymphadenectomies. CONCLUSION: During COVID-19 pandemic, patients suffering from cancer should not lose life chance, while limiting the risks associated with the virus.

Resume Objectifs Evaluer la valeur diagnostique de biomarqueurs seriques et la strategie diagnostique des tumeurs frontieres ovariennes (TFO) pour etablir des recommandations de prise en charge dans le cadre des recommandations pour la pratique clinique realisees par le College national des gynecologues et obstetriciens francais (CNGOF). Methodes Revue exhaustive de la litterature anglo-saxonne et francaise entre 1990 et 2019 sur les bases de donnees Pubmed, Cochrane et Embase reposant sur les mots cles suivants : « tumeur frontiere de l’ovaire, marqueurs tumoraux, CA125, CA19 9, ACE, CA72 4, TAG 72, HE4, algorithme ROMA, tumeurs mucineuses, sereuses et endometrioides de l’ovaire, implants peritoneaux, recidive, survie globale, et surveillance ». Parmi les 1000 references issues de l’equation de recherche bibliographique, 400 ont ete analysees. Le processus de recherche et de selection bibliographique a permis de retenir au final 30 references. Resultats Synthese de la litterature : il existe un faible niveau de preuve des travaux identifies concernant la valeur discriminante des marqueurs tumoraux (CA125, CA19-9, ACE, CA72-4, de l’HE4) et de scores specifiques entre les tumeurs ovariennes presumees benignes/TFO/tumeurs ovariennes malignes. Les taux seriques preoperatoires de CA125 sont plus eleves dans les TFO sereuses (NP4), augmentent avec la taille et le stade FIGO des TFO (NP4), en particulier dans les TFO sereuses. Cependant, un taux normal de CA125 ne permet pas d’ecarter une TFO (NP4). Le taux de positivite preoperatoire du CA19 9 dans les TFO est d’une part relativement moins frequente que celui du CA125, et d’autre part, est plus eleve dans les TFO mucineuses. Les taux preoperatoires de CA19 9 augmentent avec la taille et le stade FIGO (NP4), et sont plus eleves en cas de TFO mucineuse (NP4). Les taux de marqueurs preoperatoires eleves sont retrouves comme un facteur predictif de l’existence d’implants (CA125) (NP4), et un facteur independant de recidive (CA125) (NP4). Recommandations : aucune recommandation ne peut etre proposee concernant l’utilisation du dosage des marqueurs tumoraux (CA125, CA19-9, ACE, CA72-4, de l’HE4) ou des scores specifiques pour le diagnostic differentiel preoperatoire entre tumeurs ovariennes presumees benignes/TFO/tumeurs ovariennes malignes. En cas de suspicion de TFO mucineuse sur l’imagerie, il peut etre propose de doser le CA 19-9. Il est recommande de doser l’HE4 et le CA125 serique pour le diagnostic de masse ovarienne indetermine a l’imagerie (grade A). Si le dosage des marqueurs tumoraux est normal en pre-operatoire, le dosage systematique du dosage des marqueurs tumoraux dans le suivi des TFO n’est pas recommande (grade C). Si le dosage du CA125 est eleve en preoperatoire, il est recommande un controle regulier du dosage de CA125 dans le suivi post therapeutique des TFO sans qu’il soit possible d’en preciser le rythme et la duree (grade B)

Introduction/Background* Thanks to technical improvements, total non-conservative hysterectomy evolved towards MIS as the standard approach for early-stage endometrial cancer (EC). MIS has recently been called into question for cervical cancer treatment due to its negative prognosis impact. In this context, we carry out a study comparing OSu vs. MIS with Disease Free Survival (DFS) as primary endpoint. Methodology Retrospective study, within the French collaborative group FRANCOGYN from 1999 to 2020. All patients aged over 18 who achieved hysterectomy for endometrial cancer were included whatever the pathological subtype. Secondary endpoints were: Overall Survival (OS) and sub-group analysis according to FIGO stage, ESMO-ESGO-ESTRO Consensus Conference risk-group 2015 (E3CC), pathological sub-types, lymph node metastasis and lympho-vascular space invasion (LVSI). To assess primary endpoint, we use inverse probability of treatment weighting (IPW) based on propensity score to construct two weighted cohort. A Cox proportional-hazard model standard multivariate analysis was used for subgroup analysis. Result(s)* Nine hundred and forty-five (945) patients were included, 380 (40.2%) received OS and 565 (59.8%) received MIS. The median follow-up was 34.2 months (29.1 SD) . The study other measured characteristics were strongly unbalanced in disfavor of the OSu group for pathological subtype (p DFS was significantly impaired by the following characteristics: Age, BMI, histological grade 3 (HR=2.04, 95% CI [1.15-2.04] p = 0.015), E3CC High Risk Group (HR = 2.62, 95% CI [1.03-6.67] p = 0.43) and FIGO Stage 3 (HR= 2.21, 95% CI [1.07-4.56] p= 0.031) Conclusion* This study cover 20 years of clinical practice and consolidate MIS place for EC surgical treatment with an increasing use of MIS over years whatever the FIGO staging and clinical characteristics. Every effort should be made to improve a standardized MIS approach the more that patient is frail or at high risk of relapse.

Title: Impact of Lymphadenectomy on Survival of Patients with Serous Advanced Ovarian Cancer After Neoadjuvant Chemotherapy: A French National Multicenter Study (FRANCOGYN). Introduction/Background* The population of interest to this study comprised individuals with advanced-stage ovarian carcinoma who were exposed to neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS). Those who had not received systematic lymphadenectomy (SL; Group 1) were compared to those who had received SL (Group 2). Outcome measures included progression-free survival (PFS), overall survival (OS), and surgical complications. (Group 1). Methodology This was a retrospective, multicenter cohort study in nine referral centers of France between January 2000 and June 2017. OS analysis using the multivariate Cox regression model was performed. PFS and surgery-related morbidity were analyzed. Result(s)* Of the 255 patients included, 100 were in Group 1 and 155 in Group 2. Patient majority was, on average, younger and less comorbid, with predominant R0 surgery in Group 2. Dindo–Clavien score was similar between the two groups (p = 0.15). Median OS was 26.8 months in Group 2 and 27.6 months in Group 1. SL was not statistically significant on OS (p = 0.7). Median PFS was 18.3 months in Group 2 and 16.6 months in Group 1. SL had positive impact on PFS (p = 0.005). Conclusion* Patients who had received SL (Group 2) had significantly higher PFS regardless of node-positivity status when compared to those who had not received SL

