149 results found
Fotopoulou C, Rockall A, Lu H, et al., 2021, Validation analysis of the novel imaging-based prognostic radiomic signature in patients undergoing primary surgery for advanced high-grade serous ovarian cancer (HGSOC), BRITISH JOURNAL OF CANCER, ISSN: 0007-0920
Lu H, Cunnea P, Nixon K, et al., 2021, Discovery of a biomarker candidate for surgical stratification in high-grade serous ovarian cancer, British Journal of Cancer, Vol: 124, Pages: 1286-1293, ISSN: 0007-0920
Background: Maximal effort cytoreductive surgery is associated with improved outcomes in advanced high-grade serous ovarian cancer (HGSOC). However, despite complete gross resection (CGR), there is a percentage of patients who will relapse and die early. The aim of this study is to identify potential candidate biomarkers to help personalise surgical radicality.Methods: 136 advanced HGSOC cases who underwent CGR were identified from three public transcriptomic datasets. Candidate prognostic biomarkers were discovered in this cohort by Cox regression analysis, and further validated by targeted RNA-sequencing in HGSOC cases from Imperial College Healthcare NHS Trust (n = 59), and a public dataset. Gene set enrichment analysis was performed to understand the biological significance of the candidate biomarker.Results: We identified ALG5 as a prognostic biomarker for early tumour progression in advanced HGSOC despite CGR (HR = 2.42, 95% CI (1.57–3.75), p < 0.0001). The prognostic value of this new candidate biomarker was additionally confirmed in two independent datasets (HR = 1.60, 95% CI (1.03–2.49), p = 0.0368; HR = 3.08, 95% CI (1.07–8.81), p = 0.0365). Mechanistically, the oxidative phosphorylation was demonstrated as a potential biological pathway of ALG5-high expression in patients with early relapse (p < 0.001).Conclusion: ALG5 has been identified as an independent prognostic biomarker for poor prognosis in advanced HGSOC patients despite CGR. This sets a promising platform for biomarker combinations and further validations towards future personalised surgical care.
Hu Z, Cunnea P, Zhong Z, et al., 2021, The Oxford Classic links epithelial-to-mesenchymal transition to immunosuppression in poor prognosis ovarian cancers, Clinical Cancer Research, Vol: 27, Pages: 1570-1579, ISSN: 1078-0432
Purpose: Using RNA sequencing, we recently developed the 52-gene–based Oxford classifier of carcinoma of the ovary (Oxford Classic, OxC) for molecular stratification of serous ovarian cancers (SOCs) based on the molecular profiles of their cell of origin in the fallopian tube epithelium. Here, we developed a 52-gene NanoString panel for the OxC to test the robustness of the classifier.Experimental Design: We measured the expression of the 52 genes in an independent cohort of prospectively collected SOC samples (n = 150) from a homogenous cohort who were treated with maximal debulking surgery and chemotherapy. We performed data mining of published expression profiles of SOCs and validated the classifier results on tissue arrays comprising 137 SOCs.Results: We found evidence of profound nongenetic heterogeneity in SOCs. Approximately 20% of SOCs were classified as epithelial-to-mesenchymal transition–high (EMT-high) tumors, which were associated with poor survival. This was independent of established prognostic factors, such as tumor stage, tumor grade, and residual disease after surgery (HR, 3.3; P = 0.02). Mining expression data of 593 patients revealed a significant association between the EMT scores of tumors and the estimated fraction of alternatively activated macrophages (M2; P < 0.0001), suggesting a mechanistic link between immunosuppression and poor prognosis in EMT-high tumors.Conclusions: The OxC-defined EMT-high SOCs carry particularly poor prognosis independent of established clinical parameters. These tumors are associated with high frequency of immunosuppressive macrophages, suggesting a potential therapeutic target to improve clinical outcome.
