Prognóza

Neoadjuvant chemotherapy

• Should be limited to those for whom
• Complete resection is judged impossible
• Are not candidates for extended surgery due to comorbidities
• Data suggest this approach should be used as much as possible, and in particular in patients with no residual disease after surgery.
• archive.cancerworld.net/impact-factor/can-advanced-stage-ovarian-cancer-be-cured/

• BRCA1 mutations
• Were less likely to achieve no residual disease status than patients without the mutation (Gynecol Oncol 2015)

• Patients harbouring tumours with decreased BRCA1 levels
• Obtain greater benefit from intraperitoneal chemotherapy (Br J Cancer 2013, 108:1231–37)

• Synergy seems to exist between intraperitoneal chemotherapy and no residual disease
• Offering the highest chance of leaving no cancer cells behind.

• Patients who achieve a status of no residual disease through primary debulking surgery have the best long-term survival rates (25–50%, or higher) of all patients with advanced-stage ovarian cancer
• Irrespective of stage at diagnosis, initial disease burden, surgical complexity, or mutation status.

• SCORPION trial, 45.5% of patients judged unresectable by staging laparoscopy
• Were subsequently resected to have no residual disease (Gynecol Oncol 2015, 138 Suppl. 1:1–4)
• archive.cancerworld.net/impact-factor/can-advanced-stage-ovarian-cancer-be-cured/

• Chemotherapy decreases re-cur–rence and death
• Does not reduce the eventual likelihood of death from ovarian cancer per se
• Once surgery is completed
• Patients seem fated to survive or die
• Regardless of the best efforts of oncologists, who can delay recurrence, but not prevent it.
• BRCA1 and BRACA2 status
• Predict short-term, but not long-term survival
• archive.cancerworld.net/impact-factor/can-advanced-stage-ovarian-cancer-be-cured/

CD8/CD4 T-REG BUŇKY a SERÓZNÍ OVARIÁLNÍ KARCINOM

• Ratios of CD8+ T cells to CD4+CD25+ FOXP3+ and FOXP3- T cells correlate with
• Poor clinical outcome in human serous ovarian cancer
• Preston CC. Plos 1, 2013

Skupina 52 pacientek s pokročilým stádiem serózního ovariálního karcinomu

• 31 pacientek mělo dobrou dobu přežití ( > 60 měsíců)
• 21 pacientek mělo krátkou dobu přežití (< 18 měsíců)
• Poměr efektorů/supresorů může být mnohem důležitější faktor než samotné počty lmfocytárních buněk
• U ovariálního karcinomu by tím pádem mohly být úspěšné imunoterapeutické strategie modifikující poměry CD4(+) / CD25(+) / FOXP3(+) T-reg buněk nebo CD4(+) / CD25(+) / FOXP3(-) T- buněk oproti efektorových CD8(+) buňkám.

Serous EOC patient samples to healthy tissues

• ER stress-related proteins ATF6, GRP78, and PERK
• Are signi?cantly expressed
• Suggesting that ER stress pathways play a role in EOC.
• Expression correlated with the tumor stage
• Play a role in EOC development
• Increasing levels of GRP78 and PDI
• Lower survival rates in patients with elevated serous type EOC
• Combination of GRP78 and PDI
• Is an independent predictive factor for EOC (Qu et al., 2013; Samanta et al., 2020)
• www.readcube.com/articles/10.3389/fphar.2022.987088

Rozhodoující prognostické faktory:

• Stádium onemocnění,
• Histologický typ nádoru,
• Stupeň diferenciace,
• Věk pacientky,
• Celkový stav,
• Radikalita primární operace
• Velikost ponechaného rezidua
• Operační výkon, chemoterapii event. radioterapii
• se volí individuálně podle přesně stanovených kritérií

• Komplexní onkologické centrum FN Hradec Králové, standardní léčebný postup Verze: 2020.1, Protokol pro léčbu karcinomu vaječníku, vejcovodu a peritonea

• Overall survival (OS)
• More favourable in LGSC compared to HGSC
• LGSC, overall survival and clinical outcome
• Excellent with surgical excision alone, if the disease is confined to the ovary (stage 1).
• Extraovarian spread at diagnosis, the most common presentation
• Associated with poor outcome (Ali et al. 2013)
• erc.bioscientifica.com/view/journals/erc/29/1/ERC-21-0191.xml

1174 patients in the current analysis

• Median follow-up was 141 months. 
• Long-term overall survival (LTOS) lasting at least 10 years was 26%
• Younger age for LTOS (HR, 1.097; 95% CI, 1.042-1.155; P <.001). 
• Long-term disease-free survival (LTDFS) lasting at least 10 years was 18%. 
• Only younger age was an independent predictor of LTDFS
• Hazard ratio [HR], 1.076; 95% CI, 1.03-1.12; P <.001

• Patients who had survived at least 10 years
• Linked to a lower risk of death (HR, 0.225; 95% CI, 0.118-0.429; P <.001)

• Older patients
• Had a higher risk of relapse or death (HR, 1.047; 95% CI, 1.017-1.077; P =.002).

• 18% of patients with LTDFS lasting at least 10 years are “likely cured.”

• Pitiyarachchi O, Friedlander M, Java JJ, et al. What proportion of patients with stage 3 ovarian cancer are potentially cured following intraperitoneal chemotherapy? Analysis of the long term (?10 years) survivors in NRG/GOG randomized clinical trials of intraperitoneal and intravenous chemotherapy in stage III ovarian cancer. Gynecol Oncol. Published online July 11, 2022. doi:10.1016/j.ygyno.2022.07.004

• Only 1/4 patients are diagnosed at an early stage
• Worldwide five-year survival rate of patients with advanced ovarian cancer is 20–25%
• www.spandidos-publications.com/10.3892/mmr.2016.4897

• If chemotherapy fails to eradicate all cancer cells and some remain post-treatment (even if microscopic)
• These ultimately flourish and lead to death within 12 years of diagnosis.
• Under the proposed model, the proportion of women who are alive at 12 years is precisely the proportion with no residual cancer cells after treatment.
• archive.cancerworld.net/impact-factor/can-advanced-stage-ovarian-cancer-be-cured/