Distal pancreatectomy with splenectomy for the management of splenic hilum metastasis in cytoreductive surgery of epithelial ovarian cancer

Libing Xiang,Yunxia Tu,Tiancong He,Xuxia Shen,Ziting Li,Xiaohua Wu,Huijuan Yang 대한부인종양학회 2016 Journal of Gynecologic Oncology Vol.27 No.6

Objective: Distal pancreatectomy with splenectomy may be required for optimalcytoreductive surgery in patients with epithelial ovarian cancer (EOC) metastasized tosplenic hilum. This study evaluates the morbidity and treatment outcomes of the uncommonprocedure in the management of advanced or recurrent EOC. Methods: This study recruited 18 patients who underwent distal pancreatectomy withsplenectomy during cytoreductive surgery of EOC. Their clinicopathological characteristicsand follow-up data were retrospectively analyzed. Results: All tumors were confirmed as high-grade serous carcinomas. The mediandiameter of metastatic tumors located in splenic hilum was 3.5 cm (range, 1 to 10 cm). Optimal cytoreduction was achieved in all patients. Eight patients (44.4%) sufferedfrom postoperative complications. The morbidity associated with distal pancreatectomyand splenectomy included pancreatic leakage (22.2%), encapsulated effusion in theleft upper quadrant (11.1%), intra-abdominal infection (11.1%), pleural effusion withor without pulmonary atelectasis (11.1%), intestinal obstruction (5.6%), pneumonia(5.6%), postoperative hemorrhage (5.6%), and pancreatic pseudocyst (5.6%). Therewas no perioperative mortality. The majority of complications were treated successfullywith conservative management. During the median follow-up duration of 25 months,nine patients experienced recurrence, and three patients died of the disease. The 2-yearprogression-free survival and overall survival were 40.2% and 84.8%, respectively. Conclusion: The inclusion of distal pancreatectomy with splenectomy as part ofcytoreduction for the management of ovarian cancer was associated with high morbidity;however, the majority of complications could be managed with conservative therapy.

Mutational analysis of KRAS and its clinical implications in cervical cancer patients

Wei Jiang,Libing Xiang,Xuan Pei,Tiancong He,Xuxia Shen,Xiaohua Wu,Huijuan Yang 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.1

Objective: The predictive and prognostic role of KRAS mutations in cervical cancer remainsinconclusive. The aim of this study was to explore the clinicopathological and prognosticrelevance of KRAS mutations in invasive cervical cancers (ICC). Methods: Reverse transcription polymerase chain reaction (PCR) and Sanger sequencingwere employed to detect KRAS mutations in 876 ICC patients. Quantitative real-time PCR wasused to detect human papillomavirus (HPV) 16 and HPV 18. Results: Non-synonymous mutations of KRAS were identified in 30 (3.4%) patients. Thesemutations were more common in non-squamous cell carcinoma than in squamous cellcarcinoma (SCC) (8.2% vs. 2.2%, respectively, p<0.001) and were associated with HPV 18infection (p=0.003). The prevalence of mutations was highest (18.2%) in the uncommonhistological subtypes followed by adenocarcinoma (AC, 7.3%) and adenosquamouscarcinoma (ASC, 5.8%). During the median follow-up of 55 months, compared to patientswith wild-type KRAS, a greater percentage of patients with mutant KRAS relapsed (20.0%vs. 42.9%, respectively, p=0.007). The 3-year relapse-free survival was poorer in patientswith mutant KRAS than in patients without KRAS mutations (57.1% vs. 81.9%, respectively,p=0.001). Furthermore, the multivariate analysis showed that the presence of a KRASmutation was an independent predictor for disease recurrence (hazard ratio [HR]=2.064;95% confidence interval [CI]=1.125–3.787; p=0.019). Conclusion: KRAS mutations were predominant in non-SCCs of the cervix and wereassociated with HPV 18 infection. A combination of KRAS mutation detection andHPV genotyping would be useful in identifying patient with poor prognosis for furtherinterventions.

