Intraoperative Capsule Rupture, Postoperative Chemotherapy, and Survival of Women With Stage I Epithelial Ovarian Cancer

Koji Matsuo, Hiroko Machida, Wataru Yamagami, Yasuhiko Ebina, Yoichi Kobayashi, Tsutomu Tabata, Masanori Kaneuchi, Satoru Nagase, Takayuki Enomoto, Mikio Mikami

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To examine the incidence and prognostic effects of intraoperative capsule rupture and to assess the effectiveness of postoperative chemotherapy for intraoperative tumor rupture in apparent stage I epithelial ovarian cancer. METHODS: This is a society-based retrospective observational study in Japan that examined 15,163 women with stage IA-IC1 epithelial ovarian cancer who underwent primary surgical treatment between 2002 and 2015. Associations between intraoperative capsule rupture and cause-specific survival, and between postoperative chemotherapy and cause-specific survival among intraoperatively ruptured cases were examined by histology type (clear cell n=6,107, endometrioid n=3,910, mucinous n=3,382, and serous n=1,764). RESULTS: Clear cell histology had the highest risk of intraoperative capsule rupture (57.3%), followed by endometrioid (48.8%), serous (41.8%), and mucinous (32.0%) histologies (P<.001). On multivariable analysis, clear cell type exhibited the largest effect of intraoperative capsule rupture on cause-specific survival (adjusted hazard ratio [HR] 1.99, 95% CI 1.45-2.75), followed by serous (adjusted HR, 1.61, 95% CI 0.84-3.11), mucinous (adjusted HR 1.28, 95% CI 0.79-2.09), and endometrioid (adjusted HR, 1.14, 95% CI 0.64-2.01) tumors. Postoperative chemotherapy for intraoperatively ruptured cases did not improve cause-specific survival in any histologic types in multivariable analysis: clear cell, adjusted HR 0.86, 95% CI 0.56-1.31; serous, adjusted HR 1.08, 95% CI 0.42-2.74; mucinous, adjusted HR 1.11, 95% CI 0.55-2.27; and endometrioid, adjusted HR 2.81, 95% CI 0.85-9.30 (all, P>.05). In the cohort-level analysis of ruptured cases (n=7,227), postoperative chemotherapy use has significantly decreased in mucinous (16.3% relative decrease), endometrioid (13.1% relative decrease), and clear cell (9.3% relative decrease) (all, P<.05); but, the cohort-level 5-year cause-specific survival rate did not change over time (all, P>.05). CONCLUSION: Among apparent stage I epithelial ovarian cancer, the clear cell type possesses a disproportionally high risk of capsule rupture during adnexectomy and is associated with the most adverse effect on survival. A decrease in the use of postoperative chemotherapy for intraoperatively ruptured cases in Japan is likely the result of increasing awareness of the absence of survival benefits.

Original languageEnglish
Pages (from-to)1017-1026
Number of pages10
JournalObstetrics and gynecology
Volume134
Issue number5
DOIs
Publication statusPublished - 2019 Nov 1

Fingerprint

Capsules
Rupture
Drug Therapy
Survival
Histology
Japan
Observational Studies
Cohort Studies
Retrospective Studies
Ovarian epithelial cancer
Incidence
Neoplasms
Therapeutics

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

Intraoperative Capsule Rupture, Postoperative Chemotherapy, and Survival of Women With Stage I Epithelial Ovarian Cancer. / Matsuo, Koji; Machida, Hiroko; Yamagami, Wataru; Ebina, Yasuhiko; Kobayashi, Yoichi; Tabata, Tsutomu; Kaneuchi, Masanori; Nagase, Satoru; Enomoto, Takayuki; Mikami, Mikio.

In: Obstetrics and gynecology, Vol. 134, No. 5, 01.11.2019, p. 1017-1026.