Fotopoulou C, Berg T, Hausen A, et al., 2019, Continuous low flow ascites drainage through the urinary bladder via the Alfapump system in palliative patients with malignant ascites., BMC Palliat Care, Vol: 18
BACKGROUND: Malignant Ascites (MA) is a therapeutic dilemma significantly impairing patients' quality of life (QoL). The Sequana Medical alfapump System (AP), a subcutaneous, externally rechargeable, implantable device, continually draining ascites via the urinary bladder, has been well established in liver cirrhosis, but not yet in MA. The AP-system was evaluated in cancer patients in reducing the need for large volume paracentesis (LVP). METHODS: A retrospective multicentre evaluation of all eligible patients who received an AP for MA-palliation was performed. AP was evaluated for its ability to reduce LVP and cross-correlated with adverse events (AE), survival and retrospective physician-reported QoL. RESULTS: Seventeen patients with median age of 63 years (range: 18-81), 70.6% female, across 7 primary tumour types were analysed. Median duration of AP-implantation was 60 min (range: 30-270) and median post-implantation hospital stay: 4 days (range: 2-24). Twelve protocol-defined AE occurred in 5 patients (29.4%): 4 kidney failures, 4 pump/catheter-related blockages, 3 infections/peritonitis and 1 wound dehiscence. Median ascitic volume (AV) pumped daily was 303.6 ml/day (range:5.6-989.3) and median total AV drained was 28 L (range: 1-638.6). Median patient post-AP-survival was 111 days (range:10-715) and median pump survival was 89 days (range: 0-715). Median number of paracenteses was 4 (range: 1-15) per patient pre-implant versus 1 (range: 0-1) post-implant (p = 0.005). 71% of patients were reported to have an improvement of at least one physician reported QoL-parameters. CONCLUSIONS: AP appears to be effective in palliating patients with MA by an acceptable morbidity profile. Its broader implementation in oncology services should be further explored. TRIAL REGISTRATION: NCT03200106; June 27, 2017.
Cunnea P, Gorgy T, Petkos K, et al., 2018, Clinical value of bioelectrical properties of cancerous tissue in advanced epithelial ovarian cancer patients, Scientific Reports, Vol: 8, Pages: 1-12, ISSN: 2045-2322
Currently, there are no valid pre-operatively established biomarkers or algorithms that can accurately predict surgical and clinical outcome for patients with advanced epithelial ovarian cancer (EOC). In this study, we suggest that profiling of tumour parameters such as bioelectrical-potential and metabolites, detectable by electronic sensors, could facilitate the future development of devices to better monitor disease and predict surgical and treatment outcomes. Biopotential was recorded, using a potentiometric measurement system, in ex vivo paired non-cancerous and cancerous omental tissues from advanced stage EOC (n = 36), and lysates collected for metabolite measurement by microdialysis. Consistently different biopotential values were detected in cancerous tissue versus non-cancerous tissue across all cases (p < 0.001). High tumour biopotential levels correlated with advanced tumour stage (p = 0.048) and tumour load, and negatively correlated with stroma. Within our EOC cohort and specifically the high-grade serous subtype, low biopotential levels associated with poorer progression-free survival (p = 0.0179, p = 0.0143 respectively). Changes in biopotential levels significantly correlated with common apoptosis related pathways. Lactate and glucose levels measured in paired tissues showed significantly higher lactate/glucose ratio in tissues with low biopotential (p < 0.01, n = 12). Our study proposes the feasibility of biopotential and metabolite monitoring as a biomarker modality profiling EOC to predict surgical and clinical outcomes.
