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Impact of adjuvant hysterectomy on prognosis in patients with locally advanced cervical cancer treated with definitive chemoradiation: A meta-analysis
Abstracts / Gynecologic Oncology 145 (2017) 2–220
387 - Poster Session Impact of adjuvant hysterectomy on prognosis in patients with locally advanced cervical cancer treated with definitive chemoradiation: A meta-analysis S.H. Shim, S.J. Lee, S.N. Kim. Konkuk University School of Medicine, Seoul, South Korea Objective: To estimate the effect of adjuvant hysterectomy (AH) on prognosis in locally advanced cervical cancer (LACC) patients treated with definitive chemoradiation through a meta-analysis. Method: We systematically reviewed published studies comparing AH following chemoradiation with chemoradiation only in LACC patients through April 2016. Endpoints were mortality and recurrence rates. Study design features that possibly affected participant selection, death/recurrence detection, and manuscript publication were assessed. For pooled estimates of the effect of AH on death/ recurrence, random- or fixed-effects meta-analytical models were used after assessing cross-study heterogeneity. Results: Two randomized trials and 6 observational studies (AH following chemoradiation, 630 patients; chemoradiation only, 585 patients) met our search criteria. Fixed-effects model-based meta-analysis indicated no significant between-group difference in mortality was observed (OR = 1.01, 95% CI 0.58–1.78, P = 0.97), with low cross-study heterogeneity (P = 0.73 and I2 = 0). This pattern was observed in the subgroup analysis for study design, type of radiation, response after chemoradiation, and type of hysterectomy. The pooled OR for AH and total recurrence was 0.59 (95% CI 0.44–0.79, P b 0.05) with low cross-study heterogeneity (P = 0.289 and I2 = 17.8), favoring the AH group. However, this pattern was not observed in the subgroup analysis for the randomized trials (OR = 1.05, 95% CI 0.52–2.11, P = 0.89). There was no evidence of publication bias. Conclusion: In this meta-analysis, AH following chemoradiation does not improve survival in patients with LACC, although it seems to reduce recurrence risk. Concerning the significant morbidity of AH after chemoradiation, routine use of AH should be sublated. Future clinical trials to test the contribution of AH in patients with residual disease after chemoradiation are warranted. doi:10.1016/j.ygyno.2017.03.415
388 - Poster Session Interval debulking surgery (IDS) vs primary debulking surgery (PDS) for advanced ovarian cancer treatment: Complete cytoreduction rate and perioperative outcomes B.G. Castroa, G.F. Cintrab, M.A. Vieirab, R. Reisb, C.E.M.D.C. Andradea,b. a Faculdade de Ciências da Saúde de Barretos Dr. Paulo Prata, Barretos, Brazil, bBarretos Cancer Hospital, Barretos, Brazil Objective: Interval debulking surgery (IDS) is considered a not inferior treatment for advanced ovarian cancer compared to primary debulking surgery (PDS). Besides that, IDS is correlated with fewer perioperative complications. But few reports have concentrated on 2 important oncologic indictors: complete cytoreduction rate and delay to initiate adjuvant chemotherapy after cytoreduction. Method: We analyzed retrospectively all patients with advanced (stage III or IV) ovarian cancer who underwent cytoreduction at our institution between May 2011 and May 2016. Complete cytoreduction was considered when after debulking surgery no residual visible disease is achieved. To describe perioperative
183
outcomes, we evaluated all 30-day complications (major or minor) as described by the American College of Surgeons National Surgical Quality Improvement Program, and considered delay of chemotherapy as all cases of patients who had not started adjuvant chemotherapy until 42 days or did not perform chemotherapy after debulking surgery. These data were analyzed between IDS and PDS using the χ2 test, and a P value of b0.05 was considered significant. Results: We included 59 patients, 27 (45.8%) undergone to IDS and 32 (54.2%) to PDS. In the IDS group there was 38.1% complete cytoreduction, and in the PDS group, 32.1% (P = 0.665). Thirtyday complications occurred in 63% of cases in the IDS group and 56.2% in the PDS group (P = 0.601). Delay of chemotherapy occurred in 40.7% of patients in the IDS group and in 46.9% in the PDS group (P = 0.636). Conclusion: IDS did not have significant difference compared with PDS for complete cytoreduction rates and delay to adjuvant chemotherapy, and also there was not significant reduction in 30-day complications.
