Systematic lymph node dissection during interval debulking surgery for advanced epithelial ovarian cancer: a systematic review and meta-analysis

Giuseppe Caruso,Innocenza Palaia,Giorgio Bogani,Federica Tomao,Giorgia Perniola,Pierluigi Benedetti Panici,Ludovico Muzii,Violante Di Donato 대한부인종양학회 2022 Journal of Gynecologic Oncology Vol.33 No.5

Objective: To evaluate the efficacy and safety of systematic lymph node dissection (SyLND) at the time of interval debulking surgery (IDS) for advanced epithelial ovarian cancer (AEOC). Methods: Systematic literature review of studies including AEOC patients undergoing SyLND versus selective lymph node dissection (SeLND) or no lymph node dissection (NoLND) after neoadjuvant chemotherapy (NACT). Primary endpoints included progression-free survival (PFS) and overall survival (OS). Secondary endpoints included severe postoperative complications, lymphocele, lymphedema, blood loss, blood transfusions, operative time, and hospital stay. Results: Nine retrospective studies met the eligibility criteria, involving a total of 1,660 patients: 827 (49.8%) SyLND, 490 (29.5%) SeLND, and 343 (20.7%) NoLND. The pooled estimated hazard ratios (HR) for PFS and OS were, respectively, 0.88 (95% confidence interval [CI]=0.65–1.20; p=0.43) and 0.80 (95% CI=0.50–1.30; p=0.37). The pooled estimated odds ratios (ORs) for severe postoperative complications, lymphocele, lymphedema, and blood transfusions were, respectively, 1.83 (95% CI=1.19–2.82; p=0.006), 3.38 (95% CI=1.71– 6.70; p<0.001), 7.23 (95% CI=3.40–15.36; p<0.0001), and 1.22 (95% CI=0.50–2.96; p=0.67). Conclusion: Despite the heterogeneity in the study designs, SyLND after NACT failed to demonstrate a significant improvement in PFS and OS and resulted in a higher risk of severe postoperative complications.

Impact of COVID-19 in gynecologic oncology: a Nationwide Italian Survey of the SIGO and MITO groups

Giorgio Bogani,Giovanni Apolone,Antonino Ditto,Giovanni Scambia,Pierluigi Benedetti Panici,Roberto Angioli,Sandro Pignata,Stefano Greggi,Paolo Scollo,Mezzanzanica Delia,Massimo Franchi,Fabio Martinell 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.6

Objective: Coronavirus disease 2019 (COVID-19) has caused rapid and drastic changesin cancer management. The Italian Society of Gynecology and Obstetrics (SIGO), andthe Multicenter Italian Trials in Ovarian cancer and gynecologic malignancies (MITO)promoted a national survey aiming to evaluate the impact of COVID-19 on clinical activity ofgynecologist oncologists and to assess the implementation of containment measures againstCOVID-19 diffusion. Methods: The survey consisted of a self-administered, anonymous, online questionnaire. The survey was sent via email to all the members of the SIGO, and MITO groups on April 7, 2020,and was closed on April 20, 2020. Results: Overall, 604 participants completed the questionnaire with a response-rate of70%. The results of this survey suggest that gynecologic oncology units had set a proactiveapproach to COVID-19 outbreak. Triage methods were adopted in order to minimizein-hospital diffusion of COVID-19. Only 38% of gynecologic surgeons were concernedabout COVID-19 outbreak. Although 73% of the participants stated that COVID-19 hasnot significantly modified their everyday practice, 21% declared a decrease of the use oflaparoscopy in favor of open surgery (19%). However, less than 50% of surgeons adoptedspecific protection against COVID-19. Additionally, responders suggested to delay cancertreatment (10%–15%), and to perform less radical surgical procedures (20%–25%) duringCOVID-19 pandemic. Conclusions: National guidelines should be implemented to further promote the safety ofpatients and health care providers. International cooperation is of paramount importance,as heavily affected nations can serve as an example to find out ways to safely preserve clinicalactivity during the COVID-19 outbreak.

Tumor Infiltrating Lymphocytes in Ovarian Cancer

Gasparri, Maria Luisa,Attar, Rukset,Palaia, Innocenza,Perniola, Giorgia,Marchetti, Claudia,Donato, Violante Di,Farooqi, Ammad Ahmad,Papadia, Andrea,Panici, Pierluigi Benedetti Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.9

Several improvements in ovarian cancer treatment have been achieved in recent years, both in surgery and in combination chemotherapy with targeting. However, ovarian tumors remain the women's cancers with highest mortality rates. In this scenario, a pivotal role has been endorsed to the immunological environment and to the immunological mechanisms involved in ovarian cancer behavior. Recent evidence suggests a loss of the critical balance between immune-activating and immune-suppressing mechanisms when oncogenesis and cancer progression occur. Ovarian cancer generates a mechanism to escape the immune system by producing a highly suppressive environment. Immune-activated tumor infiltrating lymphocytes (TILs) in ovarian tumor tissue testify that the immune system is the trigger in this neoplasm. The TIL mileau has been demonstrated to be associated with better prognosis, more chemosensitivity, and more cases of optimal residual tumor achieved during primary cytoreduction. Nowadays, scientists are focusing attention on new immunologically effective tumor biomarkers in order to optimize selection of patients for recruitment in clinical trials and to identify relationships of these biomarkers with responses to immunotherapeutics. Assessing this point of view, TILs might be considered as a potent predictive immunotherapy biomarker.

