igcs 2020 abstracts: oral featured posters...sep 01, 2020 · registered delegates will have access...

IGCS 2020 Abstracts: Oral Featured Posters

Registered Delegates will have access to all posters in the Abstract Poster Hall located within the xDigital Meeting Portal from September 10 to September 24 (10 days after the meeting ends). In addition to the Abstract Poster Hall, there are two sessions dedicated

to oral featured posters. Abstracts: Oral Poster Session (Live Presentations) Sunday, September 13, 2020 2:00am – 3:45am UTC. Channel 2 Abstracts: Oral Poster Session (Pre-recorded Presentations) Saturday, September 12, 2020 13:30pm – 14:30pm UTC. Channel 4

IGCS20_1248 Oral Poster - LIVE Oral Featured Posters - Live

Overall Survival After Surgical Staging By Lymph Node Dissection Versus Sentinel Lymph Node Biopsy In Endometrial Cancer: A National Cancer Database study.

S. Garzon1, A. Mariani1, C. Day2, E. B. Habermann2, C.L. Langstraat1, G.E. Glaser1, A. Kumar1, A. Larish1

1Department of Obstetrics and Gynecology, Mayo Clinic, United States; 2Department of Health Services Research, Mayo Clinic, United States Objectives: To investigate the association between the type of lymph node (LN) assessment and overall survival (OS) in endometrial cancer (EC).

Methods: Patients with stage I-III EC who underwent a hysterectomy and LN assessment from 2012 to 2015 were identified from the National Cancer Database. Multivariable Cox proportional hazards regression analysis was performed to assess factors associated with OS.

Results: Of 68,614 patients identified, 64,796 underwent lymphadenectomy (LND) only, 1,777 sentinel lymph node biopsy only (SLN-B), and 2,041 both procedures (SLN-B/LND). On multivariable analysis, SLN-B and SLN-B/LND were not associated with different OS compared to LND (hazard ratio [HR]: 0.92; 95%CI: 0.73-1.17 - HR: 0.91; 95%CI: 0.77-1.07, respectively). Similarly, when stratified by LN status, SLN-B and SLN-B/LND reported similar OS compared to LND, both in negative (HR: 1.03; 95%CI: 0.85-1.26 – HR :0.95; 95%CI: 0.73-1.23, respectively) and positive (HR: 0.92; 95%CI: 0.55-1.54 - HR: 0.76; 95%CI: 0.57-1.03, respectively) LNs. Including only LND with ≥10 pelvic and ≥1 para-aortic LNs removed, no difference in OS was observed between LND and SLN-B or SLN-B/LND in the entire cohort, and in negative or positive LNs. In all analyses, older age, Charlson-Deyo Score ≥2, black race, higher American Joint Committee on Cancer (AJCC) pathologic T stage, grade 3, presence of lymphovascular infiltration, type-2 histology, and absence of chemotherapy or radiation therapy were independently associated with worse OS.

Conclusions: When compared to SLN-B or SLN-B/LND, LND does not appear to improve OS in EC, even in the presence of LN metastases.

20 IGCS20_1082 Oral Poster - LIVE Oral Featured Posters - Live

Long-term survival outcomes of intravenous vs intraperitoneal chemotherapy in the treatment of advanced ovarian cancer

R. Kim1, M. Maganti3, M. Bernardini1, S. Laframboise1, S. Ferguson1, T. May1

1Division of Gynecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health Systems, Canada ; 3Department of Biostatistics, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Canada Objectives:

The role of intraperitoneal (IP) chemotherapy in the management of advanced ovarian cancer has been controversial. We aimed to compare survival outcomes associated with IP vs intravenous (IV) chemotherapy.

Methods:

We reviewed the long-term survival records of 271 women with stage IIIC or IV high-grade serous ovarian cancer treated with primary cytoreductive surgery (PCS) followed by IP or intravenous (IV) chemotherapy between 2001-2015 with a minimum follow-up of 4 years. 5-year progression free (PFS) and overall survival (OS) rates were compared using Kaplan-Meier survival analysis and covariates were evaluated using Cox regression analysis.

Results:

Women who received IP chemotherapy after PCS (n=91) were more likely to have undergone aggressive surgery (p<0.001), longer surgery (p<0.001), and had no residual disease (p<0.001) compared to the IV arm (n=180). Median follow-up was 51.6 months. Five-year PFS was 19% vs. 18% (p=0.63) and OS was 73% vs. 44% (p=0.00016) in the IP vs. IV arms, respectively. After controlling for covariates in a multivariable model, the use of IP was no longer a significant predictor of OS in the entire cohort (p=0.12). In patients with 0mm residual disease, PFS was 28% vs. 26% (p=0.67) and OS was 81% vs. 60% (p=0.059) in IP (n=61) vs. IV (n=69), respectively. In patients with residual of 1-9mm, PFS was 30% vs. 48% (p=0.076) and OS was 60% vs. 43% (p=0.74) in IP (n=29) vs. IV (n=31), respectively.

Conclusions:

IP chemotherapy showed a trend towards improved survival over conventional IV chemotherapy, especially in patients with no residual disease.


Can conisation specimens predict sentinel lymph node status in early-stage cervical cancer? A SENTICOL group study

J. Mereaux1, V. BALAYA2, B. GUANI2, L. MAGAUD3, H. BONSANG-KITZIS4, C. NGÔ4, F. Lecuru1, P. Mathevet2

1Breast, gynecology and reconstructive surgery unit, Curie Institute, France; 2Gynecology Department, University Hospital of Lausanne, Switzerland; 3Public Health Department, Hospices Civils de Lyon, France; 4Gynecological and Breast Surgery and Cancerology Center, RAMSAY-Générale de Santé, Hôpital Privé des Peupliers, France Objectives: The goal of this study was to determine pathologic risk-factors on conisation specimen predicting the sentinel lymph node (SLN) in early-stage cervical cancer.

Methods: An ancillary analysis of 2 prospective multicentric database on SLN biopsy for cervical cancer (SENTICOL I and II) were carried out. Patients with IA to IB1 FIGO stage, who underwent SLN biopsy and conisation were included.

Results and Discussion: Between January 2005 and July 2012, 161 patients from 25 French centers fulfilled the inclusion criteria. The majority of patients had IB1 clinical FIGO stage (81.4%) and squamous cell carcinoma (76.3%). Macrometastases, micrometastases and Isolated tumor cells (ITCs) were found in 4 (2.5%), 6 (3.7%) and 5 (3.1%) patients respectively. Compared to negative SLN patients, patients with micrometastases or macrometastases were more likely to have lymphovascular space invasion (LVSI) (60% vs 29.5%, p = 0.04) and deep stromal invasion (DSI) ≥ 10 mm (50% vs 17.8%, p = 0.046). By multivariate analysis, DSI ≥ 10 mm on conisation specimens was an independent factor of micrometastases and macrometastases (OR = 3.91, 95%CI = [ 1.03 – 14.9], p = 0.046). Among the 94 patients with DSI < 10 mm and absence of LVSI on conisation specimens, 4 patients (4.2%) had ITCs and only one (1.1%) had micrometastases.

