Should ovarian carcinoma metastatic to the inguinal nodes be assigned stage IVB?

102

Abstracts / Gynecologic Oncology 145 (2017) 2–220

Objective: In CHORUS trial, neoadjuvant chemotherapy (NAC) arm suggests 3 cycles of NAC, interval debulking surgery (IDS), and 3 cycles of postoperative adjuvant chemotherapy (POAC). However, treatment patterns vary, in particular, the number of cycles of NAC and POAC given in clinical practice. The aim of this study was to evaluate the impact of number of NAC and POAC cycles on survival in patients who undergo NAC/IDS/POAC. Method: Data from epithelial ovarian cancer patients (stage IIIC-IV), operated on between 2006 and 2014 were consecutively recorded. All patients underwent taxane plus carboplatin chemotherapy for NAC and POAC and were analyzed according to the number of NAC (1–3 vs ≥4 cycles), POAC (1–3 vs ≥4 cycles) and total chemotherapy (NAC + POAC, 2–6 vs 6 vs ≥6 cycles). Results: A total of 126 patients with stage IIIC-IV underwent NAC followed by IDS (median age 56.5 years; stage IV, 54.8%). Patients who received fewer than 6 cycles of total chemotherapy (NAC + POAC) had poorer outcomes than other groups (6 and ≥6 cycles). The Kaplan-Meier curve and the log rank test showed no difference in either progression-free survival or overall survival according to number of NAC cycles. Furthermore, the addition of more than 3 cycles of POAC did not improve the progression-free survival or overall survival. In a multivariate Cox model, completion of chemotherapy of at least 6 cycles (NAC + POAC) had no effect on either recurrence (HR = 0.03, 95% CI 0.01–0.13) or overall survival (HR = 0.04, 95% CI 0.01–0.13). Conclusion: The completion of total chemotherapy of at least 6 cycles is an independent prognostic factor to patients who undergo NAC/IDS/POAC. However, the addition of more than 3 cycles of NAC or POACdid not affect survival in this disease subset.

grade 3 regardless of any preoperative grade. Appropriate statistical tests were used. Results: A total of 1,280 met inclusion criteria: 1,155 low-grade, 88 high-grade, and 37 discordant. Median follow-up time for the entire cohort was 58 months (range, 0.4–198 months). Median age and BMI were statistically different among the 3 cohorts. The depth of myoinvasion (DOI), presence of LVSI, and use of adjuvant therapy also significantly differed. The 5-year PFS was 95.2% (SE 0.7%) for low-grade, 82% (SE 4.6%) for high-grade, and 85.6% (SE 6%) for discordant (P b 0.001). After adjusting for age, BMI, DOI, and use of adjuvant therapy, discordant cases were not independently associated with PFS (HR = 1.799, 95% CI 0.7–4.61). The 5-year OS was 94.4% (SE 0.8%) for low-grade, 88.3% (SE 4%) for high-grade, and 90.9% (SE 5%) for discordant (P = 0.02). After adjusting for age, BMI, DOI, and use of adjuvant therapy, discordant cases retained an independent association with a worse OS (HR = 2.392, 95% CI 1.14– 5.03). (See Fig. 1.) Conclusion: The clinical behavior of stage I endometrioid endometrial carcinoma diagnosed as high-grade on preoperative biopsy and low-grade on subsequent hysterectomy seems to differ from lowgrade cases diagnosed on both preoperative and final pathology. Consideration should be given to treating these “discordant” tumors as high-grade.