Addendum: A phase II trial of cytoreductive surgery combined with niraparib maintenance in platinum- sensitive, secondary recurrent ovarian cancer: SGOG SOC-3 study

Ting-Yan Shi,Libing Xiang,Jianqing Zhu,Ji-hong Liu,Ping Zhang,Hua-ying Wang,Yanling Feng,Tao Zhu,Yingli Zhang,Aijun Yu,Wei Jiang,Xipeng Wang,Yaping Zhu,Sufang Wu,Yincheng Teng,Jiejie Zhang,Rong Jiang 대한부인종양학회 2022 Journal of Gynecologic Oncology Vol.33 No.4

A phase II trial of cytoreductive surgery combined with niraparib maintenance in platinum-sensitive, secondary recurrent ovarian cancer: SGOG SOC-3 study

Ting-Yan Shi,Sheng Yin,Jianqing Zhu,Ping Zhang,Jihong Liu,Libing Xiang,Yaping Zhu,Sufang Wu,Xiaojun Chen,Xipeng Wang,Yin-Cheng Teng,Tao Zhu,Aijun Yu,Yingli Zhang,Yanling Feng,He Huang,Wei Bao,Yanli Li 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.3

Background: In China, secondary cytoreductive surgery (SCR) has been widely used in ovarian cancer (OC) over the past two decades. Although Gynecologic Oncology Group-0213 trial did not show its overall survival benefit in first relapsed patients, the questions on patient selection and effect of subsequent targeting therapy are still open. The preliminary data from our pre-SOC1 phase II study showed that selected patients with second relapse who never received SCR at recurrence may still benefit from surgery. Moreover, poly(ADP-ribose) polymerase inhibitors (PARPi) maintenance now has been a standard care for platinum sensitive relapsed OC. To our knowledge, no published or ongoing trial is trying to answer the question if patient can benefit from a potentially complete resection combined with PARPi maintenance in OC patients with secondary recurrence. Methods: SOC-3 is a multi-center, open, randomized, controlled, phase II trial of SCR followed by chemotherapy and niraparib maintenance vs chemotherapy and niraparib maintenance in patients with platinum-sensitive second relapsed OC who never received SCR at recurrence. To guarantee surgical quality, if the sites had no experience of participating in any OC-related surgical trials, the number of recurrent lesions evaluated by central-reviewed positron emission tomography–computed tomography image shouldn't be more than 3. Eligible patients are randomly assigned in a 1:1 ratio to receive either SCR followed by 6 cycles of platinum-based chemotherapy and niraparib maintenance or 6 cycles of platinum-based chemotherapy and niraparib maintenance alone. Patients who undergo at least 4 cycles of chemotherapy and must be, in the opinion of the investigator, without disease progression, will be assigned niraparib maintenance. Major inclusion criteria are secondary relapsed OC with a platinum-free interval of no less than 6 months and a possibly complete resection. Major exclusion criteria are borderline tumors and non-epithelial ovarian malignancies, received debulking surgery at recurrence and impossible to complete resection. The sample size is 96 patients. Primary endpoint is 12-month non-progression rate. Trial Registration: ClinicalTrials.gov Identifier: NCT03983226

A prospective randomized multicenter trial for lymphadenectomy in early- stage ovarian cancer: LOVE study

Ting Deng,Kaijiang Liu,Liang Chen,Xiao-jun Chen,Hua Wen Li,Hongyan Guo,Huijiao Zhang,Libing Xiang,Xin Feng,Xiaoyu Wang,Hextan Y. S. Ngan,Jianguo Zhao,Dongling Zou,Qing Liu,Jihong Liu 대한부인종양학회 2023 Journal of Gynecologic Oncology Vol.34 No.3

Background: The Lymphadenectomy in Ovarian Neoplasms (LION) study revealed that systemic lymphadenectomy did not bring survival benefit for advanced ovarian cancer patients with clinically normal lymph nodes and was associated with a higher incidence of operative complications. However, there is no consensus on whether lymphadenectomy has survival benefit or not in early epithelial ovarian cancer (EOC). Methods: We designed the LOVE study, a multicenter, randomized controlled, phase III trial to compare the efficacy and safety of comprehensive staging surgery with or without lymphadenectomy in stages IA-IIB EOC and fallopian tube carcinomas (FTC). The hypothesis is that the oncological outcomes provided by comprehensive staging surgery without lymphadenectomy are non-inferior to those of conventional completion staging surgery in early-stage EOC and FTC patients who have indications for post-operative adjuvant chemotherapy. Patients assigned to experimental group will undergo comprehensive staging surgery, but lymphadenectomy. Patients assigned to comparative group will undergo completion staging surgery including systematic pelvic and para-aortic lymphadenectomy. All subjects will receive 3–6 cycles of standard adjuvant chemotherapy. Major inclusion criteria are pathologic confirmed stage IA-IIB EOC or FTC, and patients have indications for adjuvant chemotherapy either confirmed by intraoperative fast frozen section or previous pathology after an incomplete staging surgery. Major exclusion criteria are non-epithelial tumors and low-grade serous carcinoma. Patients with severe rectum involvement which lead to partial rectum resection will be excluded. The sample size is 656 subjects. Primary endpoint is disease-free survival.