The age-adjusted Charlson comorbidity index as a predictor of survival in surgically treated vulvar cancer patients

Violante Di Donato,Zoe Page,Carlotta Bracchi,Federica Tomao,Angela Musella,Giorgia Perniola,PierLuigi Benedetti Panici 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.1

Objective: To evaluate the impact of age-adjusted Charlson comorbidity index (ACCI) in predicting disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS) among surgically treated patients with vulvar carcinoma. The secondary aim is to evaluate its impact as a predictor of the pattern of recurrence. Methods: We retrospectively evaluated data of patients that underwent surgical treatment for vulvar cancer from 1998 to 2016. ACCI at the time of primary surgery was evaluated and patients were classified as low (ACCI 0–1), intermediate (ACCI 2–3), and high risk (>3). DFS, OS and CSS were analyzed using the Kaplan-Meir and the Cox proportional hazard models. Logistic regression model was used to assess predictors of distant and local recurrence. Results: Seventy-eight patients were included in the study. Twelve were classified as low, 36 as intermediate, and 30 as high risk according to their ACCI. Using multivariate analysis, ACCI class was an independent predictor of worse DFS (hazard ratio [HR]=3.04; 95% confidence interval [CI]=1.54–5.99; p<0.001), OS (HR=5.25; 95% CI=1.63–16.89; p=0.005) and CSS (HR=3.79; 95% CI=1.13–12.78; p=0.03). Positive nodal status (odds ratio=8.46; 95% CI=2.13–33.58; p=0.002) was the only parameter correlated with distant recurrence at logistic regression. Conclusion: ACCI could be a useful tool in predicting prognosis in surgically treated vulvar cancer patients. Prospective multicenter trials assessing the role of ACCI in vulvar cancer patients are warranted.

Immunotherapy in endometrial cancer: new scenarios on the horizon

Chiara Di Tucci,Carmela Capone,Giulia Galati,Valentina Iacobelli,Michele C Schiavi,Violante Di Donato,Ludovico Muzii,Pierluigi Benedetti Panici 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.3

This extensive review summarizes clinical evidence on immunotherapy and targeted therapy currently available for endometrial cancer (EC) and reports the results of the clinical trials and ongoing studies. The research was carried out collecting preclinical and clinical findings using keywords such as immune environment, tumor infiltrating lymphocytes, programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1) expression, immune checkpoint inhibitors, anti-PD-1/PD-L1 antibodies and others' on PubMed. Finally, we looked for the ongoing immunotherapy trials on ClinicalTrials.gov. EC is the fourth most common malignancy in women in developed countries. Despite medical and surgical treatments, survival has not improved in the last decade and death rates have increased for uterine cancer in women. Therefore, identification of clinically significant prognostic risk factors and formulation of new rational therapeutic regimens have great significance for enhancing the survival rate and improving the outcome in patients with advanced or metastatic disease. The identification of genetic alterations, including somatic mutations and microsatellite instability, and the definition of intracellular signaling pathways alterations that have a major role in in tumorigenesis is leading to the development of new therapeutic options for immunotherapy and targeted therapy.

Survival Nomograms after Curative Neoadjuvant Chemotherapy and Radical Surgery for Stage IB2-IIIB Cervical Cancer

Claudia Marchetti,Francesca De Felice,Anna Di Pinto,Alessia Romito,Angela Musella,Innocenza Palaia,Marco Monti,Vincenzo Tombolini,Ludovico Muzii,PierLuigi Benedetti Panici 대한암학회 2018 Cancer Research and Treatment Vol.50 No.3

Purpose The purpose of this study was to develop nomograms for predicting the probability of overall survival (OS) and progression-free survival (PFS) in locally advanced cervical cancer treated with neoadjuvant chemotherapy and radical surgery. Materials and Methods Nomograms to predict the 5-year OS rates and the 2-year PFS rates were constructed. Calibration plots were constructed, and concordance indices were calculated. Evaluated variables were body mass index, age, tumor size, tumor histology, grading, lymphovascular space invasion, positive parametria, and positive lymph nodes. Results In total 245 patients with locally advanced cervical cancer who underwent neoadjuvant chemotherapy and radical surgery were included for the construction of the nomogram. The 5-year OS and PFS were 72.6% and 66%, respectively. Tumor size, grading, and parametria status affected the rate of OS, whereas tumor size and positive parametria were the main independent PFS prognostic factors. Conclusion We constructed a nomogram based on clinicopathological features in order to predict 2-year PFS and 5-year OS in locally advanced cervical cancer primarily treated with neoadjuvant chemotherapy followed by radical surgery. This tool might be particularly helpful for assisting in the follow-up of cervical cancer patients who have not undergone concurrent chemoradiotherapy.