doi:10.1016/j.ygyno.2017.03.239

212 - Poster Session Withdrawn

doi:10.1016/j.ygyno.2017.03.240

213 - Poster Session Clinical behavior of FIGO stage I endometrioid endometrial adenocarcinoma diagnosed as high-grade on preoperative biopsy and low-grade on hysterectomy specimen B. Schlappe, M.B. Schiavone, D. DeLair, J.A. Ducie, A.G.Z. Eriksson, O. Zivanovic, V. Makker, R.A. Soslow, N.R. Abu-Rustum, M.M. Leitao. Memorial Sloan Kettering Cancer Center, New York, NY, USA Objective: Preoperative endometrial assessment may be discordant with final pathology. It is uncertain how best to classify cases with preoperative biopsy noted to be grade 3 and final hysterectomy specimen noted to be lower grade (i.e., discordant). The objective of this study was to determine the outcome of discordant cases. Method: All patients who had primary surgical treatment of endometrioid endometrial carcinoma from 2000 to 2012 were identified from an institutional database. Relevant patient, clinical, and pathologic characteristics were collected, including preoperative biopsy grade, adjuvant therapy, and follow-up information. For this analysis, discordant was defined as above; low-grade was defined as cases with final pathology grade 1 or 2 and with similar preoperative grade; and high-grade was defined as cases with final pathology

Fig. 1. Progression-free survival by tumor grade.

doi:10.1016/j.ygyno.2017.03.241

214 - Poster Session Should ovarian carcinoma metastatic to the inguinal nodes be assigned stage IVB? D. Nasioudis, E. Chapman-Davis, M. Frey, T.A. Caputo, S.S. Witkin, M.M. Holcomb. Weill Cornell Medicine, New York, NY, USA Objective: According to the recently revised Fédération Internationale de Gynécologie et d' Obstétrique (FIGO) staging classification, women with ovarian carcinoma and inguinal lymph nodes (LN) metastases, formerly stage III, are now considered stage IVB. The prognostic significance of this classification has yet to be evaluated. In this retrospective study we compare the survival of these patients to that of women with stage III (with aortic and/or pelvic LN metastases) and stage IV (due to distant metastasis) disease.

Abstracts / Gynecologic Oncology 145 (2017) 2–220

103

Method: A cohort of women diagnosed with ovarian carcinoma was selected from the Surveillance Epidemiology and End Results database (2004–2013). Only those who underwent cancer-directed surgery were included. Based on information from the collaborative staging fields, 3 groups were formed: group 1 (stage IV solely due to inguinal LN metastasis), group 2 (stage III with positive aortic and/or pelvic LNs), and group 3 (stage IV due to distant metastases). Overall and cancer-specific survival rates were evaluated with the KaplanMeier method. Comparisons were made with the log rank test, and a Cox hazard model was constructed. Results: A total of 12,231 women met the inclusion criteria: 151 (1.2%) with inguinal LN metastases (group 1), 4,403 (36%) with positive aortic and/or pelvic LNs (group 2), and 7,677 (62.8%) with distant metastases (group 3). Women in group 1 were older compared to those in group 2 (median age 63 vs 59 years, P b 0.001) and had smaller tumors (median size 7 vs 9 cm, P b 0.001). Five-year OS for women in group 1 was 46.3% compared to 44.9% for those in group 2 (P = 0.4) and 25.8% for those in group 3 (P b 0.001). Similarly, 5-year CSS for women in group 1 was 50.4% compared to 48.9% for those in group 2 (P = 0.3) and 27.9% for those in group 3 (P b 0.001). After controlling for age (b65 vs ≥65 years), race (white vs non-white), and histology (serous vs nonserous), group 1 was associated with better overall (HR = 0.51, 95% CI 0.4–0.66) and cancer-specific (HR = 0.48, 95% CI 0.36–0.63) mortality compared to group 3 but not compared to group 2. Conclusion: Ovarian cancer patients with inguinal LN metastases have similar survival as those with pelvic and paraaortic node involvement and improved survival compared with those harboring distant metastases. Our findings do not support the reclassification of these patients as stage IVB.

proportion of SM in the low-density range (HU −29 to 0) decreased following NACT (P = 0.029) but was unchanged with surgery. BMI and SM following NACT were significantly associated with CGR (OR = 0.926 and 0.990, respectively). When patients were stratified by BMI (Table 1), the significant association of SM to CGR was limited to patients with BMI b25 kg/m2 (P = 0.007). Conclusion: This is the first study to quantify changes in body composition over the course of ovarian cancer treatment. The results show that NACT reduces SM and increases SMD. Surprisingly, patients with a BMI b25 kg/m2 were more likely to achieve CGR if they had less SM.

doi:10.1016/j.ygyno.2017.03.242

*P values obtained using Wilcoxon-Rank Sum test.