Fotopoulou C, Sehouli J, Mahner S, et al., 2018, HIPEC: HOPE or HYPE in the fight against advanced ovarian cancer?, ANNALS OF ONCOLOGY, Vol: 29, Pages: 1610-1613, ISSN: 0923-7534
Kyrgiou M, Kalliala I, Mitra A, et al., 2017, Immediate referral to colposcopy versus cytological surveillance for minor cervical cytological abnormalities in the absence of HPV test, Cochrane Database of Systematic Reviews, Vol: 1, ISSN: 1469-493X
BackgroundA significant number of women are diagnosed with minor cytological abnormalities on cervical screening. Many authorities recommendsurveillance as spontaneous regression might occur. However,attendance for cytological follow-up decreases with time and might putsome women at risk of developing invasive disease.ObjectivesTo assess the optimum management strategy for women with minor cervical cytological abnormalities (atypical squamous cells ofundetermined significance - ASCUS or low-grade squamous intra-epithelial lesions - LSIL) at primary screening in the absence of HPV(human papillomavirus) DNA test.Search methodsWe searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL Issue 4 2016), MEDLINE,and Embase from inception to 21 April 2016.Selection criteriaWe included randomised controlled trials (RCTs) comparing immediate colposcopy to cytological surveillance in women with atyp-ical squamous cells of undetermined significance (ASCUS/borderline) or low-grade squamous intra-epithelial lesions (LSIL/milddyskaryosis).Data collection and analysisThe primary outcome measure studied was the occurrence of cervicalintra-epithelial neoplasia (CIN). The secondary outcome measuresstudied included default rate, clinically significant anxiety and depression, and other self-reported adverse effects.We classified studies according to period of surveillance, at 6, 12, 24 or 36 months, as well as at 18 months, excluding a possibleexit-examination. We calculated pooled risk ratios (RR) and 95%confidence intervals (CI) using a random-effects model with inversevariance weighting. Inter-study heterogeneity was assessedwith I2statistics.Main resultsWe identified five RCTs with 11,466 participants that fulfilledthe inclusion criteria. There were 18 cases of invasive cervical cancer,seven in the immediate colposcopy and 11 in the cytological surveillance groups, respectively. Although immediate colposcopy detectsCIN2+ and CIN3+ earlier
Fotopoulou C, Sehouli J, Aletti G, et al., 2017, Value of neoadjuvant chemotherapy for newly diagnosed advanced ovarian cancer: a European perspective., Journal of Clinical Oncology, Vol: 35, Pages: 587-590, ISSN: 1527-7755
Alifrangis C, Thornton A, Fotopoulou C, et al., 2016, Response to sunitinib (Sutent) in chemotherapy refractory clear cell ovarian cancer, Gynecologic Oncology Reports, Vol: 18, Pages: 42-44, ISSN: 2352-5789
Kyrgiou M, Kalliala I, Mitra A, et al., 2016, Immediate referral to colposcopy vs. cytological surveillance for low-grade cervical cytological abnormalities in the absence of HPV test: A systematic review and a meta-analysis of the literature, International Journal of Cancer, Vol: 140, Pages: 216-223, ISSN: 1097-0215
We performed a systematic review and meta-analysis to explore the optimum management strategy for women with atypical squamous cells of undetermined significance (ASCUS/borderline) or low-grade squamous intra-epithelial lesions (LSIL/mild dyskaryosis) cytological abnormalities at primary screening in the absence of HPV DNA test. We searched MEDLINE, EMBASE and CENTRAL and included randomised controlled trials comparing immediate colposcopy to cytological surveillance in women with ASCUS/LSIL. The outcomes of interest were occurrence of different histological grades of cervical intra-epithelial neoplasia (CIN) and default rates during follow-up. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated using a random-effect model and with inverse variance weighting. Interstudy heterogeneity was assessed using I2 statistics. Six RCTs were included. Immediate colposcopy significantly increased detection of unimportant abnormalities as opposed to repeat cytology (koilocytosis:32% vs.21%, RR:1.49, 95%CI=1.17-1.90); CIN1:21% vs.8%, RR:2.58, 95%CI=1.69-3.94). Although immediate colposcopy detected CIN2, CIN2+ and CIN3+ earlier than cytology, the differences were no longer observed at 24 months (CIN3+:10.3 vs.11.9%, RR:1.02, 95%CI=0.53-1.97), with significant inters-study heterogeneity (p<0.001,I2=93%). Default risk was significantly higher for repeat cytology (6months: 6.3 vs.13.3%, RR:3.85, 95%CI=1.27-11.63; 12months: 6.3 vs.14.8%, RR:6.39, 95%CI=1.24-32.95; 24 months: 0.9 vs.16.1%, RR:19.1,95%CI=9.02-40.4). Detection of CIN2+ for cytological surveillance over two years is similar to that of immediate colposcopy, although patients may default. Colposcopy may be first choice when good compliance is not assured, but may increase detection of insignificant lesions. This emphasizes the need for a reflex triage test to distinguish women who need diagnostic work-up from those who can return to routine recall.