Introduction/Background* Prognostic factors for epithelial ovarian cancers (EOCs) are in particular clinical factors such as pathology staging at diagnosis (FIGO stages), genetic mutation or histological phenotypes. In the present study, we explored whether fatty acid composition of adipose tissue, may be associated with recurrence-free survival in EOC. Methodology Forty-six women with epithelial ovarian cancers and 6 with borderline ovarian tumors were included between March 2017 and January 2020 in this prospective study in Tours university teaching hospital (central France). Adipose tissue specimens from four abdominal locations (superficial and deep subcutaneous, visceral epiploic and omental) were collected during surgery or exploratory laparoscopy. A fatty acid profile of adipose tissue triglycerides was established by gas chromatography. We assessed differences associated with disease recurrence. Result(s)* The content of long-chain saturated fatty acids (SFAs) was increased and that of long-chain polyunsaturated fatty acids (PUFAs) decreased in deep versus superficial subcutaneous adipose tissue in EOC patients. Nevertheless, the content of total SFAs was 28%, monounsaturated fatty acids (MUFAs) 55%, PUFAs n-6 11.5% and PUFAs n-3 about 1.3% whatever the adipose tissue. For EOC patients, median follow-up was 15 months. FIGO stage, tumor residue after surgery and body mass index, were clinical predictors of recurrence-free survival (RFS). EOC patients were separated into two groups by median fatty acid content. Content of total PUFAs (n-6+n-3), whatever the adipose tissue, was associated with RFS. RFS was about 2 times longer in EOC patients with high versus low total PUFA content (median survival: 12 vs 27 months, p = 0.01 to Conclusion* Content of total PUFAs (n-6+n-3) in abdominal adipose tissue (visceral and subcutaneous) are new prognostic factors in EOC. The origin of PUFAs depletion needs to be explored, to design a new therapeutic strategy for these patients

Introduction/Background* Introduction: Borderline ovarian tumors (BOT) represent 10-20% of epithelial tumors of the ovary. Although their prognosis is excellent, the recurrence rate can be as high as 30%, and recurrence in the infiltrative form accounts for 3% to 5% of recurrences. Affecting one third of women of childbearing age, the surgical strategy with ovarian conservation is now recommended despite a significant risk of recurrence. Few studies have focused exclusively on patients who have received ovarian conservative treatment in an attempt to identify factors predictive of recurrence and the impact on fertility. The objective of this study was to identify the risk factors for recurrence of BOT after conservative treatment. Methodology This was a retrospective, multicentre study of women who received conservative surgery for BOT between February 1997 and September 2020. We divided the patients into two groups, the ”R group” with recurrence and the ”NR group” without recurrence. Result(s)* Of 175 patients analysed, 35 patients had a recurrence (R group, 20%) and 140 had no recurrence (NR group, 80%). With a mean follow-up of 30 months (IQ 8-62.5), the overall recurrence rate was 20%. Recurrence was BOT in 17.7% (31/175) and invasive in 2.3% (4/175). The mean time to recurrence was 29.5 months (IQ 16.5-52.5). Initial complete peritoneal staging (ICPS) was performed in 42.5% of patients (n=75). In multivariate analysis, age at diagnosis, nulliparity, advanced FIGO stage, the presence of peritoneal implants, and the presence of a micropapillary component for serous tumors were factors influencing the occurrence of recurrence. The post-surgery fertility rate was 67%. Conclusion* This multicentre study is to date one of the largest studies analysing the risk factors for recurrence of BOT after conservative surgery. Five risk factors were found: age at diagnosis, nulliparity, advanced FIGO stage and presence of implants, and a micropapillary component. Only 25% of the patients with recurrence underwent SPCI. These results reinforce the interest of an initial peritoneal staging in order not to ignore an advanced tumor stage.

Resume Objectifs Definir les modalites de surveillance apres traitement d’un cancer epithelial de l’ovaire, de la trompe ou du peritoine primitif. Definir les possibilites de traitement hormonal de la menopause et de contraception apres traitement. Methodes Recherche bibliographique en langue francaise et anglaise effectuee par consultation de la base de donnees PubMed/Medline et la Cochrane Library. Resultats Apres traitement d’un cancer epithelial de l’ovaire, de la trompe ou du peritoine primitif, il est recommande une evaluation des symptomes a 3 mois, 6 mois, 12 mois, 18 mois et 24 mois, puis 1 fois par an (grade B). Pour le suivi, il est recommande de surveiller seulement par examen paraclinique les patientes avec chirurgie initiale complete (residu tumoral macroscopique nul, CC0) et avec un bon etat general (ECOG 0) par un dosage serique (HE4 ou CA125) a partir de 6 mois apres la fin de la chimiotherapie (grade C). Il n’est pas recommande de surveillance par scanner thoraco-abdomino-pelvien systematique (Grade C). En cas d’elevation serique du HE4 ou du CA125, un examen d’imagerie est recommande (grade B). Il est recommande de proposer un THM chez les patientes de moins de 45 ans apres un traitement non conservateur d’un adenocarcinome de l’ovaire, de la trompe ou du peritoine primitif sereux de haut grade (grade C) ou mucineux (grade C). Chez les femmes de plus de 45 ans, un THM n’est pas contre-indique en cas de syndrome climaterique apres traitement d’un adenocarcinome sereux de haut grade (grade B), ou apres adenocarcinome mucineux (grade C).

To draw up recommendations on the use of prophylactic gynecologic procedures during surgery for other indications.A consensus panel of 19 experts was convened. A formal conflict of interest policy was established at the onset of the process and applied throughout. The entire study was performed independently without funding from pharmaceutical companies or medical device manufacturers. The panel applied the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system to evaluate the quality of evidence on which the recommendations were based. The authors were advised against making strong recommendations in the presence of low-quality evidence. Some recommendations were ungraded.The panel studied 22 key questions on seven prophylactic procedures: 1) salpingectomy, 2) fimbriectomy, 3) salpingo-oophorectomy, 4) ablation of peritoneal endometriosis, 5) adhesiolysis, 6) endometrial excision or ablation, and 7) cervical ablation.The literature search and application of the GRADE system resulted in 34 recommendations. Six were supported by high-quality evidence (GRADE 1+/-) and 28 by low-quality evidence (GRADE 2+/-). Recommendations on two questions were left ungraded due to a lack of evidence in the literature.A high level of consensus was achieved among the experts regarding the use of prophylactic gynecologic procedures. The ensuing recommendations should result in improved current practice.