Conclusions: Patients with DSI ≥ 10 mm and LVSI had higher risk of micrometastatic and macrometastatic SLN. In this subpopulation, SLN mapping should be performed meticulously to avoid missing metastatic nodes.


COVID-19: A review of the impact of the pandemic on ovarian cancer patient advocacy organizations from around the world

F. Reid1, C. MacKay2

1World Ovarian Cancer Coalition, Canada; 2World Ovarian Cancer Coalition, Canada Introduction

The World Ovarian Cancer Coalition is a not-for-profit organization that works with patient organizations in 47 countries around the world to ensure that every woman diagnosed with ovarian cancer has the best chance of survival and best quality of life where ever she may live.

Methods

Concerned about the impact of COVID-19 on all aspects of their members’ work, a survey was conducted as part of a joint effort with four other global cancer coalitions. The consultation was completed by 28 ovarian cancer groups from 16 countries during May 2020.

Results

The pandemic has had a significant impact on the work and viability of ovarian cancer patient advocacy organizations. Half (50%) saw an increase in requests for information and support (45% increase on average) mainly relating to treatment and the fear of COVID-19. This coincided with 95% experiencing a sharp decline in income resulting in the need to reduce staff and manage a move to virtual working practices. Of those who fund research, 70% say their ability to fund or carry out research is, or may be, affected. Almost 80% had concerns about their overall current, or future viability. Groups also reported significant disruptions to ovarian cancer services, including delays in access to diagnostics and changes in treatment regimes.

Conclusions

Ovarian cancer patient advocacy groups play a vital role in supporting those who are diagnosed with ovarian cancer. The impact of the pandemic means many organizations need additional resources to ensure that they continue to provide these vital services.


Impact of COVID-19 in Gynecologic Oncology: a Nationwide Italian Survey

G. Bogani1, G. Apolone1, A. Ditto1, G. Scambia2, P. Benedetti Panici3, R. Angioli4, S. Pignata5, S. Greggi5, P. Scollo6, D. Mezzanzanica1, M. Franchi7, V. Di Donato3, G. Valabrega8, G. Ferrandina2, I. Palaia3, A. Bergamini9, L. Bocciolone9, A. Savarese10, F. Ghezzi11, J. Casarin11, V. Trojano12, V. Chinatera13, G. Giorda14, M. Malzoni15, G. Salerno16, E. Sartori17, A. Testa2, G.F. Zannoni2, F. Zullo18, E. Vizza19, G. Trojano20, A. Chiantera21, F. Raspagliesi1

1Fondazione Irccs Istituto Nazionale Dei Tumori, Italy; 2UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy, Italy; 3Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Rome, Italy, Italy; 4Department of Gynecology, University Campus Biomedico, Rome, Italy, Italy; 5Urogynaecological Medical Oncology Unit Istituto Nazionale Tumori - IRCCS - "Fondazione G. Pascale", 80131 Naples, Italy, Italy; 6Department of Gynecology, Cannizzaro Hospital, Catania, Italy, Italy; 7Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy, Italy; 8Candiolo Cancer Institute, FPO - IRCCS - Str. Prov.le 142, km. 3,95 - Candiolo (TO) 10060, Italy, Department of Oncology, University of Torino , Italy; 9Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy, Italy; 10Oncologia Medica 1, IRCCS Istituto Nazionale Tumori Regina Elena, 00144 Roma, Italy, Italy; 11Univerity of Insubria, Ospedale di Circolo Fondazione Macchi, Varese, Italy, Italy; 12Department of Obstetrics and Gynaecology , Mater Dei Hospital-Bari, Italy , Italy; 13Department of Gynecologic Oncology, University of Palermo, Palermo, Sicilia, Italy, Italy; 14Gynaecological Oncology Unit, Centro di Riferimento Oncologico (CRO) di Aviano, IRCCS, Via Franco Gallini 2, 33081, Aviano, Italy., Italy; 15Endoscopica Malzoni, Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy, Italy; 16Department of gynecology, San Camillo-Forlanini Hospital, 00152 Rome, Italy, Italy; 17Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy, Italy; 18Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy, Italy; 19Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy, Italy; 20Department of Obstetrics and Gynecology, University Medical School "A. Moro", Bari, Italy., Italy; 21Italian Society of Gynecology and Obstetrics, Italy Objective: Several attempts are done in order to control COVID-19 and promote a fair allocation of resources during the outbreak. The Italian society of obstetrics and gynecologist (SIGO), and the Multicenter Italian Trials in Ovarian cancer and gynecologic malignancies (MITO) are promoting research activities in the field of gynecologic oncology on a national basis, even in the era of COVID-19.

Methods: The SIGO and MITO group promoted a national survey aiming to evaluate the impact of COVID-19 on clinical activity of gynecologist oncologists and the implementation of containment measures of COVID-19 diffusion.

Results: Overall, 604 participants completed the questionnaire with a response rate of 70%. The results of this survey suggest that gynecologic oncology units had set a proactive approach to COVID-19 outbreak. Triage methods were adopted in order to minimize the in-hospital diffusion of COVID-19. Although 73% of the participants stated that COVID-19 has not significantly modified their everyday practice, 21% declared a decrease in the use of laparoscopy in favor of open (19%) and vaginal (2%) surgery. Interestingly, about 5% of the participants stated that the use of laparoscopic surgery has increased during the COVID-19 outbreak. However, less than 50% of surgeons adopted specific protection against COVID-19. Additionally, responders suggested to delay cancer treatment (10-15%), and to perform less radical surgical procedures (20-25%) during COVID-19 pandemic.

Conclusions: International cooperation is of paramount importance, as heavily affected nations can serve as an example to find out ways to safely preserve clinical activity during the COVID-19 outbreak


Patterns of Recurrence in Vulvar Cancer: A Nationwide Population-based Study

D. Zach1, E. Åvall Lundqvist2, H. Åvall Lundqvist1, J. Hemming3, K. Hellman4, A. Flöter Rådestad5

1Dept of Gynecological Cancer, Dept of Women’s and Children’s Health, Karolinska University Hospital, Karolinska Institute, Sweden; 2Dept of Oncology and Dept of Biomedical and Clinical Sciences, University Linköping, Sweden; 3Dept of Oncology and Pathology, Karolinska Institute, Sweden; 4Dept of Gynecological Cancer, Dept of Oncology and Pathology,Karolinska University Hospital, Karolinska Institute, , Sweden; 5Dept of Hereditary Cancer, Dept of Women’s and Children’s Health,Karolinska University Hospital, Karolinska Institute, Sweden OBJECTIVES

To explore patterns of recurrence and prognostic factors in patients with vulvar squamous cell carcinoma (VSCC) in Sweden.