215 - Poster Session The effects of neoadjuvant chemotherapy and interval debulking surgery on body composition in patients with advanced ovarian cancer M.D. Goncalvesa,b, J. Vitarellob, Q. Zhoub, A. Iasonosb, D. Halpennyb, J.J. Muellerb, O. Zivanovicb, K.A. Cadooa, J. Konnerb. aWeill Cornell Medical College, New York, NY, USA, bMemorial Sloan Kettering Cancer Center, New York, NY, USA Objective: The aim of this study was to quantify changes in body composition during ovarian cancer treatment and relate these changes to achieving complete gross resection (CGR). Method: At 3 time points over the course of treatment, lumbar skeletal muscle volume (SM), skeletal muscle density (SMD), visceral adipose tissue volume (VAT), and subcutaneous adipose tissue volume (SAT) were measured in a cohort of 102 patients with advanced-stage ovarian cancer undergoing neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS) at our institution from 2008 to 2013. SM, SMD, VAT, and SAT were obtained from routine computed tomography images done at the time of diagnosis, following NACT, and following IDS. These variables were compared using the Wilcoxon rank sum test. SM at diagnosis and following NACT were compared to achieving CGR using logistic regression. Results: The median SM, VAT, and SAT at diagnosis were 353 cm3 (range 197–497), 232 cm3 (range 13–982), and 554 cm3 (range 75– 1,564). SM was significantly reduced to 335 cm3 (range 233–473) following NACT (P b 0.001), whereas the VAT and SAT were unchanged. VAT was reduced from 212 cm3 (range 11–933) to 176 cm3 (range 25–878) following the omentectomy performed during IDS (P b 0.001), whereas SM and SAT were unchanged. The

Table 1 Relationship between Muscle Volume and Complete Gross Resection by Body Mass Index. BMI b 25 (N = 44) Following NACT

CGR

Any Residual

p-value*

Muscle Volume Median(Mean) Range

309 (306.7) 241 - 377

336 (342.7) 298 - 473

0.007

Following NACT

CGR

Any Residual

p-value*

Muscle Volume Median(Mean) Range

327 (330.9) 266 - 420

321 (337.1) 233 - 471

1

Following NACT

CGR

Any Residual

p-value*

Muscle Volume Median(Mean) Range

371 (377.5) 291 - 461

397 (392.9) 325 - 448

0.396

BMI:25-30 (N =31)

BMI N=30(N =27)

doi:10.1016/j.ygyno.2017.03.243

216 - Poster Session Decreasing levels of BMI1 as a therapeutic approach in endometrial cancer M.E. Buechela, A.K. Crima, A. Deya, S.K. Dwivedia, S. Banerjee Mustafia, R. Bhattacharyab. aThe University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA, bThe University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK, USA Objective: Endometrial cancer is the most common gynecologic malignancy, with rising incidences in developed countries. While surgery provides significant survival benefit to early-stage patients, those with recurrent metastatic disease have dismal prognosis. There is emerging knowledge of molecular alterations such as PI3K pathway and KRAS mutations. While targeting KRAS has been difficult, targeting PI3K has not proven to be very effective. Hence there is a critical need to identify novel therapeutic targets. BMI1, a member of the polycomb repressor complex-1, regulates chromatin structure and is indispensable for self-renewal of both normal and cancer stem cells. BMI1 is frequently upregulated, and its expression correlates with poor prognosis in several types of cancer making it a promising target for therapeutics. We seek to determine the clinical significance of BMI1 in endometrial cancer with an effort to develop it as a potential therapeutic target. Method: Using endometrial cancer cell lines that represent type I and type II disease and patient tissue microarray, we are investigating the association of BMI1 with clinicopathologic variables. Standardized cell-based assays of viability, invasion, clonal growth,