It is recommended to classify Borderline Ovarian Tumors (BOTs) according to the WHO classification. Transvaginal and suprapubic ultrasonography are recommended for the analysis of an ovarian mass (Grade A). In case of an undetermined ovarian lesion on ultrasonography, it is recommended to perform a pelvic MRI (Grade A) with a score for malignancy (ADNEX MR/O-RADS) (Grade C) included in the report and to formulate a histological hypothesis (Grade C). Pelvic MRI is recommended to characterize a tumor suspected of being BOT (Grade C). It is recommended to evaluate serum levels of HE4 and CA125 and to use the ROMA score for the diagnosis of indeterminate ovarian mass on imaging (grade A). If there is a suspicion of a mucinous BOT on imaging, serum levels of CA 19-9 may be proposed (Grade C). For Early Stages (ES) of BOT, if surgery without risk of tumor rupture is possible, laparoscopy with protected extraction is recommended over laparotomy (Grade C). For treatment of a bilateral serous ES BOT with a strategy to preserve fertility and/or endocrine function, bilateral cystectomy is recommended where possible (Grade B). For mucinous BOTs with a treatment strategy of fertility and/or endocrine function preservation, unilateral salpingo-oophorectomy is recommended (grade C). For mucinous BOTs treated by initial cystectomy, unilateral salpingo-oophorectomy is recommended (grade C). For serous or mucinous ES BOTs, routine hysterectomy is not recommended (Grade C). For ES BOTs, lymphadenectomy is not recommended (Grade C). For ES BOTs, appendectomy is recommended only in case of a macroscopically pathological appendix (Grade C). Restaging surgery is recommended in cases of serous BOTs with micropapillary architecture and an incomplete abdominal cavity inspection during initial surgery (Grade C). Restaging surgery is recommended for mucinous BOTs after initial cystectomy or in cases where the appendix was not examined (Grade C). If restaging surgery is decided for ES BOTs, the following procedures should be performed: peritoneal washing (grade C), omentectomy (grade B), complete exploration of the abdominal cavity with peritoneal biopsies (grade C), visualization of the appendix and appendectomy in case of a pathological macroscopic appearance (grade C) as well as unilateral salpingo-oophorectomy in case of a mucinous BOT initially treated by cystectomy (grade C). In advanced stages (AS) of BOT, it is not recommended to perform a lymphadenectomy as a routine procedure (Grade C). For AS BOT in a patient with a desire to fall pregnant, conservative treatment involving preservation of the uterus and all or part of the ovary may be proposed (Grade C). Restaging surgery aimed at removing all lesions, not performed initially, is recommended for AS BOTs (Grade C). After treatment, follow-up for a duration greater than 5 years is recommended due to the median recurrence time of BOTs (Grade B). It is recommended that a systematic clinical examination be carried out during follow-up of a treated BOT (Grade B). If the determination of tumor markers is normal preoperatively, the routine dosage of tumor markers in BOT follow-up is not recommended (Grade C). In case of an initial elevation in serum CA 125 levels, it is recommended to monitor CA 125 during follow up (Grade B). In case of conservative treatment, it is recommended to use transvaginal and transabdominal ultrasound during follow up of a treated BOT (Grade B). In the event of a BOT recurrence in a woman of childbearing age, a second conservative treatment may be proposed (Grade C). A consultation with a physician specialized in Assisted Reproductive Technique (ART) should be offered in the case of BOTs in women of childbearing age (Grade C). When possible, a conservative surgical strategy is recommended to preserve fertility in women of childbearing age (Grade C). In the case of optimally treated BOT, there is no evidence to contraindicate the use of ART. The use of hormonal contraception after serous or mucinous BOT is not contraindicated (Grade C). After management of mucinous BOT, for women under 45 years, given the benefit of Hormonal Replacement Therapy (HRT) on cardiovascular and bone risks, and the lack of hormone sensitivity of mucinous BOTs, it is recommended to offer HRT (Grade C). Over 45 years of age, HRT can be prescribed in case of a climacteric syndrome after individual benefit to risk assessment (Grade C).

Objective Cancer of the vulva recurrences vary considerably over time and are influenced by several pathological, surgical and adjuvant therapeutic prognostic factors. However, limited information is available about patterns of disease recurrence and prognosis. We analysed patterns of vulvar cancer recurrence based on a large French multicentre database. Methods Data of women with histologically proven squamous cell carcinoma (SCC) and other vulvar cancer treated between 1976 and 2016 were retrospectively abstracted from five institutions with prospectively maintained vulvar cancer databases in France. The endpoints were pattern of recurrence, recurrence free survival (RFS) and overall survival (OS). Time to the first recurrence in a specific site was evaluated by using cumulative incidence analysis (Gray’s test) and competing risks regression analysis to estimate sub-distribution hazard ratios and 95% CIs. Results In the whole population, recurrences were observed in 188 of the 617 women (30%) with local-regional, distant and multifocal recurrences in 18% (109/617), 3% (17/617), 10% (62/617), respectively. The median time to recurrence with Interquartile Range (IQR) was 13 months IQR [8–30]. The overall respective 3-years OS and RFS were 78.5% (IC95%: 74.5–82.5) and 75.5% (IC95%: 71.1–80.0). According to FIGO stage, lymph node status and positive lympho-vascular invasion (LVSI), pattern and time of loco-regional and distant recurrence were significantly different. There wasn’t interaction between FIGO stage and LVSI in OS neither RFS (p = 0.08 and 0.9 respectively). Conclusion and discussion We report specific time and site patterns of first recurrence according to FIGO stage, lymph node status and lymphovascular invasion status. Positive LVSI is an important and independent prognostic factor. Defining patterns of recurrence may provide useful information for developing follow-up recommendations and designing therapeutic approaches.

Recommendations for the management of patients with gynecological cancer during the COVID-19 pandemic period.Recommendations based on the consensus conference model.In the case of a COVID-19 positive patient, surgical management should be postponed for at least 15 days. For cervical cancer, the place of surgery must be re-evaluated in relation to radiotherapy and Radio-Chemotherapy-Concomitant and the value of lymph node staging surgeries must be reviewed on a case-by-case basis. For advanced ovarian cancers, neo-adjuvant chemotherapy should be favored even if primary cytoreduction surgery could be envisaged. It is lawful not to offer hyperthermic intraperitoneal chemotherapy during a COVID-19 pandemic. In the case of patients who must undergo interval surgery, it is possible to continue the chemotherapy and to offer surgery after 6 cycles of chemotherapy. For early stage endometrial cancer, in case of low and intermediate preoperative ESMO risk, hysterectomy with bilateral annexectomy associated with a sentinel lymph node procedure should be favored. It is possible to consider postponing surgery for 1 to 2 months in low-risk endometrial cancers (FIGO Ia stage on MRI and grade 1-2 endometrioid cancer on endometrial biopsy). For high ESMO risk, it ispossible to favor the MSKCC algorithm (combining PET-CT and sentinel lymph node biopsy) in order to omit pelvic and lumbar-aortic lymphadenectomies.During COVID-19 pandemic, patients suffering from cancer should not lose life chance, while limiting the risks associated with the virus.