METHODS

A nationwide population-based retrospective cohort study, including women diagnosed with VSCC between 2012-2015 and registered in the Swedish Quality Registry for Gynecologic Cancer. Further information about recurrences and follow-up was retrieved from medical charts. Prognostic factors (groin surgery; age (> 79 years vs < 65 years), stage (I-II vs III-IV)) for recurrence-free (RFS) and overall survival (OS) were analyzed by multivariate regression models.

RESULTS

489 eligible women were included. Median follow-up was 5.3 years. The overall recurrence rate was 22.3%; in 56% local, in 27.5% groin and in 7.3% distant recurrences. 63.3% of all women with a recurrence reported symptoms. Groin surgery was withheld in 13% of women with presumed stage IB-II.

Poorer RFS and OS was significantly associated with older age (HR 3.44; p<0.001 for RFS; HR 5.03; p<0.001 for OS), withheld groin surgery (withheld versus performed: HR 0.53; p=0.001 for RFS; HR 0.49; p=0.001 for OS) and advanced FIGO stage (HR 2.41; p<0.001 for RFS; HR 2.48; p<0.001 for OS).

Recurrences diagnosed in-between follow-up visitations were significantly larger (30mm versus 18mm, p=0.003) but after adjustment for age, type of recurrence and time since treatment not associated with worse survival.

CONCLUSIONS

This population-based study confirms previous findings of predominantly local recurrences in vulvar cancer. Besides known prognostic factors as age and FIGO-stage, withheld groin surgery was associated with worse RFS and OS.

The value of regular follow-up remains undetermined.


Endometrial cancer: laparoscopy vs robotic surgery. A large single-institution retrospective analysis.

E. Perrone1, I. Capasso1, A. Gioè1, S. Restaino1, E. Distefano1, G. Dinoi1, G. Scambia1, F. Fanfani1

1Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Catholic University of Sacred Heart, Italy Introduction

Minimally invasive surgery (MIS) is the gold standard for endometrial cancer staging. Among MIS approaches, laparoscopy (LPS) and robotic surgery (RS) are the major techniques. The aim of this study is to compare these two approaches in endometrial cancer staging.

Methods

In this large single-institution retrospective study we enrolled 1221 consecutive clinical stage I-II-III endometrial cancer patients undergone MIS surgical staging at the Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS. We compared 766 patients treated by LPS and 455 by RS, on the basis of perioperative and oncological outcomes (disease free survival, DFS and overall survival, OS). A sub-analysis of the high-risk population was performed in the two cohorts.

Results

The two cohorts were homogeneous in terms of perioperative and pathological data. We recorded differences in number of relapse/progression (11.7% in LPS vs 7% in RS, p value= 0.008) and in number of deaths (9.8% in LPS vs 4.8% in RS, p value=0.002). Whereas, in the univariable analysis, the age > 65, grading, the LVSI positivity and the risk group were independent predictors of DFS and OS. In the multivariable analysis the association of the age and grading was significant for DFS and OS. In the sub-analysis, the univariable and the multivariable confirmed the influence of the age in DFS and OS, despite of the MIS approach.

Conclusions/implications

In our large retrospective analysis, we confirmed that robotic surgery in superimposable to the standard laparoscopic approach for MIS endometrial cancer staging also for the high-risk population.


Meta-analysis comparing influence of no adjuvant treatment, postoperative radiotherapy and/or chemotherapy on survival in patients after primary surgery including lymphadenectomy for early stage uterine carcinosarcoma

V. Student1, S. Garzon1, L. Prokop2, M.H. Murad3, I. Sedlakova4, A. Mariani1

1Department of Obstetrics and Gynecology, Mayo Clinic, United States; 2Library Public Services, Mayo Clinic, United States; 3Center for the Science of Health Care Delivery, Mayo Clinic, United States; 4Univ Hosp, Hradec Kralove, Charles Univ, Fac Med Hradec Kralove, Czech Republic Introduction: Uterine carcinosarcoma (UCS, malignant mixed Müllerian tumor) is rare but aggressive form of endometrial cancer according to metastatic potential. Standard treatment is primary surgery. Adjuvant therapy improves survival in advance disease but its benefit remains unclear in stage I (FIGO 2009). Methods: A systematic review and meta-analysis to compare influence of no adjuvant treatment (No AT) +/- postoperative vaginal brachytherapy (VBT), adjuvant external beam radiation therapy (EBRT) +/-VBT, adjuvant chemotherapy (CT) +/-VBT, and adjuvant CT + EBRT+/-VBT on survival in patients with stage I UCS after primary surgery including at least hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy. Prospectively stated selection criteria, data collection and comprehensive search strategy was registered on PROSPERO. Investigators independently extracted data. Random-effects meta-analysis was used to estimate risk ratios (RR). Results: We included 14 retrospective observational studies with 1,090 UCS patients (Figure 1). No AT+/-VBT was associated with higher mortality and recurrence compared to CT+/-VBT and compared to CT+EBRT+/-VBT; but no significant difference from EBRT+/-VBT. Both, CT+/-VBT and CT+ EBRT+/-VBT, had significantly lower mortality and recurrence compared to EBRT+/-VBT. There was higher mortality associated with CT+/-VBT compared to CT+EBRT+/-VBT. Heterogeneity was minimal in all analyses; however, none of these comparisons were randomized and the estimates were imprecise due to the small number of events (Figure 2). Conclusion/Implications: Adjuvant chemotherapy appears to be effective in controlling recurrences and reduce mortality in early stage UCS.


Therapeutic role of pelvic and para-aortic lymphadenectomy in apparent early stage epithelial ovarian cancer.

N. Bizzarri1, A. Du Bois2, R. Fruscio3, F. De Felice4, P. De Iaco5, J. Casarin6, E. Vizza7, V. Chiantera8, G. Corrado1, S. Cianci1, P. Harter2, B. Ataseven2, M. Bommert2, A.M Perrone5, S. Magni3, D. Ferrari3, B. Zambetti3, G. Scambia1, A. Fagotti1

1Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Italy; 2Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, Germany; 3Department of Obstetrics and Gynecology, Università degli Studi Milano-Bicocca, San Gerardo Hospital, Italy; 4Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Italy; 5Gynecologic Oncology Unit, S.Orsola-Malpighi Hospital, Italy; 6Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Italy; 7Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Italy; 8Department of Gynecologic Oncology, ARNAS Civico, University of Palermo, Italy Introduction: The therapeutic role of pelvic and para-aortic lymphadenectomy in surgical staging of apparent early-stage epithelial ovarian cancer (aeEOC) is still unclear. Recently, ESGO-ESMO consensus established that re-staging lymphadenectomy is not recommended if patients are already due to receive adjuvant chemotherapy for high-risk eEOC. The aim of this study was to evaluate the potential therapeutic role of systematic lymphadenectomy in patients with eEOC.

