Analysis of the Safety and Pregnant Outcomes of Fertility-Sparing Surgery in Ovarian Malignant Sex Cord-Stromal Tumors: A Multicenter Retrospective Study

Background: To assess the difference in survival between fertility-sparing surgery (FSS) and radical surgery (RS) and explore pregnant outcomes after FSS in stage I malignant sex cord-stromal tumors (MSCSTs).Methods: We performed a multicenter retrospective cohort study on patients who were diagnosed with stage IA or IC MSCSTs. Inverse Probability of Treatment Weighting was performed between the FSS and RS groups. The Chi-square test and Kaplan-Meier method were used to compare the categorical variables and disease-free survival (DFS). The binary logistic regression analysis and Cox proportional hazards regression analysis were used to identify high-risk factors related to DFS and pregnancy.Results: A total of 107 patients were included, of whom 54 (50.5%) women underwent FSS, and 53 (49.5%) women underwent RS. After IPTW, 208 patients were obtained, and all of the covariates were well balanced. After a median follow-up time of 50 months (range 7-156 months), there was no significant difference of DFS between the two groups in both unweighted cohort (P=0.969) or weighted cohort (P=0.792). In the weighted cohort, stage IC (P=0.014), tumor diameter >8 cm (P=0.003), incomplete staging surgery (P=0.003) and no adjuvant chemotherapy (P <0.001) were 4 high-risk factors associated with a shorter DFS. Among 14 patients who had pregnancy desire, 11 (78.6%) women conceived successfully, and the live birth rate was 76.9%. In univariate analysis, only adjuvant chemotherapy (P=0.009) was associated with infertility.Conclusions: On the premise of complete staging surgery, FSS is safe and feasible in stage IA and IC MSCSTs with satisfactory reproductive outcomes.

CLINICOPATHOLOGICAL STUDY OF OVARIAN NEOPLASMS – AN INSTITUTIONAL PERSPECTIVE

Objective: The objective of the study was to know the frequency and histomorphological patterns of ovarian neoplasms concerning age. Methods: A 2-year retrospective study was done in the pathology department, GITAM Institute of Medical Sciences and Research. Data were retrieved from laboratory records, H & E slides of ovarian biopsies of diagnosed neoplasms were screened. Results: During the study period, 70 ovarian neoplasms were reported. Ovarian tumors were categorized according to the WHO classification. In this study surface, epithelial tumors were most common at 87.14% followed by germ cell tumors at 11.42% and sex cord-stromal tumors at 1.42%. Serous cystadenoma was the most common benign surface epithelial tumor. Conclusion: Histopathology is the gold standard for diagnosing ovarian neoplasms. Newer diagnostic techniques such as immunohistochemistry and morphometric analysis help decide management and prognosis.

“Chronic fatigue, quality of life and long-term side-effects of chemotherapy in patients treated for non-epithelial ovarian cancer: national case-control protocol study of the GINECO-Vivrovaire rare tumors INCa French network for rare malignant ovarian tumors”

Background Germ cell tumors and sex cord stromal tumors are rare cancers of the ovary. They mainly affect young women and are associated with a high survival rate. The standard treatment mainly involves conservative surgery combined with chemotherapy [bleomycin, etoposide and cisplatin (BEP)] depending on the stage and the prognostic factors, as for testicular cancers. As reported in testicular cancer survivors, chemotherapy may induce sequelae impacting quality of life, which has not yet been evaluated in survivors of germ cell tumors and sex cord stromal tumors. The GINECO-VIVROVAIRE-Rare tumor study is a two-step investigation aiming to assess i) chronic fatigue and quality of life and ii) long-term side-effects of chemotherapy with a focus on cardiovascular and pulmonary disorders. Methods Using self-reported questionnaires, chronic fatigue and quality of life are compared between 134 ovarian cancer survivors (cancer-free ≥2 years after treatment) treated with surgery and chemotherapy and 2 control groups (67 ovarian cancer survivors treated with surgery alone and 67 age-matched healthy women). Medical data are collected from patient records. In the second step evaluating the long-term side-effects of chemotherapy, a subgroup of 90 patients treated with chemotherapy and 45 controls undergo the following work-up: cardiovascular evaluation (clinical examination, non-invasive cardiovascular tests to explore heart disease, blood tests), pulmonary function testing, audiogram, metabolic and hormonal blood tests. Costs of sequelae will be also assessed. Patients are selected from the registry of the INCa French Network for Rare Malignant Ovarian Tumors, and healthy women by the ‘Seintinelles’ connected network (collaborative research platform). Discussion This study will provide important data on the potential long-term physical side-effects of chemotherapy in survivors of Germ Cell Tumors (GCT) and Sex Cord Stromal Tumors (SCST), especially cardiovascular and pulmonary disorders, and neurotoxicity. The identification of long-term side-effects can contribute to adjusting the treatment of ovarian GCT or SCST patients and to managing follow-up with adapted recommendations regarding practices and chemotherapy regimens, in order to reduce toxicity while maintaining efficacy. Based on the results, intervention strategies could be proposed to improve the management of these patients during their treatment and in the long term. Trial registration This trial was registered at clinicaltrials.gov: 03418844, on 1 February 2018. This trial was registered on 25 October 2017 under the unique European identification number (ID-RCB): 2017-A03028–45. Recruitment Status: Recruiting. Protocol version Version n° 4.2 dated from Feb 19, 2021. Trial sponsor Centre François Baclesse, 3 avenue du Général Harris, F-14076 Caen cedex 05, France.