Lago V, Minig L, Fotopoulou C, 2016, Incidence of lymph node metastases in apparent early-stage low-grade epithelial ovarian cancer: a comprehensive review, International Journal of Gynecological Cancer, Vol: 26, Pages: 1407-1414, ISSN: 1525-1438
Objectives: This study aimed to determine the incidence of lymph node (LN) metastases in presumed stage I-II low-grade epithelial ovarian cancer (EOC).Methods: Eligible studies were identified from MEDLINE and EMBASE (time frame, 2015–1975), that analyzed patients with clinical or radiologic presumed early-stage EOC who underwent a complete pelvic and para-aortic lymphadenectomy as part of their surgical staging. The number and site of dissected and involved LNs and the correlation with overall outcome are analyzed. The term low grade and also the older term well differentiated were used.Results: Thirteen of 978 identified studies were selected, and 13 of 75 studies were identified as eligible. A total of 1403 patients were analyzed in these 13 retrospective studies. The final International Federation of Gynecology and Obstetrics staging after completed surgical staging was I to II in 912 patients (65%). A total of 338 patients (24%) had grade 1 tumors whereas 473 patients (34%) had grade 2, and 502 patients (36%) had grade 3 tumors. Systematic lymphadenectomy was performed in 1159 patients (83%), whereof 1142 (82%) were pelvic and para-aortic LN dissections.In 185 patients (13%), an upstaging from an apparent clinical stage I-II to IIIC occurred because of LN involvement: 64 (35%) of the patients had only pelvic LNs metastases, 69 (37%) had only para-aortic LNs metastasis, and 51 (28%) had both a pelvic and para-aortic LN involvement. When analyzing only the patients with low-grade (grade 1 as the old classification) presumed early-stage disease (n = 273), only 8 patients (2.9%; range, 0–6.2) were identified with LNs metastases present.Conclusions: The incidence of occult LN metastases in apparent early-stage low-grade EOC is 2.9% in a metaanalysis of retrospective studies. Future larger-scale prospectively assessed studies with established surgical quality of the LN dissection are warranted to establish the true incidence of LN metastasis in presumed e
Kumar S, Long J, Rudge G, et al., 2016, SOCQER-2 Study: Preliminary analysis of multicentre recruitment after surgery in advanced ovarian cancer, INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER, Vol: 26, Pages: 832-833, ISSN: 1048-891X
Querleu D, Planchamp F, Chiva L, et al., 2016, European Society of Gynaecologic Oncology Quality Indicators for Advanced Ovarian Cancer Surgery, INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER, Vol: 26, Pages: 1354-1363, ISSN: 1048-891X
du Bois A, Ewald-Riegler N, de Gregorio N, et al., 2016, Borderline tumours of the ovary: A cohort study of the Arbeitsgemeinschaft Gynakologische Onkologie AGO Study Group (vol 49, pg 1905, 2013), EUROPEAN JOURNAL OF CANCER, Vol: 65, Pages: 192-193, ISSN: 0959-8049
Fotopoulou C, 2016, Cervical intraepithelial neoplasia: screening and management (vol 77, pg C118, 2016), BRITISH JOURNAL OF HOSPITAL MEDICINE, Vol: 77, Pages: 544-544, ISSN: 1750-8460
Nasser S, Lazaridis A, Evangelou M, et al., 2016, Correlation of pre-operative CT findings with surgical & histological tumor dissemination patterns at cytoreduction for primary advanced and relapsed epithelial ovarian cancer: A retrospective evaluation, Gynecologic Oncology, Vol: 143, Pages: 264-269, ISSN: 1095-6859