Methods: Multi-center retrospective cohort study with CE approval, comparing women with aeEOC who underwent no lymphadenectomy (NL) versus lymph node sampling (SL) versus adequate systematic bilateral pelvic and para-aortic lymphadenectomy (AL) (defined as ≥20 lymph-nodes).

Inclusion criteria: epithelial ovarian carcinoma; no bulky (≥10mm short axis) pelvic or para-aortic lymph nodes at CT-scan; complete intra-peritoneal staging and at least 3 cycles of platinum-based adjuvant chemotherapy.

Results: 639 of 2,559 patients with FIGO stage IA-IIIA1 ovarian cancer, met inclusion criteria. 360 (56.3%) underwent AL, 150 (23.5%) SL and 129 (20.2%) NL (Table 1). AL patients were younger (p<0.001), experienced a higher number of grade 3-5 post-operative complications (p=0.008) and had a longer time to start chemotherapy (p=0.034). There was no difference in intra-operative complications. Median follow-up was 63 months (range, 5-342). The 5-year disease-free survival (DFS) was 79.7% vs. 76.5% vs. 68.3% (p=0.006) (Figure 1), and 5-year overall survival (OS) was 92.3% vs. 94.5% vs. 89.8% (p=0.165) (Figure 2) in women who received AL vs. SL vs. NL, respectively. Lymphadenectomy represented independent factor for DFS improvement, HR 0.52 (95%CI 0.37-0.73) (p<0.001).

Conclusion: Pelvic and para-aortic lymphadenectomy in surgical staging of eEOC improves DFS for the price of increasing post-operative complications and time to chemotherapy but does not affect OS.


Prevalence and prognosis of Lynch syndrome and sporadic mismatch repair deficiency in the combined PORTEC-1,-2 and -3 endometrial cancer trials

C. Post1, E. Stelloo1, V. Smit1, D. Ruano1, C.M. Tops1, L. Vermij1, T.A. Rutten1, I.M. Jürgenliemk-Schulz2, L.C. Lutgens3, J.J. Jobsen4, R.A. Nout1, E.J. Crosbie5, M.E. Powell6, L. Mileshkin7, A. Leary8, P. Bessette9, S.M. de Boer1, N. Horeweg1, T. van Wezel1, T. Bosse1, C.L Creutzberg1

1Leiden University Medical Center, Netherlands; 2University Medical Center Utrecht, Netherlands; 3MAASTRO Clinic, Netherlands; 4Medical Spectrum Twente, Netherlands; 5University of Manchester, St Mary's Hospital, United Kingdom; 6Barts Health NHS Trust, United Kingdom; 7Peter MacCallum Cancer Centre, Australia; 8Gustave Roussy Cancer Center – INSERM U981, Université Paris Saclay, France; 9University of Sherbrooke, Canada Introduction:

Here we aimed to evaluate the prevalence and prognosis of Lynch Syndrome (LS)-associated endometrial cancer (EC) in relation to sporadic mismatch repair deficient EC (MMRd-EC) in the combined PORTEC-1,-2 and 3 trials comprising 1336 ECs .

Methods:

MMR-status was determined by MMR-immunohistochemistry (MLH1/PMS2/MSH6/MSH2). MMRd-ECs with detected promoter hypermethylation of MLH1 were classified as sporadic (methylated MMRd-EC). For unmethylated MMRd-EC cases tumor and normal tissue next-generation sequencing was performed. ECs with MMR germline mutations were classified as LS-associated (LS MMRd-EC). Unmethylated MMRd-ECs without MMR germline mutations were classified as MMRd-EC due to other causes (other MMRd-EC). Overall and recurrence-free survival were estimated and compared using Kaplan-Meier method and pairwise log-rank test.

Results:

Among the 1336 ECs, 926 were MMR proficient. Of the 410 MMRd-EC, 376 could be fully triaged; 281 (75%) were methylated MMRd-ECs; 37 (10%) LS MMRd-ECs, and 58 (15%) other MMRd-ECs. The overall LS prevalence was 2.8%. Overall 5-year survival for LS MMRd-EC was 89% (95%CI 79–100%; p=0.055), other MMRd-EC 96% (92–100%; p=0.001), both compared to methylated MMRd-EC 79% (74–84%); 5-year recurrence-free survival was 92% (84–100%; p=0.123), 95% (89–100%; p=0.002), compared to 79% (74–84%), respectively.

Conclusion:

The prevalence of LS in the PORTEC EC trial population was 3% and within the MMRd group 10%. LS MMRd-EC seems to have a better overall and recurrence-free survival than sporadic

MMRd-EC caused by hypermethylation. Further research into the underlying causes of non-hypermethylated somatic MMRd-EC is ongoing.


Comprehensive molecular assessment of mismatch repair deficiency in Lynch-associated ovarian cancers using next-generation sequencing (NGS) panel

S. Kim1, L. Oldfield3, A. Tone2, A. Pollette4, E. Van de Laar2, S. Pederson3, J. Wellum3, B. Clarke4, T. Pugh3, S. Ferguson1

1Department of Obstetrics and Gynecology, University of Toronto, Canada; 2Division of Gynecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health Systems, Canada; 3Department of Medical Biophysics, University of Toronto, Canada; 4Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada Objectives:

Abnormalities in mismatch repair (MMR) gene may be the result of pathogenic germline (Lynch syndrome) and somatic mutations as well as epigenetic events. We aimed to examine the cause of MMR defects (MMRd) in non-serous/non-mucinous ovarian cancer (OC) through targeted mutational sequencing.

Methods:

Women with non-serous/mucinous OC (N = 215) were prospectively recruited from three cancer centers in Ontario, Canada. Tumors were assessed for MMR protein expression by immunohistochemistry. Matched MMRd tumor-normal samples were run on a custom NGS panel to identify germline and somatic mutations, copy number variants, rearrangements and promoter methylation in MMR and associated genes.

Results:

Of 215 women enrolled in our study, 185 (86%) had OC and 30 (14%) had synchronous OC and endometrial cancer. Twenty-eight (13%) cases were MMRd, 11 of which were synchronous. Using the NGS panel, Lynch syndrome (LS) was detected in 39% of MMRd cases (11/28; 7 OC and 4 synchronous): 7 MSH6, 2 MLH1, 1 PMS2, and 1 MSH2. An explanation for the observed MMR phenotype was available for 18/20 deficient cases, including 9/10 MLH1-/PMS2- (7 somatic methylation, 1 bi-allelic somatic deletion, 1 germline mutation), 0/1 PMS2-, 6/7 MSH6- (6 germline mutations) and 2/2 MSH2-/MSH6- (1 germline mutation, 1 bi-allelic somatic mutation). Concordance between clinical and research panel sequencing results was 90%.

Conclusions: Use of our custom NGS panel allows for the streamlined assessment of hereditary and somatic causes of MMR deficiency in OC and may be an attractive screening strategy for LS in this population.


