Stephanie A Scott1, Marta Llaurado Fernandez2, Hannah Kim2, Laurie Elit3, Melica Nourmoussavi4, Sarah Glaze5, Lesley Roberts6, Saul L Offman6, Kurosh Rahimi7, Alice Lytwyn8, Monalisa Sur9, C Blake Gilks2, Kara Matheson6, Martin Köbel10, Amy Dawson2, Anna V Tinker2, Janice S Kwon2, Paul Hoskins2, Jennifer L Santos2, Andrea Cheung2, Diane Provencher4, Mark S Carey2. 1. Department of Obstetrics and Gynecology, Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: StephanieA.scott@nshealth.ca. 2. Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada. 3. Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada. 4. Division of Gynecologic-Oncology, Centre Hospitalier de Université de Montréal, (CHUM) and Centre de recherche du CHUM, Montreal, Quebec, Canada. 5. Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada. 6. Department of Obstetrics and Gynecology, Dalhousie University, Halifax, Nova Scotia, Canada. 7. Department of Pathology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada. 8. Department of Pathology and Molecular Medicine, Health Research Methods, Evaluation, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada. 9. Department of Pathology and Molecular Medicine, McMaster University and The Juravinski Hospital and Cancer Centre, Hamilton, Ontario, Canada. 10. Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada.
Abstract
OBJECTIVE: Patients with advanced low-grade serous carcinoma (LGSC) have poor long-term survival rates. As a rare histotype, there are uncertainties regarding the use of current therapies. Thus, we studied practice patterns and treatment outcomes as part of a national initiative to better understand and improve the care of women with advanced LGSC. METHODS: This retrospective cohort study was conducted in 5 Canadian referral institutions from 2000 to 2016. Data collection and pathology reporting were standardized. Outcome measures included overall survival (OS), progression-free survival (PFS), progression-free intervals (PFI), and time to next treatment (TTNT). Cox regression analysis was used to evaluate the effects of clinical and pathologic factors on outcomes and prognosis. RESULTS: There were 134 patients (stage II-IV) with a median follow-up of 32.4 months (range 1.6-228). Four primary treatments were compared across institutions: 1) surgery followed by chemotherapy (56%), 2) neoadjuvant chemotherapy (NACT) followed by surgery (27%), 3) surgery alone (9%), and 4) surgery followed by anti-hormone therapy (4%). Primary platinum/paclitaxel chemotherapy was used in 81%. Patients treated with NACT had worse PFS. Multivariable Cox regression analysis identified lesser residual disease, younger age, and primary peritoneal origin as variables significantly associated with better OS/PFS (p < 0.03). One institution had significantly better PFS than the others (p = 0.025), but this finding could be related to a higher frequency of primary peritoneal LGSC. PFI and TTNT intervals in patients with relapsed disease were not significantly different after the first relapse irrespective of treatment type. CONCLUSIONS: There are notable differences in practice patterns across Canada. This underscores the need for ongoing strategies to measure, evaluate and achieve optimal patient outcomes for women with advanced LGSC.
OBJECTIVE:Patients with advanced low-grade serous carcinoma (LGSC) have poor long-term survival rates. As a rare histotype, there are uncertainties regarding the use of current therapies. Thus, we studied practice patterns and treatment outcomes as part of a national initiative to better understand and improve the care of women with advanced LGSC. METHODS: This retrospective cohort study was conducted in 5 Canadian referral institutions from 2000 to 2016. Data collection and pathology reporting were standardized. Outcome measures included overall survival (OS), progression-free survival (PFS), progression-free intervals (PFI), and time to next treatment (TTNT). Cox regression analysis was used to evaluate the effects of clinical and pathologic factors on outcomes and prognosis. RESULTS: There were 134 patients (stage II-IV) with a median follow-up of 32.4 months (range 1.6-228). Four primary treatments were compared across institutions: 1) surgery followed by chemotherapy (56%), 2) neoadjuvant chemotherapy (NACT) followed by surgery (27%), 3) surgery alone (9%), and 4) surgery followed by anti-hormone therapy (4%). Primary platinum/paclitaxel chemotherapy was used in 81%. Patients treated with NACT had worse PFS. Multivariable Cox regression analysis identified lesser residual disease, younger age, and primary peritoneal origin as variables significantly associated with better OS/PFS (p < 0.03). One institution had significantly better PFS than the others (p = 0.025), but this finding could be related to a higher frequency of primary peritoneal LGSC. PFI and TTNT intervals in patients with relapsed disease were not significantly different after the first relapse irrespective of treatment type. CONCLUSIONS: There are notable differences in practice patterns across Canada. This underscores the need for ongoing strategies to measure, evaluate and achieve optimal patient outcomes for women with advanced LGSC.