This work was carried out under the aegis of the CNGOF (Collège national des gynécologues et obstétriciens français) and proposes guidelines based on the evidence available in the literature. The objective was to define the diagnostic and surgical management strategy, the fertility preservation and surveillance strategy in Borderline Ovarian Tumor (BOT). No screening modality can be proposed in the general population. An expert pathological review is recommended in case of doubt concerning the borderline nature, the histological subtype, the invasive nature of the implant, for all micropapillary/cribriform serous BOT or in the presence of peritoneal implants, and for all mucinous or clear cell tumors (grade C). Macroscopic MRI analysis should be performed to differentiate the different subtypes of BOT: serous, seromucinous and mucinous (intestinal type) (grade C). If preoperative biomarkers are normal, follow up of biomarkers is not recommended (grade C). In cases of bilateral early serous BOT with a desire to preserve fertility and/or endocrine function, it is recommended to perform a bilateral cystectomy if possible (grade B). In case of early mucinous BOT, with a desire to preserve fertility and/or endocrine function, it is recommended to perform a unilateral adnexectomy (grade C). Secondary surgical staging is recommended in case of serous BOT with micropapillary appearance and uncomplete inspection of the abdominal cavity during initial surgery (grade C). For early-stage serous or mucinous BOT, it is not recommended to perform a systematic hysterectomy (grade C). Follow up after BOT must be pursued for more than 5 years (grade B). Conservative treatment involving at least the conservation of the uterus and a fragment of the ovary in a patient wishing to conceive may be proposed in advanced stages of BOT (grade C). A new surgical treatment that preserves fertility after a first non-invasive recurrence may be proposed in women of childbearing age (grade C). It is recommended to offer a specialized consultation for Reproductive Medicine when diagnosing BOT in a woman of childbearing age. Hormonal contraceptive use after serous or mucinous BOT is not contraindicated (grade C).

To evaluate the diagnostic value of serum biomarkers in the management strategy of borderline ovarian tumours (BOT) to make management recommendations.English and French review of literature from 1990 to 2019 based on publications from Pubmed, Medline, Cochrane, with keywords: borderline ovarian tumors, tumour markers, CA125, CA19 9, ACE, CA72 4, TAG72, HE4, ROMA, mucinous, serous, mucinous, endometrioid ovarian tumours, peritoneal implants, recurrence, overall survival, follow-up. Among 1000 references, 400 were selected and only 30 were screened for this work.Literature review: there is low evidence in literature concerning the discriminating value of serum tumour biomarkers (CA125, CA19-9, CEA, CA72-4, HE4) and specific score between presumed benign ovarian tumour/BOT/ovarian cancer (LE4). Serum CA125 antigen is higher in case of serous borderline ovarian tumour (LE4), increase with the tumor height, the FIGO stage, notably in case of serous borderline ovarian tumor. However, a normal value rate of serum CA125 antigen does not rule out a BOT (LE4). The preoperative positivity rate of CA19 9 in case of TFO is relatively lower than that of CA125 and is higher in mucinous TFO. The preoperative rate of serum CA19 9 antigen increases with the tumour height and the FIGO stage (LE4) and are higher in case of mucinous BOT (LE4). Preoperative rates of serum HE4 are not different between histologic type of BOT. A high level of serum biomarkers (CA125) is a predictive factor of peritoneal implants (LE4) and an independent predictive factor of recurrence (CA125) (LE4).no recommendation can be made about the use of serum tumour biomarkers (CA125, CA19-9, CEA, CA72-4, HE4) or specific score in order to distinguish benign ovarian tumor/borderline ovarian tumor/ovarian cancer in case of indeterminate mass. In case of suspicion of mucinous ovarian tumour on imaging, the systematic dosage of serum CA19-9 antigen can be proposed (grade C). In case of an ovarian indeterminate mass on imaging; dosage of serum HE4 and C125 is recommended. If preoperative dosage of serum tumor biomarkers is normal, their systematic dosage is not recommended in the follow-up of BOT (grade C). If preoperative dosage of CA125 is high, the systematic dosage of CA125 is recommended in the follow-up of BOT with no precisions about the rhythm and the duration of the follow-up (grade B).

The incidence (rate/100,000) of BOT gradually increases with age from 15-19 years of age and peaks at nearly 4.5 cases/100,000 for the 55-59 year age group (NP3). In the presence of a benign ovarian mass, the standardized risk ratio of serous and mucinous BOT is 1.69, (95% CI 1.39-2.03) and 1.75, (95% CI 1.45-2.10), respectively (NP2). At diagnosis, a median age of diagnosis of OFA is 46 years, unilateral forms (79.7% of cases) are predominant compared to cancers (45.3%) (0.001) and FIGO I stages represent nearly 63.7% of cases (NP3). The 5-year survival rates for FIGO I, II, III, IV stages are: 99.7% (95% CI: 96.2-100%), 99.6% (95% CI: 92.6-100%), 95.3% (95% CI: 91.8-97.4%), 77.1% (95% CI: 58.0-88.3%), respectively (NP3). Survivors at 5 years for serous and mucinous tumours are 99.7% (95% CI: 99.2-99.9%), 98.5% (95% CI: 96.9-99.3%), respectively (NP3). An epidemiological association exists between personal BOT risk and: (1) a familial history of BOT/certain cancers (pancreas, lung, bone, leukemia) (NP3), (2) a personal history of benign ovarian cyst (NP2), (3) a personal history of pelvic inflammatory disease (IGH), (4) the use of intrauterine device levonorgestrel (NP3), (5) the use of oral contraceptive pills (NP3), (6) multiparity (NP3), (7) hormone replacement therapy (NP3), (8) high consumption of coumestrol (NP4), (9) medical treatment of infertility with progesterone (NP3), (10) non-steroidal anti-inflammatory drug (NSAID). An epidemiological association exists between previous/actual tabacco consumption and the risk of mucinous ovarian BOT (NP2). Relative risk (RR) varies between 2.2 and 2.7, however the relationship is not necessarily a causal one. An epidemiological association exists between overweight/obesity and the risk of serous BOT (NP2). RR varies between 1.2 to 1.8. The high Vitamin D was inversely associated to the risk of serous BOT (NP4). The risk of mucinous BOT was lowered with paracetamol use (OR=0.77; 95% CI: 0.60-0.98) (NP3). However, the relationship between these factors and BOT is not necessarily a causal one and no screening modality can be proposed in the general population (gradeC).

International audience; This work was carried out under the aegis of the CNGOF (Collège national des gynécologues et obstétriciens français) and proposes guidelines based on the evidence available in the literature. The objective was to define the diagnostic and surgical management strategy, the fertility preservation and surveillance strategy in Borderline Ovarian Tumor (BOT). No screening modality can be proposed in the general population. An expert pathological review is recommended in case of doubt concerning the borderline nature, the histological subtype, the invasive nature of the implant, for all micropapillary/cribriform serous BOT or in the presence of peritoneal implants, and for all mucinous or clear cell tumors (grade C). Macroscopic MRI analysis should be performed to differentiate the different subtypes of BOT: serous, seromucinous and mucinous (intestinal type) (grade C). If preoperative biomarkers are normal, follow up of biomarkers is not recommended (grade C). In cases of bilateral early serous BOT with a desire to preserve fertility and/or endocrine function, it is recommended to perform a bilateral cystectomy if possible (grade B). In case of early mucinous BOT, with a desire to preserve fertility and/or endocrine function, it is recommended to perform a unilateral adnexectomy (grade C). Secondary surgical staging is recommended in case of serous BOT with micropapillary appearance and uncomplete inspection of the abdominal cavity during initial surgery (grade C). For early-stage serous or mucinous BOT, it is not recommended to perform a systematic hysterectomy (grade C). Follow up after BOT must be pursued for more than 5 years (grade B). Conservative treatment involving at least the conservation of the uterus and a fragment of the ovary in a patient wishing to conceive may be proposed in advanced stages of BOT (grade C). A new surgical treatment that preserves fertility after a first non-invasive recurrence may be proposed in women of childbearing age (grade C). It is recommended to offer a specialized consultation for Reproductive Medicine when diagnosing BOT in a woman of childbearing age. Hormonal contraceptive use after serous or mucinous BOT is not contraindicated (grade C).