doi:10.1016/j.ygyno.2017.03.416
389 - Poster Session Analysis of clinicopathologic factors predicting disease recurrence in lymph node-negative early-stage endometrial cancer patients who underwent comprehensive surgical staging T.W. Konga, J.H. Sona, K.H. Songb, J. Paeka, S.J. Changa, H.S. Ryua. aAjou University School of Medicine, Suwon, South Korea, bAjou University Hospital, Suwon, South Korea Objective: The aim of this study was to evaluate clinicopathologic factors affecting disease recurrence in patients with FIGO stage I-II endometrial cancer. Method: We retrospectively reviewed clinicopathologic data of 260 FIGO stage I-II endometrial cancer patients who underwent comprehensive surgical staging between March 2000 and June 2016. All patients had endometrioid adenocarcinoma. Several clinicopathologic factors including age, CA-125, tumor grade, depth of myometrial invasion, lymphovascular space invasion (LVSI), and cervical stromal invasion were selected. Sites of disease recurrence and all possible clinicopathologic factors related to the risk of disease recurrence were evaluated using univariate and multivariate Cox proportional hazard regression. Results: The median follow-up time was 42 months (range, 3–178 months). Five patients (1.9%) showed disease recurrence (1 patient, locoregional; 3 patients, distant or lymphatic). In univariate analysis, tumor grade 3 (P b 0.001), deep (50% or more of myometrial thickness) myometrial invasion (P = 0.013), and positive LVSI (P = 0.003) were related to disease-free survival (DFS). Multivariate analysis demonstrated that positive LVSI (OR = 22.457, 95% CI 1.053–478.866, P = 0.046) and tumor grade 3 (OR = 61.554, 95% CI 2.069–1831.546, P = 0.017) represented independent prognostic factors related to disease recurrence. Conclusion: LVSI and tumor grade 3 are significantly related to distant metastasis and shorter DFS in lymph node-negative earlystage endometrial cancer patients with endometrioid histology. Therefore, the use of systemic adjuvant therapy should be further investigated in these patients.
doi:10.1016/j.ygyno.2017.03.417
387 - Poster Session Impact of adjuvant hysterectomy on prognosis in patients with locally advanced cervical cancer treated with definitive chemoradiation: A meta-analysis S.H. Shim, S.J. Lee, S.N. Kim. Konkuk University School of Medicine, Seoul, South Korea Objective: To estimate the effect of adjuvant hysterectomy (AH) on prognosis in locally advanced cervical cancer (LACC) patients treated with definitive chemoradiation through a meta-analysis. Method: We systematically reviewed published studies comparing AH following chemoradiation with chemoradiation only in LACC patients through April 2016. Endpoints were mortality and recurrence rates. Study design features that possibly affected participant selection, death/recurrence detection, and manuscript publication were assessed. For pooled estimates of the effect of AH on death/ recurrence, random- or fixed-effects meta-analytical models were used after assessing cross-study heterogeneity. Results: Two randomized trials and 6 observational studies (AH following chemoradiation, 630 patients; chemoradiation only, 585 patients) met our search criteria. Fixed-effects model-based meta-analysis indicated no significant between-group difference in mortality was observed (OR = 1.01, 95% CI 0.58–1.78, P = 0.97), with low cross-study heterogeneity (P = 0.73 and I2 = 0). This pattern was observed in the subgroup analysis for study design, type of radiation, response after chemoradiation, and type of hysterectomy. The pooled OR for AH and total recurrence was 0.59 (95% CI 0.44–0.79, P b 0.05) with low cross-study heterogeneity (P = 0.289 and I2 = 17.8), favoring the AH group. However, this pattern was not observed in the subgroup analysis for the randomized trials (OR = 1.05, 95% CI 0.52–2.11, P = 0.89). There was no evidence of publication bias. Conclusion: In this meta-analysis, AH following chemoradiation does not improve survival in patients with LACC, although it seems to reduce recurrence risk. Concerning the significant morbidity of AH after chemoradiation, routine use of AH should be sublated. Future clinical trials to test the contribution of AH in patients with residual disease after chemoradiation are warranted. doi:10.1016/j.ygyno.2017.03.415
