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Intraoperative Capsule Rupture, Postoperative Chemotherapy, and Survival of Women With Stage I Epithelial Ovarian Cancer

To examine the incidence and prognostic effects of intraoperative capsule rupture and to assess the effectiveness of postoperative chemotherapy for intraoperative tumor rupture in apparent stage I epithelial ovarian cancer. METHODS: This is a society-based retrospective observational study in Japan...

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Autores principales: Matsuo, Koji, Machida, Hiroko, Yamagami, Wataru, Ebina, Yasuhiko, Kobayashi, Yoichi, Tabata, Tsutomu, Kaneuchi, Masanori, Nagase, Satoru, Enomoto, Takayuki, Mikami, Mikio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6818978/
https://www.ncbi.nlm.nih.gov/pubmed/31599824
http://dx.doi.org/10.1097/AOG.0000000000003507
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author Matsuo, Koji
Machida, Hiroko
Yamagami, Wataru
Ebina, Yasuhiko
Kobayashi, Yoichi
Tabata, Tsutomu
Kaneuchi, Masanori
Nagase, Satoru
Enomoto, Takayuki
Mikami, Mikio
author_facet Matsuo, Koji
Machida, Hiroko
Yamagami, Wataru
Ebina, Yasuhiko
Kobayashi, Yoichi
Tabata, Tsutomu
Kaneuchi, Masanori
Nagase, Satoru
Enomoto, Takayuki
Mikami, Mikio
author_sort Matsuo, Koji
collection PubMed
description To examine the incidence and prognostic effects of intraoperative capsule rupture and to assess the effectiveness of postoperative chemotherapy for intraoperative tumor rupture in apparent stage I epithelial ovarian cancer. METHODS: This is a society-based retrospective observational study in Japan that examined 15,163 women with stage IA-IC1 epithelial ovarian cancer who underwent primary surgical treatment between 2002 and 2015. Associations between intraoperative capsule rupture and cause-specific survival, and between postoperative chemotherapy and cause-specific survival among intraoperatively ruptured cases were examined by histology type (clear cell n=6,107, endometrioid n=3,910, mucinous n=3,382, and serous n=1,764). RESULTS: Clear cell histology had the highest risk of intraoperative capsule rupture (57.3%), followed by endometrioid (48.8%), serous (41.8%), and mucinous (32.0%) histologies (P<.001). On multivariable analysis, clear cell type exhibited the largest effect of intraoperative capsule rupture on cause-specific survival (adjusted hazard ratio [HR] 1.99, 95% CI 1.45–2.75), followed by serous (adjusted HR, 1.61, 95% CI 0.84–3.11), mucinous (adjusted HR 1.28, 95% CI 0.79–2.09), and endometrioid (adjusted HR, 1.14, 95% CI 0.64–2.01) tumors. Postoperative chemotherapy for intraoperatively ruptured cases did not improve cause-specific survival in any histologic types in multivariable analysis: clear cell, adjusted HR 0.86, 95% CI 0.56–1.31; serous, adjusted HR 1.08, 95% CI 0.42–2.74; mucinous, adjusted HR 1.11, 95% CI 0.55–2.27; and endometrioid, adjusted HR 2.81, 95% CI 0.85–9.30 (all, P>.05). In the cohort-level analysis of ruptured cases (n=7,227), postoperative chemotherapy use has significantly decreased in mucinous (16.3% relative decrease), endometrioid (13.1% relative decrease), and clear cell (9.3% relative decrease) (all, P<.05); but, the cohort-level 5-year cause-specific survival rate did not change over time (all, P>.05). CONCLUSION: Among apparent stage I epithelial ovarian cancer, the clear cell type possesses a disproportionally high risk of capsule rupture during adnexectomy and is associated with the most adverse effect on survival. A decrease in the use of postoperative chemotherapy for intraoperatively ruptured cases in Japan is likely the result of increasing awareness of the absence of survival benefits.