Introduction/Background In a previous pilot study we found that polyunsaturated n-3 fatty acids of marine origin were associated with Breast cancer multifocality. In the present study, we aimed to confirm these results altogether with investigating clinical and histological factors associated with breast cancer focality in a larger cohort of women with positive hormone-receptors breast cancer. Methodology One hundred sixty-one consecutive women presenting with non-metastatic breast cancer with positive hormone-receptors underwent breast-imaging procedures including a Magnetic Resonance Imaging prior to treatment. Breast adipose tissue specimens were collected during surgery. We established a biochemical profile of adipose tissue fatty acids by gas chromatography. Clinicopathologic characteristics were correlated with multifocality. We assessed whether these factors were predictive of breast cancer focality. Results We found that tumor size (OR=1.06 95%CI[1.02– 1.09], p Conclusion These differences in lipid content may contribute to mechanisms through which peritumoral adipose tissue fuels breast cancer multifocality. Disclosure Nothing to disclose.

Introduction/Background The aim of this study was to evaluate the impact of lymphovascular space invasion (LVSI) on overall survival (OS) and recurrence-free survival (RFS) in patients treated for epithelial ovarian cancer (EOC). Methodology Retrospective multicentre study of the research group FRANCOGYN between January 2001 and May 2016. All patients managed for EOC and for whom the presence or absence of LVSI was specified, were included. Patient‘s characteristics with LVSI (LVSI-1) were compared to those without LVSI (LVSI-0). We evaluated the presence of independent risk factors of LVSI. survival analysis were performed in all population and according to frequent pathological subtypes. Results 493 patients were included. Among them, 164 patients had LVSI (33,3%). More LVSI were observed in advanced stage (p Conclusion LVSI in EOC has an impact on OS and RFS. It can be considered as a major prognostic factor to consider in patients with ovarian cancer. Disclosure Nothing to disclose.

Introduction/Background The aim of this study was tocompare in patients managed for epithelial ovarian cancer; overall survival (OS) between women with isolated lymph node recurrence (ILNR) to those with isolated peritoneal localization of recurrence (ICR). Methodology Data from 1,508 patients with ovarian cancer were retrospectively collected, from January 1, 2000 to December 31, 2016, from the FRANCOGYN database, regrouping data from 11 centers specialized in ovary treatment. Median overall survival was determined using the Kaplan-Meier method. Patients included had a first recurrence defined as ILNR or isolated peritoneal recurrence during their follow up. Results 79 patients (5.2%) presented ILNR, and 247 (16.4%) patients recurred with isolated carcinomatosis. Complete lymphadenectomy was more achieved in ILNR group vs ICR group (67.1% vs 53.4%, p=0.004) and the number of pelvic lymph nodes involved was higher (2.4 vs 1.1, p=0.008). The number of involved pelvic LN was an independent predictor of ILNR (OR=1.231, 95% CI [1.074–1.412], p=0.0024). The 3-year and 5-year OS in the ILNR were 85.2% and 53.7% respectively, compared to 68.1% and 46.8% in patients with ICR. There was no significant difference in terms of OS after initial diagnosis (p=0.18). 3- year and 5-year OS after the diagnosis of recurrence were 62.6% and 15.6% in the ILNR group, and 44% and 15.7% in patients with ICR (p=0.21). Conclusion ILNR does not seem to be associated with a better prognosis in terms of OS. Disclosure Nothing to disclose.

Introduction/Background In vulvar cancer, it is admitted that tumor-free margin distance is one of the most important element for locoregional control. It is currently recommended to surgically remove the tumor with at least an 8 mm tumor-free margin. The aim of this study was to evaluate the impact of tumor-free margin distance on recurrence and survival in vulvar cancer. Methodology From 2005 to 2016, 112 patients surgically treated for a vulvar squamous cell cancer were included in a retrospective multicenter study. Overall, disease-free and metastasis-free survivals were analyzed according to tumor-free margin distance. Results Patients were divided into three groups : group 1 (margin Conclusion This study did not reveal a significant impact of tumor-free margin distance on recurrence and survival in vulvar cancer. Moreover, the benefit of re-excision seems stronger when tumor-free margins are positive or very close ( Disclosure Nothing to disclose.

Introduction/Background The most appropriate management for patients with stage IV ovarian cancer remains unclear. Our objective was to understand the main determinants associated with survival and to discuss best surgical management in these patients. Methodology Data of 1038 patients with confirmed ovarian cancer treated between 1996 and 2016 were extracted from maintained databases of 7 French referral gynecologic oncology institutions. Patients with stage IV diseases were selected for further analysis. The Kaplan Meier method was used to estimate the survival distribution. A Cox proportional hazards model including all the parameters statistically significant in univariable analysis, was used to account for the influence of multiple variables. Results Two hundred and eight patients met our inclusion criteria: 65 (31.3%) never underwent debulking surgery, 52 (25%) underwent primary debulking surgery (PDS) and 91 (43.8%) neoadjuvant chemotherapy and interval debulking surgery (NACT-IDS). Patients not operated had a significantly worse overall survival than patients that underwent PDS or NACT - IDS (p Conclusion Presence of distant metastases should not refrain surgeons from performing radical procedures, whenever the patient is able to tolerate. Maximal surgical efforts should be done to minimize residual disease as it is the main determinant of survival. Disclosure Nothing to disclose.

Introduction/Background Standard of care worldwide of locally advanced cancer tend to be non surgical (chemoradiation therapy) with no certainty if this attitude improves survival or not. Therefore, it is important to assess the value of hysterectomy in addition to chemoradiation therapy in this context. The sole randomized controlled trial (Morice 2012) designed to answer a similar question was closed early due to poor accrual and included 61 women, reported no difference in overall and recurrence-free survival between chemoradiation therapy and hysterectomy versus chemoradiotherapy alone. Methodology Data from 1,963 patients with cervical cancer were collected retrospectively from1 January 2000 to 31 December 2016, from the FRANCOGYN database, pooling data from 12 centres. Survival was determined using the Kaplan-Meier method. Univariate and multivariate analyses were performed to define prognostic factors of survival. Patients included had IB2 to IIB FIGO stage. Results 739 were included with a mean age of 53.5 years (±13.5). 634 women had available data of imaging after chemoradiotherapy. Management according to the presence of residue on imaging is presented on figure 1. 376 women had hysterectomy. There were significant differences for the 5-year Overall Survival (OS) rates between women who underwent hysterectomy and women who did not (p There were also significant differences for the 5-year Disease-Free Survival (DFS) rates between the two groups (p Conclusion A potential positive effect of hysterectomy after chemoradiation therapy for stage IB2 to IIB cervical cancer should be considered. Disclosure Nothing to disclose.