What’s new in gynecologic pathology 2021: ovary and fallopian tube

The 5th edition of the World Health Organization (WHO) Classification of Female Genital Tumors was published in 2020. Although the classification of ovarian and fallopian tube neoplasms is largely unchanged from the prior (4th) edition, this newsletter compiles the most important refinements in these organ sites, including serous and non-serous epithelial tumors, and sex cord-stromal tumors.

Association between Postoperative Adjuvant Chemotherapy and Disease-Specific Survival in Women with Ovarian Sex Cord-Stromal Tumors: A SEER-based Study

Background Ovarian sex cord-stromal tumors (SCSTs) are relatively rare tumor. The standard treatment is surgery, while adjuvant chemotherapy remains controversial. This study evaluated the effect of adjuvant chemotherapy and disease-specific survival (DSS) in patients with SCSTs.Methods 323 Patients with SCSTs were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. Demographic and clinicopathological characteristics were compared using Mann–Whitney U-test, Fisher’s exact test, and chi-square test. DSS were estimated by Kaplan–Meier and compared with the log-rank test. Cox proportional hazards model was used to control for confounders.Results A total of 323 patients were included in this study, and the mean age was 44 years (range, 10-89 years). The most common histologic subtype was granulosa cell tumor (GCT) (n=197, 61%). 60.7% were diagnosed with stage IA or IB disease and 18% with stage IC disease. Among them, 62.2% of patients (n=201) received chemotherapy. The Median follow-up time was 71 months (range,1-224 months). 12.7% (41/323) of patients experienced death. Patients who did not received chemotherapy (n=122) had better DSS compared to those who received chemotherapy, 5-year DSS rates were 93.5% VS 80.3% (P = 0.0005), 10-year DSS rates were 93.0% and 78.69% (P = 0.0002). Multiple Cox regression analysis showed that higher stage (p＜0.001), poor differentiation（P=0.24）, larger tumor size(size＞10cm) （P=0.018） were independently associated with an increased hazard of death，while histological subtype（P=0.082）,adjuvant chemotherapy(p=0.762), complete staging surgery（p=0.554）was not associated with prognosis.ConclusionChemotherapy could not improve the prognosis and may be associated with poorer DSS. Age, histopathologic subtype, complete staging surgery, lymphadenectomy are not associated with prognosis.

The effect of fertility-sparing surgery on sexuality and global quality of life in women with malignant ovarian germ cell and sex cord stromal tumors: an analysis of the CORSETT database of the AGO study group

Purpose Malignant ovarian germ cell (MOGCT) and sex cord stromal tumors (SCST) are ovarian neoplasms that affect disproportionally young women. Little is known about the impact of surgical and adjuvant management of these patient’s sexual life. This study investigated the effect of fertility-sparing surgery on sexual activity and global quality of life (gQoL) in women with MOGCT and SCST. Methods CORSETT was an observational, multicenter, mixed retrospective/prospective cohort study of the AGO study group. Women of any age who had been diagnosed with MOGCTs and SCSTs between 2001 and 2011 were asked to complete the Sexual Activity Questionnaire (SAQ) and the EORTC QLQ-C30. Results In total, 355 patients were included. Of these, 152 patients with confirmed histological diagnosis had completed the questionnaires. A total of 106 patients were diagnosed with SCST and 46 with MOGCT. Totally, 83 women (55%) were sexually active. After fertility-sparing surgery, patients had a 2.6 fold higher probability for being sexually active than after non-fertility-conserving treatment (unadjusted odds ratio (OR) 2.6, p = 0.01). After adjustment for age, time since diagnosis, FIGO stage, histology and phase of disease, the OR dropped to 1.8 (p = 0.22). Of the sexually active patients, 35 (42%) reported high levels of discomfort during intercourse; 38% after fertility-sparing; and 58% after non-fertility-sparing surgery (adjusted OR 2.8, p = 0.18). Women with fertility-conserving treatment reported a significantly better global QoL (Fadj 2.1, 6.2 points difference, p = 0.03) but not more pleasure during intercourse than women without fertility-sparing surgery (Fadj 0.4, p = 0.52). Conclusion Fertility preserving approaches should be offered to every patient, when oncologically acceptable.

Histomorphological Spectrum of Ovarian Masses in a Tertiary Centre of Eastern Nepal

Aims: To analyze the trends of ovarian masses in a tertiary centre in eastern Nepal. Methods: This was a retrospective cross sectional study conducted in Department of Pathology at Nobel Medical College and teaching hospital, Biratnagar, Nepal. Database of two years from April 2019 to April 2021 was searched. Gross and microscopic findings of cases including demographic details of patients with ovarian mass were analyzed and presented by descriptive parameters. Results: Out of 127 cases of ovarian masses studied, 95 (74.8%) were neoplastic. The common types were Germ cell tumors were (47; 37%), epithelial tumors (43; 33.9%) and endometriotic cyst (23; 18.1%). Mean age was 38.1 (range: 17-77) years in benign, 47.1 (30 – 70) years in malignant and 36.9 (21-53) years in non-neoplastic tumors; 11 cases were malignant and 63.6% were solid; and 23.8% of serous tumors were bilateral. Conclusions: Benign neoplastic lesions were the most common lesions and presented earlier than borderline and malignant lesions. Endometriotic cysts comprised the most common non- neoplastic lesions. The non-neoplastic lesions were predominantly cystic and the malignant lesions were predominantly solid. Most of the benign lesions were solid-cystic. Most mucinous tumors and all the sex-cord stromal tumors were unilateral while the seromucinous tumor and a significant number of serous tumors were bilateral.