Risk Factors Associated with Increasing Incidence of Uterine Cancer After Correcting for Hysterectomy

C. Liao1, K. Tran2, M. Richardson2, K. Darcy7, C. Tian3, C.A. Hamilton6, L. Maxwell3, A. Mann4, D.S. Kapp5, J.K. Chan4

1Kaohsiung Veterans General Hospital, Taiwan; 2University of California, Los Angeles, United States; 3Walter Reed National Military Medical Center, United States; 4Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, United States; 5Stanford University School of Medicine, United States; 6Inova Schar Cancer Institute , United States; 7Virginia Commonwealth University School of Medicine Inova Fairfax Campus, United States Objective: To evaluate the demographic factors associated with the increase in incidence of uterine cancer after correcting for hysterectomy.

Methods: From 2001-2016, incidence rates of uterine cancers (epithelial carcinoma and sarcomas) were estimated from United States Cancer Statistics after correcting for hysterectomy prevalence based on Behavioral Risk Factor Surveillance System data. SEER*Stat and Joinpoint regression were used to calculate incidence rate (per 100,000) and average annual percent change (AAPC).

Results: Of 720,984 patients, 78% White , 10% Black, 8% Hispanic, and 3% Asian/Pacific-Islander. After correcting for hysterectomy, the estimated incidence increased from 27.1 to 42/100,000 women. Over 15 years, the incidence increased from 40.8 to 42.9 with an annual percent increase (AAPC) of 0.5% per year (p<0.05). The 65-69 year old group had the highest incidence (185.4). With respect to race, the highest baseline incidence was in Blacks at 49.5 that increased 2.3% per year (AAPC). Whites had an incidence of 43.6 with an annual percent increase of only 0.4%. The Hispanics had an incidence of 35.0 (AAPC=1.1%), then Asians incidence 24.0 (AAPC=1.3%). The intersectionality of age and race showed that the group with the highest risk was 65-69 year old and Black with an incidence of 281.1 (AAPC=2.3%).

Conclusion: The intersectionality of age and race found age 65-69 Black women with the highest incidence of uterine cancer with a six-fold increase compared to the general population, using hysterectomy-corrected data. Further studies are warranted to determine potential genetic, social-determinant, or environment exposures to explain these findings.


Survival outcomes in endometrial cancer patients having lymphadenectomy, sentinel node mapping followed by lymphadectomy and sentinel node mapping alone: long-term results of a propensity-matched analysis

G. Bogani1, C. Pinelli1, A. Ditto1, J. Casarin2, F. Ghezzi2, F. Raspagliesi1

1Fondazione IRCCS Istituto Nazionale Dei Tumori, Italy; 2University of Insubria, Italy Objective: Sentinel node mapping (SLNM) has replaced lymphadenectomy for staging surgery in apparent early-stage endometrial cancer (EC). Here, we evaluate long-term survival of three different approaches of nodal assessment in EC

Methods: This is a multi-institutional retrospective study evaluating long-term outcomes (at least 3 years) of patients having lymphadenectomy, SLNM followed by lymphadenectomy and SLNM alone. We applied a propensity-matched algorithm. Survival outcomes were assessed using Kaplan-Meier and Cox proportional hazard models

Results: Applying a propensity score matching algorithm we selected 180 patients having SLNM (90 SLNM vs. 90 SLNM followed by lymphadenectomy). Additionally, a control group of 180 patients having lymphadenectomy was selected. Overall, 10% of patients were diagnosed with positive nodes. Low volume disease was observed in 16 cases (5 micrometastasis and 11 isolated tumor cells). Patients having SLNM followed by lymphadenectomy had a higher possibility to be diagnosed with a stage IIIC disease in comparison to lymphadenectomy alone (p=0.02); while we did not observe a difference in the diagnostic value of SLNM followed by lymphadenectomy and SLNM (p=0.389). Median follow-up time was 69 (7- 206) months. There were no statistical differences in terms of disease-free (p=0.570, log-rank test) and overall survival (p=0.911, log-rank test); Similarly, they did not impact on survival outcomes after stratification by low, intermediate and high-risk patients.

Conclusions: Our study highlighted that SLNM provides similar long-term oncologic outcomes than lymphadenectomy, even in high-risk patients. Further evidence is warranted to assess the prognostic value of low volume disease detected by ultrastaging in patients following SLNM.

32 IGCS20_1018 Oral Poster - TAPED Oral Featured Posters - Pre-Recorded

Development of a triage tool including HE4, D-dimer, and fibrinogen for the assessment of women presenting with pelvic masses

K. McKendry1, S. Duff2, S. O'Toole1

1Saint James's Hospital, Ireland; 2Saint James's Hospital, Ireland Introduction:

10% of pre- and 20% of post-menopausal women presenting with a pelvic mass will receive a diagnosis of ovarian cancer (OC). Algorithms are being formulated to improve on CA125 alone in classifying women presenting with pelvic masses as high or low risk for OC. The aim of this study was to evaluate novel biomarkers HE4, the Risk of Ovarian Malignancy Algorithm, the Risk of Malignancy Index I and II, D-dimer, and fibrinogen, alone or in combination, compared to CA125.

Methods:

Pre-operative serum samples were collected from 274 patients undergoing primary debulking surgery in an Irish tertiary referral centre. Logistic regression models and ROC curves were fitted for each biomarker alone and in combination. The partial area under the curve (pAUC) in the 90-100% specificity range was determined. Biomarker cutoffs were calculated at 90-100% and 98% specificity.

Results:

There were 89 pre- and 185 post-menopausal women, consisting of 144 benign, 41 borderline, and 89 OC cases. In the premenopausal group, no biomarker(s) outperformed CA125 (AUC 0.73; 95% CI 0.63-0.84). In the postmenopausal group, HE4 + D-dimer + fibrinogen outperformed CA125 alone (AUC 0.83 versus 0.77, p= 0.023). HE4 + D-dimer had the highest pAUC at 72.59 (95% CI 66.16-79.72) and outperformed CA125 (p = 0.001).

Conclusion:

The addition of biomarker(s) to CA125 does not increase OC detection in premenopausal women. A novel biomarker panel (HE4 + D-dimer + fibrinogen) improved the diagnostic accuracy of CA125 alone in postmenopausal women and could aid in the preoperative triaging of pelvic masses.


Molecular Subtype Diagnosis of Endometrial Carcinoma: Comparison of NGS Panel and Promise Classifier

J. Huvila1, K. Orte1, P. Vainio1, T. Mettälä2, T. Joutsinimi2, S. Hietanen2

1Department of Pathology, University of Turku and Turku University Hospital, Finland; 2Department of Gynecology and Obstetrics, University of Turku and Turku University Hospital, Finland Objectives: The molecular classification of endometrial carcinoma (EC) is taking the diagnosis on EC to a more comprehensive level and will aid to better identify those patients whose disease is likely to behave differently than predicted when using traditional risk stratification. We are transitioning towards the use of molecular classification in a clinical context; however, it remains undetermined, which would be the optimal approach.