Research output: Contribution to journalArticle

Matsuo, K, Machida, H, Yamagami, W, Ebina, Y, Kobayashi, Y, Tabata, T, Kaneuchi, M, Nagase, S, Enomoto, T & Mikami, M 2019, 'Intraoperative Capsule Rupture, Postoperative Chemotherapy, and Survival of Women With Stage I Epithelial Ovarian Cancer', Obstetrics and gynecology, vol. 134, no. 5, pp. 1017-1026. https://doi.org/10.1097/AOG.0000000000003507
Matsuo, Koji ; Machida, Hiroko ; Yamagami, Wataru ; Ebina, Yasuhiko ; Kobayashi, Yoichi ; Tabata, Tsutomu ; Kaneuchi, Masanori ; Nagase, Satoru ; Enomoto, Takayuki ; Mikami, Mikio. / Intraoperative Capsule Rupture, Postoperative Chemotherapy, and Survival of Women With Stage I Epithelial Ovarian Cancer. In: Obstetrics and gynecology. 2019 ; Vol. 134, No. 5. pp. 1017-1026.
@article{4a62d45baebc408091181a7edf2bc310,
title = "Intraoperative Capsule Rupture, Postoperative Chemotherapy, and Survival of Women With Stage I Epithelial Ovarian Cancer",
abstract = "OBJECTIVE: To examine the incidence and prognostic effects of intraoperative capsule rupture and to assess the effectiveness of postoperative chemotherapy for intraoperative tumor rupture in apparent stage I epithelial ovarian cancer. METHODS: This is a society-based retrospective observational study in Japan that examined 15,163 women with stage IA-IC1 epithelial ovarian cancer who underwent primary surgical treatment between 2002 and 2015. Associations between intraoperative capsule rupture and cause-specific survival, and between postoperative chemotherapy and cause-specific survival among intraoperatively ruptured cases were examined by histology type (clear cell n=6,107, endometrioid n=3,910, mucinous n=3,382, and serous n=1,764). RESULTS: Clear cell histology had the highest risk of intraoperative capsule rupture (57.3{\%}), followed by endometrioid (48.8{\%}), serous (41.8{\%}), and mucinous (32.0{\%}) histologies (P<.001). On multivariable analysis, clear cell type exhibited the largest effect of intraoperative capsule rupture on cause-specific survival (adjusted hazard ratio [HR] 1.99, 95{\%} CI 1.45-2.75), followed by serous (adjusted HR, 1.61, 95{\%} CI 0.84-3.11), mucinous (adjusted HR 1.28, 95{\%} CI 0.79-2.09), and endometrioid (adjusted HR, 1.14, 95{\%} CI 0.64-2.01) tumors. Postoperative chemotherapy for intraoperatively ruptured cases did not improve cause-specific survival in any histologic types in multivariable analysis: clear cell, adjusted HR 0.86, 95{\%} CI 0.56-1.31; serous, adjusted HR 1.08, 95{\%} CI 0.42-2.74; mucinous, adjusted HR 1.11, 95{\%} CI 0.55-2.27; and endometrioid, adjusted HR 2.81, 95{\%} CI 0.85-9.30 (all, P>.05). In the cohort-level analysis of ruptured cases (n=7,227), postoperative chemotherapy use has significantly decreased in mucinous (16.3{\%} relative decrease), endometrioid (13.1{\%} relative decrease), and clear cell (9.3{\%} relative decrease) (all, P<.05); but, the cohort-level 5-year cause-specific survival rate did not change over time (all, P>.05). CONCLUSION: Among apparent stage I epithelial ovarian cancer, the clear cell type possesses a disproportionally high risk of capsule rupture during adnexectomy and is associated with the most adverse effect on survival. A decrease in the use of postoperative chemotherapy for intraoperatively ruptured cases in Japan is likely the result of increasing awareness of the absence of survival benefits.",
author = "Koji Matsuo and Hiroko Machida and Wataru Yamagami and Yasuhiko Ebina and Yoichi Kobayashi and Tsutomu Tabata and Masanori Kaneuchi and Satoru Nagase and Takayuki Enomoto and Mikio Mikami",
year = "2019",
month = "11",
day = "1",
doi = "10.1097/AOG.0000000000003507",
language = "English",
volume = "134",
pages = "1017--1026",
journal = "Obstetrics and Gynecology",
issn = "0029-7844",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Intraoperative Capsule Rupture, Postoperative Chemotherapy, and Survival of Women With Stage I Epithelial Ovarian Cancer

