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1. Can we replace adjuvant chemotherapy with surveillance for stage IA-C immature ovarian teratomas of any grade? an international multicenter analysis.

Author

Bergamini, Alice, Sarwar, Naveed, Ferrandina, Gabriella, Scarfone, Giovanna, Short, Dee, Aguiar, Xianne, Camnasio, Cristina, Kaur, Baljeet, Savage, Philip M., Cormio, Gennaro, Lim, Adrian, Pignata, Sandro, Mangili, Giorgia, and Seckl, Michael J.

Subjects
*CANCER relapse, *COMBINED modality therapy, *MEDICAL cooperation, *MULTIVARIATE analysis, *OVARIAN tumors, *PATIENT safety, *PUBLIC health surveillance, *RESEARCH, *TERATOMA, *TUMOR classification, *DESCRIPTIVE statistics, *TUMOR grading
Abstract

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. 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. 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. 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. • Surveillance does not worsen prognosis of postpubertal stage I ovarian immature teratomas. • When suspecting a recurrence, surgery is recommended to assess the presence of immature disease. • Adjuvant chemotherapy should be reserved for the treatment of recurrent immature grade 2-3 disease. [ABSTRACT FROM AUTHOR]

Published
2020
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2. Can we replace adjuvant chemotherapy with surveillance for stage IA-C immature ovarian teratomas of any grade? an international multicenter analysis

Author

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, and Philip Savage

Subjects
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
Abstract

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.

Published
2020

3. Can we replace adjuvant chemotherapy with surveillance for stage IA-C immature ovarian teratomas of any grade? an international multicenter analysis

Author

Bergamini, A., Sarwar, N., Ferrandina, G., Scarfone, G., Short, D., Aguiar, X., Camnasio, C., Kaur, B., Savage, P. M., Cormio, G., Lim, A., Pignata, S., Mangili, G., Seckl, M. J., Ferrandina G. (ORCID:0000-0003-4672-4197), Bergamini, A., Sarwar, N., Ferrandina, G., Scarfone, G., Short, D., Aguiar, X., Camnasio, C., Kaur, B., Savage, P. M., Cormio, G., Lim, A., Pignata, S., Mangili, G., Seckl, M. J., and Ferrandina G. (ORCID:0000-0003-4672-4197)

Abstract

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.

Published
2020

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