Methods: In this study,s we characterized patients (n=60) whose disease had a different than anticipated clinical course determined by current risk stratification tools and histomorphologically corresponding control samples. The aim was to access the molecular classification using two different methods; by performing the FoundationOne CDx NGS panel and using the ProMisE classifier and performing immunohistochemical stainings for MMR proteins and p53. POLE mutation status was in both settings derived from FoundationOne results.

Results: 64 patients were entered in this study, and in 60 cases, the molecular classification was successful. MSI status was available from 53 cases. Tumour molecular subtype was of prognostic significance and showed the expected correlations with grade and histotype. Molecular subtype diagnosis based on NGS and ProMisE was in complete agreement for 50 of 53 tumors. In 2 tumors, a TP53 mutation was detected on NGS, but immunostaining showed subclonal pattern, and 1 case was MSI based on NGS but MMR deficient by immunohistochemistry.

Conclusions: Both NGS panel sequencing of formalin-fixed paraffin embedded endometrial carcinomas and molecular subtype diagnosis based primarily on immunostaining (ProMisE) yield identical results in 94.3% (kappa – 0.91) of cases.


Screening for cervical cancer in women under the age of 25: a cross-sectional study at an University Hospital in Minas Gerais - Brazil

L. Barbosa1, B. Napoleão1, M. Franco1, E. Ferreira-Filho2, S. Nicolau3

1Vale do Sapucaí University, Brazil; 2University of Sao Paulo, Brazil; 3Federal University of Sao Paulo, Brazil The main risk factor for cervical cancer (CC) is persistent infection by oncogenic types of human-papillomavirus. This infection promotes cellular changes leading to the emergence of pre-neoplastic lesions that, if left untreated, can progress to invasive neoplasia. In Brazil, screening programs that aim to detect these CC precursor lesions through cervical cytology are recommended only for women between 25 and 64 years old, who have had at least one sexual intercourse. This study aims to evaluate the histological diagnoses and the frequency of patients under 25 years of age who were referred to colposcopy due to altered colpocytologies; and the distribution of high-grade lesions according to age. Method: Cross-sectional study, with retrospective data collection from medical records of asymptomatic patients between 15 and 24 years old referred to the Hospital das Clínicas Samuel Libânio due to changes in the screening test (pap smear). Result: Among the 4,527 women aged 15 to 24 years, 304 (6.7%) had abnormal cytologies, 73 of whom (24%) were referred for colposcopy. Biopsy was performed in 63 patients. Approximately 65% of high-grade lesions (CIN 2+) were in the 21- to 24-year age range, including one case of “in situ” carcinoma and one case of invasive squamous carcinoma. Conclusion: The highest rate of high-grade lesion was found in the 21-24 age group. This highlights the importance of reevaluating the indication for CC screening in younger women. Furthermore a better understanding of the risk factors involved in the evolution of these lesions in young patients is necessary.


Clinical management of gynecologic cancer patients during COVID-19 pandemia: the experience of Day Hospital Tumori Femminili of Fondazione Policlinico Agostino Gemelli, IRCCS

E. Palluzzi1, G. Corrado1, G. Bolomini1, L. Vertechy1, C. Bottoni1, E. Teodorico1, C. Marchetti1, M. Distefano1, G. Scambia1, G. Ferrandina1

1Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Italy

INTRODUCTION: During COVID-19 pandemia there was the need to reorganize cancer care. Italian and European association published recommendations to evaluate the risk/benefit ratio of delaying anticancer adjuvant/neoadjuvant/first line treatment, delaying all other treatments or manteinance therapy, reducing the risk for medical and paramedical staff. In this scenario, the aim of our work is to retrospective evaluate the activity of Day Hospital (DH) Tumori Femminili of Fondazione Policlinico Agostino Gemelli, IRCCS, for the medical management of gynecologic cancer patients between February and April 2020.

METHODS: Based on published recommendations, with local Health Direction guidelines we draft the Security Protocol to modulate the access of patients into the DH: to perform visits only of new patients or for clinical urgency and to convert on telemedicine the other contacts; to perform a phone/telematic pre-triage the day before the scheduled access and an “in site” pre-triage with measurement of body temperature and administration of a survey for the self-certification of absence risk factors for COVID-19 infection; no caregivers were allowed into DH; surgical masks and gloves were obligatory for anyone.

RESULTS: We registered 3223 accesses/contacts into our DH for intravenous/oral chemotherapy and visits. The activity was similar to that recorded in 2019 in the same two-month period (3311 accesses). Despite the high patients flow we had only two cases of confirmed COVID-19 infection and no cases among healthcare staff.

CONCLUSIONS: Based on the adopted Security Protocol we have guaranteed continuity of care to all our patients and limited the spread of the COVID-19 infection.

36 IGCS20_1102 Dupe - 1103; diff authors Oral Poster - TAPED Oral Featured Posters - Pre-Recorded

Prognostic Value and Association with Veliparib Benefit of Modeled CA-125 Elimination Kinetics (KELIM) in Patients with Newly Diagnosed Ovarian Cancer: Analysis from the VELIA/GOG-3005 Study

B. You1, G. Fleming3, M. Bookman4, K.N. Moore5, K.D. Steffensen6, R.L. Coleman7

1EMR UCBL/HCL 3738, Univ Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Sud, GINECO, and Centre d’Investigation des Thérapeutiques en Oncologie et Hématologie de Lyon (CITOHL), Hospices Civils de Lyon (IC-HCL), France ; 3AbbVie, United States; 4University of Chicago Medicine, United States; 5Kaiser Permanente Northern California, United States; 6Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, United States; 7Lillebaelt University Hospital of Southern Denmark, and the University of Southern Denmark, Denmark Introduction: In VELIA (Phase 3), veliparib with carboplatin/paclitaxel (CP), followed by veliparib maintenance (veliparib-throughout) led to improved progression-free survival (PFS) vs CP alone (control). This exploratory analysis assessed the prognostic and predictive value of the modeled CA-125 elimination rate constant, KELIM.

Methods: KELIM was estimated from treatment-related pharmacodynamic modeling of CA-125 values. Median KELIM was used to define favourable (≥median) /unfavourable (<median) KELIM groups. Patients were analyzed by surgery type: primary (PDS) or interval (IDS) debulking surgery.

Results: In the IDS population (N=154), patients with favourable KELIM had a higher frequency of complete surgery vs unfavourable KELIM (51.9% vs 32.4%), confirming KELIM as a chemosensitivity marker. In both PDS (N=700) and IDS populations, median PFS was longer with favourable KELIM vs unfavourable KELIM, demonstrating a prognostic value. In the PDS population, median PFS was longer in the veliparib-throughout arm relative to control irrespective of KELIM (29.6 vs. 20.9 and 18.2 vs 15.4 months in favourable and unfavourable KELIM groups, respectively; Figure 1). In the IDS population, median PFS was longer with veliparib-throughout vs control for patients with favourable KELIM only (29.3 vs 20.8 months; Figure 2).