In the gynecology emergency departments, a pregnancy of uncertain viability is diagnosed in 29% of all first-trimester pregnancy medical consultations that require an ultrasound. The question of pregnancy viability is therefore common in our medical practice and comes along with human implications. In 2014, the French National College of Obstetricians and Gynecologists (CNGOF) promulgated clear guidelines regarding missed early miscarriage diagnosis and treatment. We wanted to evaluate our level of compliance with the diagnosis dimension of those guidelines and assess their optimization level since they were published.This retrospective and descriptive study is based on all missed early miscarriage that were taken care of within the gynecology emergency department at the CHU in Tours (France) over the course of three non-consecutive years. The year 2013 has been considered - before the guidelines were promulgated, 2015 - just after the guidelines were promulgated and lastly, 2018 in order to have the necessary distance for the interpretation. The following criteria was assessed for each year: the diagnostic ultrasound criteria; when relevant, the monitoring ultrasound deadlines; and the details regarding any patient management errors if errors were made. Secondarily, the uterine evacuation treatment procedures were examined.The study population includes 297 women. The non-compliance with the guidelines affected 20% of the women in 2013, 12% in 2015 and 15% in 2018 (p = 0.25 when comparing the pre-guideline and post-guideline periods). An ultrasound performed too early is the most common error made each year even though its frequency has decreased (p = 0.03). The least experienced sonographers tend to be rather cautious, performing additional unnecessary examinations and scheduling excessive additional monitoring ultrasound deadlines. Only 13% of the medication-based therapies made uterine evacuation successful. If the initial use of prostaglandin substances was not successful, no additional dose of medication enabled any women patient to avoid surgery.The compliance with the guidelines regarding pregnancies of uncertain viability is not optimal. Partial improvements in our own patient care management have been made since the publication of the guidelines; however, the main risk at stake is to terminate the evolution of a normal pregnancy due to some remaining medical misjudgments. The introduction of quality scores for clinical ultrasound images would be an interesting topic to discuss.

The aim was to review the clinical impact of lymph node ratio (LNR) of groin metastatic nodal disease in women with vulvar squamous cell carcinoma.Cohort study of women with vulvar squamous cell carcinoma, managed between January 2005 and December 2015, in five institutions in France with prospectively maintained databases (French multicenter tertiary care centers).In total, 636 women managed for VSCC of whom 508 (79.9%) underwent surgical groin nodal staging.Comparison of overall and recurrence free survival between women according to LNR.In total, 176 women (34.6%) had at least one positive lymph node (LN). There was a significant differences for the 5-year overall survival and recurrence free survival rates between women with LNR0.2 and women with LNR0.2.LNR seems to be a significant prognostic factor in women with vulvar squamous cell carcinoma.

International audience; Adjuvant chemotherapy by carboplatin and paclitaxel is recommended for all high-grade ovarian and tubal cancers (FIGO stages I-IIA) (grade A). After primary surgery is complete, 6 cycles of intravenous chemotherapy (grade A) are recommended, or a discussion with the patient about intraperitoneal chemotherapy, according to her risk-benefit ratio. After complete interval surgery for FIGO stage III, hyperthermic intraperitoneal chemotherapy (HIPEC) can be proposed, in accordance with the modalities of the OV-HIPEC trial (grade B). In cases of postoperative tumor residue or in FIGO stage IV tumors, chemotherapy associated with bevacizumab is recommended (grade A).

International audience; An MRI is recommended for an ovarian mass that is indeterminate on ultrasound. The ROMA score (combining CA125 and HE4) can also be calculated (grade A). In presumed early-stage ovarian or tubal cancers, the following procedures should be performed an omentectomy (at a minimum, infracolic), an appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C), and pelvic and para-aortic lymphadenectomies (grade B) for all histologic types, except the expansile mucinous subtypes, for which lymphadenectomies can be omitted (grade C). Minimally invasive surgery is recommended for early-stage ovarian cancer, when there is no risk of tumor rupture (grade B). For FIGO stages III or IV ovarian, tubal, and primary peritoneal cancers, a contrast-enhanced computed tomography (CT) scan of the thorax/abdomen/pelvis is recommended (grade B), as well as laparoscopic exploration to take multiple biopsies (grade A) and a carcinomatosis score (Fagotti score at a minimum) (grade C) to assess the possibility of complete surgery (i.e., leaving no macroscopic tumor residue). Complete surgery by a midline laparotomy is recommended for advanced ovarian, tubal, or primary peritoneal cancer (grade B). For advanced cancers, para-aortic and pelvic lymphadenectomies are recommended when metastatic adenopathy is clinically or radiologically suspected (grade B). When adenopathy is not suspected and when complete peritoneal surgery is performed as the initial surgery for advanced cancer, the lymphadenectomies can be omitted because they do not modify either the medical treatment or overall survival (grade B). Primary surgery (before other treatment) is recommended whenever it appears possible to leave no tumor residue (grade B).

International audience; An MRI is recommended for an ovarian mass that is indeterminate on ultrasound. The ROMA score (combining CA125 and HE4) can also be calculated (Grade A). In presumed early-stage ovarian or tubal cancers, the following procedures should be performed an omentectomy (at a minimum, infracolic), an appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C), and pelvic and para-aortic lymphadenectomies (Grade B) for all histologic types, except the expansile mucinous subtypes, for which lymphadenectomies can be omitted (grade C). Minimally invasive surgery is recommended for early-stage ovarian cancer, when there is no risk of tumor rupture (grade B). Adjuvant chemotherapy by carboplatin and paclitaxel is recommended for all high-grade ovarian and tubal cancers (FIGO stages I-IIA) (grade A). For FIGO stage III or IV ovarian, tubal, and primary peritoneal cancers, a contrast-enhanced computed tomography (CT) scan of the thorax/abdomen/pelvis is recommended (Grade B), as well as laparoscopic exploration to take multiple biopsies (grade A) and a carcinomatosis score (Fagotti score at a minimum) (grade C) to assess the possibility of complete surgery (i.e., leaving no macroscopic tumor residue). Complete surgery by a midline laparotomy is recommended for advanced ovarian, tubal, or primary peritoneal cancers (grade B). For advanced cancers, para-aortic and pelvic lymphadenectomies are recommended when metastatic adenopathy is clinically or radiologically suspected (grade B). When adenopathy is not suspected and when complete peritoneal surgery is performed as the initial surgery for advanced cancer, the lymphadenectomies can be omitted because they do not modify either the medical treatment or overall survival (grade B). Primary surgery (before other treatment) is recommended whenever it appears possible to leave no tumor residue (grade B). After primary surgery is complete, 6 cycles of intravenous chemotherapy (grade A) are recommended, or a discussion with the patient about intraperitoneal chemotherapy, according to her risk-benefit ratio. After complete interval surgery for FIGO stage III disease, hyperthermic intraperitoneal chemotherapy (HIPEC) can be proposed, in accordance with the modalities of the OV-HIPEC trial (grade B). In cases of postoperative tumor residue or in FIGO stage IV tumors, chemotherapy associated with bevacizumab is recommended (grade A).