388 - Poster Session Interval debulking surgery (IDS) vs primary debulking surgery (PDS) for advanced ovarian cancer treatment: Complete cytoreduction rate and perioperative outcomes B.G. Castroa, G.F. Cintrab, M.A. Vieirab, R. Reisb, C.E.M.D.C. Andradea,b. a Faculdade de Ciências da Saúde de Barretos Dr. Paulo Prata, Barretos, Brazil, bBarretos Cancer Hospital, Barretos, Brazil Objective: Interval debulking surgery (IDS) is considered a not inferior treatment for advanced ovarian cancer compared to primary debulking surgery (PDS). Besides that, IDS is correlated with fewer perioperative complications. But few reports have concentrated on 2 important oncologic indictors: complete cytoreduction rate and delay to initiate adjuvant chemotherapy after cytoreduction. Method: We analyzed retrospectively all patients with advanced (stage III or IV) ovarian cancer who underwent cytoreduction at our institution between May 2011 and May 2016. Complete cytoreduction was considered when after debulking surgery no residual visible disease is achieved. To describe perioperative
183
outcomes, we evaluated all 30-day complications (major or minor) as described by the American College of Surgeons National Surgical Quality Improvement Program, and considered delay of chemotherapy as all cases of patients who had not started adjuvant chemotherapy until 42 days or did not perform chemotherapy after debulking surgery. These data were analyzed between IDS and PDS using the χ2 test, and a P value of b0.05 was considered significant. Results: We included 59 patients, 27 (45.8%) undergone to IDS and 32 (54.2%) to PDS. In the IDS group there was 38.1% complete cytoreduction, and in the PDS group, 32.1% (P = 0.665). Thirtyday complications occurred in 63% of cases in the IDS group and 56.2% in the PDS group (P = 0.601). Delay of chemotherapy occurred in 40.7% of patients in the IDS group and in 46.9% in the PDS group (P = 0.636). Conclusion: IDS did not have significant difference compared with PDS for complete cytoreduction rates and delay to adjuvant chemotherapy, and also there was not significant reduction in 30-day complications.
doi:10.1016/j.ygyno.2017.03.416
389 - Poster Session Analysis of clinicopathologic factors predicting disease recurrence in lymph node-negative early-stage endometrial cancer patients who underwent comprehensive surgical staging T.W. Konga, J.H. Sona, K.H. Songb, J. Paeka, S.J. Changa, H.S. Ryua. aAjou University School of Medicine, Suwon, South Korea, bAjou University Hospital, Suwon, South Korea Objective: The aim of this study was to evaluate clinicopathologic factors affecting disease recurrence in patients with FIGO stage I-II endometrial cancer. Method: We retrospectively reviewed clinicopathologic data of 260 FIGO stage I-II endometrial cancer patients who underwent comprehensive surgical staging between March 2000 and June 2016. All patients had endometrioid adenocarcinoma. Several clinicopathologic factors including age, CA-125, tumor grade, depth of myometrial invasion, lymphovascular space invasion (LVSI), and cervical stromal invasion were selected. Sites of disease recurrence and all possible clinicopathologic factors related to the risk of disease recurrence were evaluated using univariate and multivariate Cox proportional hazard regression. Results: The median follow-up time was 42 months (range, 3–178 months). Five patients (1.9%) showed disease recurrence (1 patient, locoregional; 3 patients, distant or lymphatic). In univariate analysis, tumor grade 3 (P b 0.001), deep (50% or more of myometrial thickness) myometrial invasion (P = 0.013), and positive LVSI (P = 0.003) were related to disease-free survival (DFS). Multivariate analysis demonstrated that positive LVSI (OR = 22.457, 95% CI 1.053–478.866, P = 0.046) and tumor grade 3 (OR = 61.554, 95% CI 2.069–1831.546, P = 0.017) represented independent prognostic factors related to disease recurrence. Conclusion: LVSI and tumor grade 3 are significantly related to distant metastasis and shorter DFS in lymph node-negative earlystage endometrial cancer patients with endometrioid histology. Therefore, the use of systemic adjuvant therapy should be further investigated in these patients.
doi:10.1016/j.ygyno.2017.03.417