AU - Matsuo, Koji

AU - Machida, Hiroko

AU - Yamagami, Wataru

AU - Ebina, Yasuhiko

AU - Kobayashi, Yoichi

AU - Tabata, Tsutomu

AU - Kaneuchi, Masanori

AU - Nagase, Satoru

AU - Enomoto, Takayuki

AU - Mikami, Mikio

PY - 2019/11/1

Y1 - 2019/11/1

N2 - OBJECTIVE: To examine the incidence and prognostic effects of intraoperative capsule rupture and to assess the effectiveness of postoperative chemotherapy for intraoperative tumor rupture in apparent stage I epithelial ovarian cancer. METHODS: This is a society-based retrospective observational study in Japan that examined 15,163 women with stage IA-IC1 epithelial ovarian cancer who underwent primary surgical treatment between 2002 and 2015. Associations between intraoperative capsule rupture and cause-specific survival, and between postoperative chemotherapy and cause-specific survival among intraoperatively ruptured cases were examined by histology type (clear cell n=6,107, endometrioid n=3,910, mucinous n=3,382, and serous n=1,764). RESULTS: Clear cell histology had the highest risk of intraoperative capsule rupture (57.3%), followed by endometrioid (48.8%), serous (41.8%), and mucinous (32.0%) histologies (P<.001). On multivariable analysis, clear cell type exhibited the largest effect of intraoperative capsule rupture on cause-specific survival (adjusted hazard ratio [HR] 1.99, 95% CI 1.45-2.75), followed by serous (adjusted HR, 1.61, 95% CI 0.84-3.11), mucinous (adjusted HR 1.28, 95% CI 0.79-2.09), and endometrioid (adjusted HR, 1.14, 95% CI 0.64-2.01) tumors. Postoperative chemotherapy for intraoperatively ruptured cases did not improve cause-specific survival in any histologic types in multivariable analysis: clear cell, adjusted HR 0.86, 95% CI 0.56-1.31; serous, adjusted HR 1.08, 95% CI 0.42-2.74; mucinous, adjusted HR 1.11, 95% CI 0.55-2.27; and endometrioid, adjusted HR 2.81, 95% CI 0.85-9.30 (all, P>.05). In the cohort-level analysis of ruptured cases (n=7,227), postoperative chemotherapy use has significantly decreased in mucinous (16.3% relative decrease), endometrioid (13.1% relative decrease), and clear cell (9.3% relative decrease) (all, P<.05); but, the cohort-level 5-year cause-specific survival rate did not change over time (all, P>.05). CONCLUSION: Among apparent stage I epithelial ovarian cancer, the clear cell type possesses a disproportionally high risk of capsule rupture during adnexectomy and is associated with the most adverse effect on survival. A decrease in the use of postoperative chemotherapy for intraoperatively ruptured cases in Japan is likely the result of increasing awareness of the absence of survival benefits.

AB - OBJECTIVE: To examine the incidence and prognostic effects of intraoperative capsule rupture and to assess the effectiveness of postoperative chemotherapy for intraoperative tumor rupture in apparent stage I epithelial ovarian cancer. METHODS: This is a society-based retrospective observational study in Japan that examined 15,163 women with stage IA-IC1 epithelial ovarian cancer who underwent primary surgical treatment between 2002 and 2015. Associations between intraoperative capsule rupture and cause-specific survival, and between postoperative chemotherapy and cause-specific survival among intraoperatively ruptured cases were examined by histology type (clear cell n=6,107, endometrioid n=3,910, mucinous n=3,382, and serous n=1,764). RESULTS: Clear cell histology had the highest risk of intraoperative capsule rupture (57.3%), followed by endometrioid (48.8%), serous (41.8%), and mucinous (32.0%) histologies (P<.001). On multivariable analysis, clear cell type exhibited the largest effect of intraoperative capsule rupture on cause-specific survival (adjusted hazard ratio [HR] 1.99, 95% CI 1.45-2.75), followed by serous (adjusted HR, 1.61, 95% CI 0.84-3.11), mucinous (adjusted HR 1.28, 95% CI 0.79-2.09), and endometrioid (adjusted HR, 1.14, 95% CI 0.64-2.01) tumors. Postoperative chemotherapy for intraoperatively ruptured cases did not improve cause-specific survival in any histologic types in multivariable analysis: clear cell, adjusted HR 0.86, 95% CI 0.56-1.31; serous, adjusted HR 1.08, 95% CI 0.42-2.74; mucinous, adjusted HR 1.11, 95% CI 0.55-2.27; and endometrioid, adjusted HR 2.81, 95% CI 0.85-9.30 (all, P>.05). In the cohort-level analysis of ruptured cases (n=7,227), postoperative chemotherapy use has significantly decreased in mucinous (16.3% relative decrease), endometrioid (13.1% relative decrease), and clear cell (9.3% relative decrease) (all, P<.05); but, the cohort-level 5-year cause-specific survival rate did not change over time (all, P>.05). CONCLUSION: Among apparent stage I epithelial ovarian cancer, the clear cell type possesses a disproportionally high risk of capsule rupture during adnexectomy and is associated with the most adverse effect on survival. A decrease in the use of postoperative chemotherapy for intraoperatively ruptured cases in Japan is likely the result of increasing awareness of the absence of survival benefits.

UR - http://www.scopus.com/inward/record.url?scp=85074118383&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85074118383&partnerID=8YFLogxK

U2 - 10.1097/AOG.0000000000003507

DO - 10.1097/AOG.0000000000003507

M3 - Article

C2 - 31599824

AN - SCOPUS:85074118383

VL - 134

SP - 1017

EP - 1026

JO - Obstetrics and Gynecology

JF - Obstetrics and Gynecology

SN - 0029-7844

IS - 5

ER -