Conclusion:

In VELIA, KELIM was prognostic for PFS and IDS outcomes. Current data suggest KELIM may be associated with veliparib benefit. Ongoing analyses will explore how baseline characteristics contribute to KELIM predictive/prognostic value.


Quantitative evaluation of lymph-vascular space invasion (LVSI) in patients affected by endometrial cancer: prognostic and clinical implications

S. Restaino1, L. Tortorella1, E. Perrone1, G. Monterossi1, A. Gioè2, I. Capasso2, E. La Fera2, G. Dinoi2, G. Scambia2, F. Fanfani2, G. Zannoni3, V. Chiantera4

1Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Ginecologia Oncologica, Dipartimento per la Tutela della Salute della Donna e della Vita Nascente, Italy; 2Università Cattolica del Sacro Cuore, Italy; 3Department of Histopathology, Università Cattolica del S. Cuore, Italy; 4Department of Gynecologic Oncology, University of Palermo, Italy Objectives: Lymph-vascular space invasion (LVSI) is associated with an increased risk of recurrence. Usually, the interpretation of LVSI is just qualitative, as presence or absence. The aim of this study is to examine the quantitative analysis of LVSI.

Methods: Retrospective multicentre study. It included 2300 consecutive patients who received a histologically confirmed diagnosis of endometrial cancer between January 2000 and December 2018 at the Gynaecologic Oncology Unit of two tertiary hospitals in Italy.

Results: The rate of lymph node metastasis increased from the 5% in patients with no LVSI, to 15% in patients with focal LVSI and 33% in those with diffuse LVSI (p < .001). There is a progressive increase of prognostic impact of focal and diffuse LVSI on the risk of node metastasis (AOR = 2.12, 95% CI 1.19, 3.79 for focal LVSI and AOR = 3.67, 95% CI 2.30, 5.86). Distant recurrences were more frequent in patients with diffuse LVSI compared with no LVSI (24.9% vs 6.6% respectively, p < .001). We found that adjuvant treatments, specifically adjuvant radiations, were associated with improved OS and DFS (median DFS = 19 months vs 97 months respectively for no adjuvant and radiation therapy, p < .001) in patients with diffuse LVSI.

Conclusion: The presence of diffuse LVSI is an independent risk factor of both lymph node metastasis and distant recurrence in endometrial cancer patients. It is associated with decreased OS and DFS. Adjuvant radiation improved survival regardless of grading, histotype, and lymph nodal metastasis in women with diffuse LVSI.


A training program to build capacity for cervical cancer prevention in Mozambique

M. Salcedo1, M. Varon3, M. Varon3, E. Baker3, E. Baker3, N. Osman4, E. David5, R. Rangeiro6, D. Changule6, V. Andrade7, C.M. Oliveira8, A. Neves9, J. Carns10, C. Lorenzoni6, K.M. Schmeler3, K.M. Schmeler3

1Obstetrics and Gynecology Department, Federal University of Health Sciences of Porto Alegre/Irmandade Santa Casa de Misericordia de Porto Alegre, Brazil ; 3Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital, Thailand; 4Universidade Eduardo Mondlane (UEM), Mozambique; 5Ministerio da Saude de Moçambique (MISAU), Mozambique; 6Hospital Central de Maputo, Mozambique; 7Hospital de Câncer de Barretos, Brazil; 8Diagnóstico das Américas-DASA, Brazil; 9Hospital Geral José Macamo, Mozambique; 10Department of Bioengineering, Rice University, United States Introduction:

Cervical cancer is the primary cause of cancer among women in Mozambique. There is a shortage of providers trained to deliver cervical cancer screening and manage pre-invasive lesions. We describe a training program to build local capacity to deliver quality cervical cancer prevention services in Mozambique.

Methods:

The program includes training courses led by faculty from the United States (US) and Brazil, and consists of lectures followed by hands-on training stations to practice colposcopy, cervical biopsy, ablation and loop electrosurgical excision procedure (LEEP) using innovative training models. Participants then perform the procedures in clinic with supportive supervision from the international faculty. The courses are complemented by monthly videoconference telementoring sessions, held in Portuguese using the Project ECHO® (Extension for Community Healthcare Outcomes) model.

Results:

From 2016 to 2020, 10 courses were held in the cities of Maputo (n=8), Beira (n=1) and Nampula (n=1). There were 347 participants with an average of 34 participants per course. The courses have recently transitioned from only international faculty to include Mozambican gynecologists, including two fellows from the IGCS Global Curriculum program. A total of 15 ECHO sessions were held with ~25 participants/session, 30 patient cases discussed and 14 lectures delivered.

Conclusion:

This collaboration between Mozambique, Brazil and the US is building local capacity to prevent cervical cancer through training, mentoring and support of local providers. Due to the COVID-19

pandemic, the courses are being transitioned to a virtual format led by the Mozambican doctors with the international faculty joining remotely.


Development of a nomogram to predict interval debulking surgery feasibility when primary cytoreduction is not an option.

A. Rosati1, C. Marchetti1, F. DeFelice3, V. Tranquillo2, V. Iacobelli1, L. Quagliozzi1, V. Salutari1, G. Scambia4, A. Fagotti4

1Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Italy; 2Università Cattolica del Sacro Cuore, Italy; 3Division of Radiotherapy and Oncology, Policlinico Umberto I,Università La Sapienza, Italy; 4Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS,Università Cattolica del Sacro Cuore, Italy Introduction: Neoadjuvant chemotherapy (NACT) and subsequent interval debulking surgery (IDS) has been proposed as an alternative to primary debulking surgery in advanced epithelial ovarian carcinoma. However, no biomarkers of NACT efficacy are reliable in predicting chemo response. This study aimed to identify pre-operative factors of IDS success probability.

Methods: Single institution, retrospective study. Preoperative variables were used to predict the likelihood of IDS using multivariable models. A nomogram was developed and internal validation was performed.

Results: 359 women were submitted to NACT between January 2016 and June 2019.

A complete cytoreductive surgery was achieved in 255 (85%) patients, while an optimal/suboptimal cytoreduction was reached in the remaining 46 (15%) and 58 (16%) did not undergo surgery after NACT. Women with BRCA 1/2 mutation (OR 4.84, CI 95% 1.75—13.34; p= 0.002) and lower tumour load (OR 8.15, CI 95%1.06-62.32; p= 0.043) were more likely to undergo IDS. Among patients who did not undergo IDS, only 5 (13%) presented with BRCA 1/2 mutation, compared with 34 (87%) wild type BRCA (p<0.001). According to the predictive model, we constructed a nomogram to report the probability of IDS using five variables: age, Charlson-comorbidity category, histology, LPS-PIV and BRCA-status (Figure1). The calibration plot demonstrated good agreement between predicted and actual probability of surgical treatment (Figure2).