National audience; Adjuvant chemotherapy with carboplatin and paclitaxel is recommended for all high-grade ovarian or Fallopian tube cancers, stage FIGO I-IIA (grade A). After a complete first surgery, it is recommended to deliver 6 cycles of intravenous (grade A) or to propose intraperitoneal (grade B) chemotherapy, to be discussed with patient, according to the benefit/risk ratio. After a complete interval surgery for a FIGO III stage, the hyperthermic intra peritoneal chemotherapy (HIPEC) can be proposed in the same conditions of the OV-HIPEC trial (grade B). In case of tumor residue after surgery or FIGO stage IV, chemotherapy associated with bevacizumab is recommended (grade A). For BRCA mutated patient, Olaparib is recommended (grade B).

National audience; Faced to an undetermined ovarian mass on ultrasound, an MRI is recommended and the ROMA score (combining CA125 and HE4) can be proposed (grade A). In case of suspected early stage ovarian or fallopian tube cancer, omentectomy (at least infracolonic), appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C) and pelvic and para-aortic lymphadenectomy are recommended (grade B) for all histological types, except for the expansive mucinous subtype where lymphadenectomy may be omitted (grade C). Minimally invasive surgery is recommended for early stage ovarian cancer, if there is no risk of tumor rupture (grade B). Laparoscopic exploration for multiple biopsies (grade A) and to evaluate carcinomatosis score (at least using the Fagotti score) (grade C) are recommended to estimate the possibility of a complete surgery (i.e. no macroscopic residue). Complete medial laparotomy surgery is recommended for advanced cancers (grade B). It is recommended in advanced cancers to perform para-aortic and pelvic lymphadenectomy in case of clinical or radiological suspicion of metastatic lymph node (grade B). In the absence of clinical or radiological lymphadenopathy and in case of complete peritoneal surgery during an initial surgery for advanced cancer, it is possible not to perform a lymphadenectomy because it does not modify the medical treatment and the overall survival (grade B). Primary surgery is recommended when no tumor residue is possible (grade B).

Adjuvant chemotherapy with carboplatin and paclitaxel is recommended for all high-grade ovarian or Fallopian tube cancers, stage FIGO I-IIA (grade A). After a complete first surgery, it is recommended to deliver 6 cycles of intravenous (grade A) or to propose intraperitoneal (grade B) chemotherapy, to be discussed with patient, according to the benefit/risk ratio. After a complete interval surgery for a FIGO III stage, the hyperthermic intra peritoneal chemotherapy (HIPEC) can be proposed in the same conditions of the OV-HIPEC trial (grade B). In case of tumor residue after surgery or FIGO stage IV, chemotherapy associated with bevacizumab is recommended (grade A). For BRCA mutated patient, Olaparib is recommended (grade B).

Faced to an undetermined ovarian mass on ultrasound, an MRI is recommended and the ROMA score (combining CA125 and HE4) can be proposed (grade A). In case of suspected early stage ovarian or fallopian tube cancer, omentectomy (at least infracolonic), appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C) and pelvic and para-aortic lymphadenectomy are recommended (grade B) for all histological types, except for the expansive mucinous subtype where lymphadenectomy may be omitted (grade C). Minimally invasive surgery is recommended for early stage ovarian cancer, if there is no risk of tumor rupture (grade B). Laparoscopic exploration for multiple biopsies (grade A) and to evaluate carcinomatosis score (at least using the Fagotti score) (grade C) are recommended to estimate the possibility of a complete surgery (i.e. no macroscopic residue). Complete medial laparotomy surgery is recommended for advanced cancers (grade B). It is recommended in advanced cancers to perform para-aortic and pelvic lymphadenectomy in case of clinical or radiological suspicion of metastatic lymph node (grade B). In the absence of clinical or radiological lymphadenopathy and in case of complete peritoneal surgery during an initial surgery for advanced cancer, it is possible not to perform a lymphadenectomy because it does not modify the medical treatment and the overall survival (grade B). Primary surgery is recommended when no tumor residue is possible (grade B).

To evaluate the diagnostic value of serum/urinary biomarkers and the operability diagnosis strategy to make management recommendations.Bibliographical search in French and English languages by consultation of Pubmed, Cochrane and Embase databases.For the diagnosis of a suspicious adnexal mass on imaging: Serum CA125 antigen is recommended (grade A). Serum CAE is not recommended (grade C). The low evidence in literature concerning diagnostic value of CA19.9 does not allow any recommendation concerning its use. Serum Human epididymis protein 4 (HE4) is recommended (grade A). Comparison of data concerning diagnosis value of CA125 and HE4 show similar results for the prediction of malignancy in case of a suspicious adnexal mass on imaging (NP1). Urinary HE4 is not recommended (grade A). The use of circulating tumor DNA is not recommended (grade A). Tumor associated antigen-antibodies (AAbs) is not recommended (grade B). The use of ROMA score (Risk of Ovarian Malignancy Algorithm) is recommended (grade A). The use of Copenhagen index (CPH-I), R-OPS score, OVA500 is not recommended (grade C). For the prediction of resectability of an ovarian cancer with peritoneal carcinomatosis in the context of a primary debulking surgery: It is not recommendend to use serum CA125 (grade A). The low evidence in literature concerning diagnostic value of HE4 does not allow any recommendation concerning its use in this context. No recommendation can be given concerning CA19.9 and CAE. For the prediction of resectability of an ovarian cancer with peritoneal carcinomatosis in the context of surgery after neoadjuvant chemotherapy: the low evidence in literature concerning diagnostic value of serum markers in this context does not allow any recommendation concerning their use in this context. Place of laparoscopy for the prediction of resectability in case of upfront surgery of an ovarian cancer with peritoneal carcinomatosis robust data shows that the use of laparoscopy significantly reduce futile laparotomies (LE1). Laparoscopy is recommended in this context (grade A). Fagotti score is a reproducible tool (LE1) permitting the evaluation of feasibility of an optimal upfront debulking (NP4), its use is recommended (grade C). A Fagotti score≥8 is correlated to a low probability of complete or optimal debulking surgery (LE4) (grade C). There is no sufficient evidence to recommend the use of the modified Fagotti score or any other laparoscopic score (LE4). In case of laparotomy for an ovarian cancer with peritoneal carcinomatosis, the use of Peritoneal Cancer Index (PCI) is recommended (grade C). For the prediction of overall survival, disease free survival and the prediction of postoperative complications, the clinical and statistical of actually available tools do not allow any recommendation.

