Treatment results for patients with low grade ovarian cancer

Objective: to analyze treatment outcomes in patients with low-grade ovarian cancer (OC) of all stages and evaluate factors affecting overall survival (OS) and progression-free survival (PFS).
Materials and methods. A retrospective analysis of 57 patients with low-grade OC was performed at the N. N. Blokhin National Medical Research Center of Oncology from 2018 to 2023. The primary endpoint was disease-free survival (DFS) and overall survival (OS). The secondary endpoint was assessment of survival-affecting factors. Statistical analysis included descriptive statistics and survival analysis.
Results. Early-stage disease was diagnosed in 17 patients (29.9 %), advanced stage in 40 patients (70.1 %). In advanced stages, regional lymph node involvement was observed in 27.5 % of cases. Primary debulking surgery was performed in 28 patients (70 %), interval debulking surgery in 12 patients (30 %). Regarding the completeness of cytoreduction, primary complete resection was achieved in 21 (75 %) of cases, and optimal resection in 6 (21.4 %), suboptimal – 1 (3,6 %) case. In the interval debulking surgery, complete resection was achieved in 5 (41.7 %) of cases, and optimal removal in 4 (33.3 %), while 2 patients (16.7 %) underwent suboptimal surgery and 1 patient (8.3 %) underwent exploratory laparotomy. The PCI score for primary complete surgery was 7.5 points, for optimal surgery – 11.5 points. For complete interval surgery, the PCI was 8 points, for optimal interval surgery – 13 points. In the early-stage ovarian cancer (OC) group, 3-year OS and DFS were 100 % with a median follow-up of 30.4 months (12–57 months). In the advanced stage low-grade OC, 3-year OS was 100 % in patients who underwent primary cytoreductive surgery, while in the interval cytoreduction group it was 66.7 % with a median follow-up of 35.5 months (3–72 months). Primary debulking surgery significantly improved overall survival rates. The overall recurrence rate was 40 % (n=16), with a recurrence rate of 25 % (n=7) in the primary debulking surgery group and 75 % (n=9) in the interval debulking surgery group. The mean time to recurrence was 11.6 (3–34) months, with a median follow-up of 35.5 (3–68) months. The progression-free survival (PFS) was 72.8 % in the primary debulking surgery group and 17.5 % in the interval debulking surgery group.
Conclusion. Our data confirm that in patients with low-grade serous OC, complete debulking surgery correlates with improved PFS and OS. However, primary debulking surgery compared to interval debulking surgery, demonstrates significantly better oncological outcomes. Patients with low grade OC should receive surgical treatment in an oncology center with a high level of surgical care and the possibility of involving surgeons from other specialties.

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