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spelling pubmed-68189782019-11-26 Intraoperative Capsule Rupture, Postoperative Chemotherapy, and Survival of Women With Stage I Epithelial Ovarian Cancer Matsuo, Koji Machida, Hiroko Yamagami, Wataru Ebina, Yasuhiko Kobayashi, Yoichi Tabata, Tsutomu Kaneuchi, Masanori Nagase, Satoru Enomoto, Takayuki Mikami, Mikio Obstet Gynecol Contents To examine the incidence and prognostic effects of intraoperative capsule rupture and to assess the effectiveness of postoperative chemotherapy for intraoperative tumor rupture in apparent stage I epithelial ovarian cancer. METHODS: This is a society-based retrospective observational study in Japan that examined 15,163 women with stage IA-IC1 epithelial ovarian cancer who underwent primary surgical treatment between 2002 and 2015. Associations between intraoperative capsule rupture and cause-specific survival, and between postoperative chemotherapy and cause-specific survival among intraoperatively ruptured cases were examined by histology type (clear cell n=6,107, endometrioid n=3,910, mucinous n=3,382, and serous n=1,764). RESULTS: Clear cell histology had the highest risk of intraoperative capsule rupture (57.3%), followed by endometrioid (48.8%), serous (41.8%), and mucinous (32.0%) histologies (P<.001). On multivariable analysis, clear cell type exhibited the largest effect of intraoperative capsule rupture on cause-specific survival (adjusted hazard ratio [HR] 1.99, 95% CI 1.45–2.75), followed by serous (adjusted HR, 1.61, 95% CI 0.84–3.11), mucinous (adjusted HR 1.28, 95% CI 0.79–2.09), and endometrioid (adjusted HR, 1.14, 95% CI 0.64–2.01) tumors. Postoperative chemotherapy for intraoperatively ruptured cases did not improve cause-specific survival in any histologic types in multivariable analysis: clear cell, adjusted HR 0.86, 95% CI 0.56–1.31; serous, adjusted HR 1.08, 95% CI 0.42–2.74; mucinous, adjusted HR 1.11, 95% CI 0.55–2.27; and endometrioid, adjusted HR 2.81, 95% CI 0.85–9.30 (all, P>.05). In the cohort-level analysis of ruptured cases (n=7,227), postoperative chemotherapy use has significantly decreased in mucinous (16.3% relative decrease), endometrioid (13.1% relative decrease), and clear cell (9.3% relative decrease) (all, P<.05); but, the cohort-level 5-year cause-specific survival rate did not change over time (all, P>.05). CONCLUSION: Among apparent stage I epithelial ovarian cancer, the clear cell type possesses a disproportionally high risk of capsule rupture during adnexectomy and is associated with the most adverse effect on survival. A decrease in the use of postoperative chemotherapy for intraoperatively ruptured cases in Japan is likely the result of increasing awareness of the absence of survival benefits. Lippincott Williams & Wilkins 2019-11 2019-10-10 /pmc/articles/PMC6818978/ /pubmed/31599824 http://dx.doi.org/10.1097/AOG.0000000000003507 Text en © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Contents
Matsuo, Koji
Machida, Hiroko
Yamagami, Wataru
Ebina, Yasuhiko
Kobayashi, Yoichi
Tabata, Tsutomu
Kaneuchi, Masanori
Nagase, Satoru
Enomoto, Takayuki
Mikami, Mikio
Intraoperative Capsule Rupture, Postoperative Chemotherapy, and Survival of Women With Stage I Epithelial Ovarian Cancer
title Intraoperative Capsule Rupture, Postoperative Chemotherapy, and Survival of Women With Stage I Epithelial Ovarian Cancer
title_full Intraoperative Capsule Rupture, Postoperative Chemotherapy, and Survival of Women With Stage I Epithelial Ovarian Cancer
title_fullStr Intraoperative Capsule Rupture, Postoperative Chemotherapy, and Survival of Women With Stage I Epithelial Ovarian Cancer
title_full_unstemmed Intraoperative Capsule Rupture, Postoperative Chemotherapy, and Survival of Women With Stage I Epithelial Ovarian Cancer
title_short Intraoperative Capsule Rupture, Postoperative Chemotherapy, and Survival of Women With Stage I Epithelial Ovarian Cancer
title_sort intraoperative capsule rupture, postoperative chemotherapy, and survival of women with stage i epithelial ovarian cancer
topic Contents
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6818978/
https://www.ncbi.nlm.nih.gov/pubmed/31599824
http://dx.doi.org/10.1097/AOG.0000000000003507
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