Conclusions: This is the first nomogram developed in this setting and it might help physicians with their decision-making algorithm.


Integrated model of patient factors, resectability score and surgical complexity index to

predict surgical outcome in debulking surgery for advanced ovarian cancer

L. Hogen1, S. LAFRAMBOISE1, T. May1, A. Ding3, M. Bernardini1

1Princess Margaret Cancer Center, Canada ; 3Queen's University, Canada Objectives:

To assess integrated prediction model (IPM) including patient factors, radiological and surgical complexity scores, as a tool to predict optimal debulking (OD) in patients with newly diagnosed advanced ovarian cancer (AOC).

Methods:

Starting October-1-2018, all patients with newly diagnosed AOC were presented in designated ovarian cancer rounds. Decision for primary debulking (PDS) or neoadjuvant chemotherapy was made based on radiologic and clinical factors. For the IPM we used: 1. Patient factors score (Age, ECOG, albumin) 2. Resectability score: designated radiologists scored specific radiologic criteria (previously identified as associated with suboptimal debulking). 3. Surgical complexity index: surgeons scoring of anticipated procedures required to achieve OD.

Surgical outcome, complications and time to chemotherapy were recorded.

Results:

Ninety-five patients met inclusion criteria (October-2018 to August-2019). Forty-four (47%) underwent PDS: 39 (89%) had optimal debulking: 12 to <1cm and 27 to no visible residual disease. 5/44(11%) had “open-and-close” procedure due to non-resectable disease at the time of surgery.

Median Length of stay was 6 days, (1-14d), time from surgery to chemo was 25 days, (7-42d), and grade 3 complications were recorded in 9 patients (20%).

Patients triaged to PDS were significantly younger (median 57 vs. 67, p<0.0001), had lower patient factors scores (median 0.5 vs 2 p<0.0001), lower resectability score (median 2 vs. 4, p<0.0001) and lower surgical complexity index (median 5 vs. 9 p<0.0001).

Conclusion:

IPM is an effective clinical tool in managing patients with newly diagnosed AOC, and can be utilized to select patients who will benefit from PDS.


Increase in Uterine Serous Carcinoma: Will it Surpass Uterine Endometrioid Cancer? A population analysis of 720,984 uterine cancer patients.

C. Liao1, K. Tran2, M. Richardson2, K. Darcy7, C. Tiao6, C.A. Hamilton5, L. Maxwell6, A. Mann3, J. Cohen2, D.S. Kapp4, J. Chan3

1Kaohsiung Veterans General Hospital, Taiwan; 2University of California, Los Angeles, United States; 3Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, United States; 4Stanford University School of Medicine, United States; 5Inova Schar Cancer Institute, United States; 6Walter Reed National Military Medical Center, United States; 7Virginia Commonwealth University School of Medicine Inova Fairfax Campus, United States Objective: To evaluate the trends of uterine serous carcinoma compared to endometrioid uterine cancer.

Methods: From 2001-2016, incidence rates were estimated from United States Cancer Statistics after correcting for hysterectomy prevalence based on Behavioral Risk Factor Surveillance System data. SEER*Stat and Joinpoint regression were used to calculate incidence (per 100,000) and average annual percent change (AAPC).

Results: Of 720,984 patients (78% White, 10% Black, 8% Hispanic, 3% Asian/Pacific-Islander), the proportion of endometrioid, uterine serous carcinoma (USC), clear-cell, and sarcoma were 73.7%, 5.9%, 1.3%, and 2.0% respectively. In 2016, incidence of endometrioid was approximately 10-fold higher than USC (30.6 vs. 3.6). Of USC patients, the age group with the highest incidence was 75-79 year olds (24.7). Of note, Blacks had the highest incidence of USC at 9.1 compared to 3.0 in Whites.

Over the 15 year study period, there was a 4.6% increase in USC per year compared to no increase in endometrioid cancer (p<0.05).

Of USC patients, the highest increase was in ages 70-74 (AAPC 5.7%). Blacks, Hispanics, and Whites had an annual increase of +6.7%, +8.6%, and +4.3%, respectively. The intersectionality of age 70-74 and Black with USC had an AAPC of +7.3%. A predictive model shows USC incidence would surpass endometrioid in Blacks within 15 years.

Conclusion: Compared to Whites, Blacks have a 3-fold higher overall incidence of uterine serous cancer and is increasing at 6.7% per year. For Black women, this aggressive histology is projected to surpass endometrioid cancer in 15 years.


Clinicopathologic Predictors Of Early Relapse In Advanced Epithelial Ovarian Cancer; Development Of Prediction Models Using Nationwide Data

S. Said1, R. Bretveld2, H. Koffijberg3, G. Sonke4, R.F.P.M. Kruitwagen5, J.A. de Hullu1, A.M. van Altena1, S. Siesling2, M.A. van der Aa2

1Department of Obstetrics and Gynecology, Radboud Institute for Health Sciences, Radboud university medical center, Netherlands; 2Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Netherlands; 3Department of Health Technology and Services Research, Technical Medical Center, University of Twente, Netherlands; 4Department of Medical Oncology, The Netherlands Cancer Institute, Netherlands; 5Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Netherlands Objective:

To identify clinicopathologic factors predictive of early relapse (i.e. a platinum-free interval (PFI) of ≤6 months) in advanced epithelial ovarian cancer (EOC) in first-line treatment, and to develop and internally validate risk prediction models for early relapse.

Methods:

All consecutive patients diagnosed with advanced EOC between 01-01-2008 and 31-12-2015 were identified from the Netherlands Cancer Registry. Patients who underwent debulking and platinum-based chemotherapy as initial EOC treatment were selected. Two prediction models, a pretreatment and postoperative model, were developed. Candidate predictors of early relapse were fitted into multivariable logistic regression models. Model selection was performed using backward selection (p-value<0.20). Model performance was assessed on calibration and discrimination. Internal validation was performed through bootstrapping to correct for model optimism.

Results:

A total of 4,557 advanced EOC patients were identified, including 3,171 late or non-relapsers and 1,302 early relapsers. Early relapsers were more likely to have FIGO stage IV, mucinous or clear cell type EOC, ascites, >1 cm residual disease, and to have undergone interval debulking. The final pretreatment model demonstrated subpar model performance (AUC=0.65 [95%-CI 0.64-0.67]). The final postoperative model based on FIGO stage, histologic subtype, presence of ascites, type of debulking, and residual disease after debulking, demonstrated good model performance (AUC=0.72 [95%-CI 0.71-0.74]). Bootstrap validation revealed minimal optimism of the final postoperative model.

Conclusion:

A good (postoperative) discriminative model has been developed and presented online that predicts the risk of early relapse in advanced EOC patients. Although external validation is still required, this prediction model can support treatment decision-making in daily clinical practice.

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