To define follow-up modalities after an epithelial ovarian, tubal or primitive peritoneal cancer. To define possibilities of hormone replacement therapy (HRT) and contraceptive use after treatment.Systematic review of the literature in French and English langage conducted on Pubmed/Medline and the Cochrane Library.After the treatment of an epithelial ovarian, tubal or primitive peritoneal cancer, symptoms evaluation for follow-up is recommended at 3 months, 6 months, 12 months, 18 months, 24 months, and then yearly (Grade B). Only patients with an initial complete surgery (CC0, without any macroscopic signs of disease), and with a good general condition (ECOG 0) should be followed with paraclinic tests, with a serum HE4 or CA125 concentration measurement, from 6 months after the end of treatments (GradeC). Systematic follow-up with CT of the chest, abdomen, and pelvis is not recommended (GradeC). Imaging test is recommended in case of an increased serum concentration of HE4 or CA125 (Grade B). An HRT should be proposed to women younger than 45 after a non-conservative treatment for a high grade serous (GradeC) or for a mucinous (GradeC) ovarian, tubal or primitive peritoneal adenocarcinoma. HRT is not contra-indicated in women older than 45 presenting a climacteric syndrome after the treatment of a high grade serous (Grade B) or of a mucinous (GradeC) ovarian, tubal or primitive peritoneal adenocarcinoma.

To evaluate delay to access to adjuvant radiotherapy for women with breast cancer and to study impact on prognosis.A restrospective descriptive study in the teaching hospital of Tours between 1st January 2007 and 31th December 2013. All women managed for an invasive breast cancer during this period were included with exclusion of women with indication of chemotherapy (neoadjuvant/adjuvant). Delay between surgery and radiotherapy were recorded. Overall survival and recurrence free survival were used to evaluate the impact of delays on prognosis.Of the 1855 women with an invasive breast cancer, 904 (48.7%) had an adjuvant radiotherapy without chemotherapy. In the whole population, a delay surgery-radiotherapy90 days was found as an independent factor negatively impacting recurrence free survival (HR=2.12 [1.03-4.36] p=0.04). In the group of patient with a breast conservative surgery, a delay surgery-radiotherapy65 days was found as an independent factor negatively impacting recurrence free survival with HR=2.29 [1.16-4.54], p=0.02. A delay surgery-radiotherapy70 days was found as an independent factor negatively impacting Overall survival and HR=3.41 [1.005-11.62], p=0.04.Delay to access to adjuvant radiotherapy is an independent factor impacting patient's survival, especially in the case of breast conservative therapy.

The aim of our study was to evaluate the impact of young age on breast cancer presentation and women's prognosis.We performed a descriptive retrospective study in the university teaching hospital of Tours from January 2007 to December 2013. All women managed for an invasive breast cancer were included. The population was divided in 2 groups according to age: ≤40 years and40 years. We studied differences in histological, management and outcome characteristics.Two thousand and eighty three women with an invasive breast cancer were included. A hundred and fifty five in the group of women with an age ≤40 years and 1928 in the group of women with an age40 years. Histological characteristics of breast cancer in younger women were worse than in their older counterparts (with more aggressive features: grade 3, negative hormone receptors, positive Her 2 status, triple negative molecular sub-type). Overall survival was lower in young women than in women age40 years (P=0.05),as was recurrence free survival (P0.001), locoregional recurrence free survival (P=0.02) and distant metastasis free survival(P0.001). Age≤40 years was an independent factor predictive of poor recurrence free survival.In our study we found an impact of age≤40 years on invasive breast cancer presentation and prognosis.

Triples negative breast cancer defined by the absence of expression of the hormone receptors and HER2 protein, are considered as aggressive tumours with bad outcome in comparison to the hormone sensitive tumours. The aim of the study was to evaluate the link between hormone factors and prognostic factors of triple-negative tumours.All patients managed for a triple-negative breast cancer between January, 2009 and December, 2013 were included. For every patient, collected data were the clinical, histological, adjuvant or neoadjuvant treatments, as well as survival data.During the study period, 1682 patients were operated for a breast cancer, among which 1444 presented at least an invasive tumour. One hundred and fifty-five women (10.7%) had a negative triple tumour. The average age of diagnosis was 56.4years, is significantly younger than for patients with other types of tumours, P=0.0001. For women with a triple-negative tumour, the parity was the only hormonal factor identified as an independent factor for axillary lymph node involvement (OR=1.53; 95% CI [1.10-2.25] P=0.02) and previous hormone replacement therapy as an independent factor of locoregional recurrence (OR=0.13 [0.005-0.64] P=0.001). We did not find any hormonal factor predictive of distant metastasis. We did not find any difference in overall survival according to the parity (P=0.72), the Body mass index (P=0.62) or the use of HRT (P=0.49).Hormone factors seem to have a prognostic implication for triple-negative despite the absence of hormone receptors expression.

The aim of this study was to evaluate the impact of pathological complete response (pCR) on overall survival (OS) and recurrence-free survival (RFS) according to molecular subtypes in women treated for an invasive breast cancer after neoadjuvant chemotherapy (NAC).All women (n=225) managed with a neoadjuvant chemotherapy for an invasive breast cancer in our institution between January 2007 and December 2013 were included. The characteristics of patients with pCR (pCR-1), breast pCR and axillary pCR were compared to those without pCR (pCR-0) according to the molecular subtypes: luminal A (n=62), luminal B (n=77), Her-2 (n=31) and triple negative (n=55).NAC concerned 225 patients of whom 36 (16%) had pCR. Achievement of pCR led to significantly better overall survival in women with Her-2 tumors (35% versus 100%, P=0.035) and also to significantly better locoregional survival in women treated for triple negative tumors (P=0.026). Predictive factors of pCR were a high pathologic grade: OR=2.39, IC 95% (1.19-4.83), P=0.008; Her-2 molecular subtype (P=0.008); positive estrogenic hormonal receptors (P=0.006), a positive Her-2 receptor: OR=2.58, IC 95% (1.20-5.54), P=0.01.Achievement of pCR is an intermediate marker of survival in women managed with NAC for breast cancer.

The aim of our study was to evaluate the existence of predictive factors of conservative breast surgery after neoadjuvant chemotherapy (NAC) for breast cancer.We included all women with invasive breast cancer who received NAC and underwent breast surgery between January 2007 and December 2013 in our institution. Univariable and multivariable analyses were performed to determine the association between clinical and histological factors and conservative breast surgery.During the study period, 229 women were included of whom 73 had breast conservative surgery (32%). At univariable analysis, significant predictive factors were age (OR 0.97 [CI 95% 0.95-0.99], P=0.02), radiological size (OR 0.97 [CI 95% 0.96-0.99], P0.001), multifocality (OR 0.53 [CI 95% 0.27-1.05], P=0.06), breast inflammation (OR 0.15 [CI 95% 0.07-0.32], P0.001) and the type of hormone receptors (P=0.12). In multivariable analysis, all these factors but age were significant factors and thus considered as independent predictive factors.This work permitted to identify independent predictive factors of breast conservative surgery after NAC for breast cancer that will be included in a risk scoring system that we aim to evaluate prospectively.