ObjectivesComputed tomography (CT) is an essential part of preoperative planning prior to cytoreductive surgery for primary and relapsed epithelial ovarian cancer (EOC). Our aim is to correlate pre-operative CT results with intraoperative surgical and histopathological findings at debulking surgery.MethodsWe performed a systematic comparison of intraoperative tumor dissemination patterns and surgical resections with preoperative CT assessments of infiltrative disease at key resection sites, in women who underwent multivisceral debulking surgery due to EOC between January 2013 and December 2014 at a tertiary referral center. The key sites were defined as follows: diaphragmatic involvement(DI), splenic disease (SI), large (LBI) and small (SBI) bowel involvement, rectal involvement (RI), porta hepatis involvement (PHI), mesenteric disease (MI) and lymph node involvement (LNI).ResultsA total of 155 patients, mostly with FIGO stage IIIC disease (65%) were evaluated (primary = 105, relapsed = 50). Total macroscopic cytoreduction rates were: 89%. Pre-operative CT findings displayed high specificity across all tumor sites apart from the retroperitoneal lymph node status, with a specificity of 65%.The ability however of the CT to accurately identify sites affected by invasive disease was relatively low with the following sensitivities as relating to final histology:32% (DI), 26% (SI), 46% (LBI), 44% (SBI), 39% (RI), 57% (PHI), 31% (MI), 63% (LNI).ConclusionPre-operative CT imaging shows high specificity but low sensitivity in detecting tumor involvement at key sites in ovarian cancer surgery. CT findings alone should not be used for surgical decision making.
Mitra A, Tzafetas M, Lyons D, et al., 2016, Cervical intraepithelial neoplasia: screening and management., British Journal of Hospital Medicine, Vol: 77, Pages: C118-C123, ISSN: 1750-8460
Globally, cervical cancer remains the fourth most common female malignancy, with over 528 000 new cases and 266 000 deaths in 2012; 84% of these occurred in low-resource settings (Ferlay et al, 2015). Cervical cancer is largely preventable through organized screening programmes, which can detect pre-malignant disease and treat it before invasive disease develops. Cervical intraepithelial neoplasia is the pre-malignant, dysplastic condition of the uterine cervix, which in a small proportion of cases will eventually progress to invasive cervical cancer if left untreated.
Meinhold-Heerlein I, Fotopoulou C, Harter P, et al., 2016, The new WHO classification of ovarian, fallopian tube, and primary peritoneal cancer and its clinical implications (vol 293, pg 695, 2016), ARCHIVES OF GYNECOLOGY AND OBSTETRICS, Vol: 293, Pages: 1367-1367, ISSN: 0932-0067
Fotopoulou C, Jones BP, Savvatis K, et al., 2016, Maximal effort cytoreductive surgery for disseminated ovarian cancer in a UK setting: challenges and possibilities, Gynecologic Oncology, ISSN: 1095-6859
OBJECTIVE: To assess surgical morbidity and mortality of maximal effort cytoreductive surgery for disseminated epithelial ovarian cancer (EOC) in a UK tertiary center. METHODS/MATERIALS: A monocentric prospective analysis of surgical morbidity and mortality was performed for all consecutive EOC patients who underwent extensive cytoreductive surgery between 01/2013 and 12/2014. Surgical complexity was assessed by the Mayo clinic surgical complexity score (SCS). Only patients with high SCS ≥5 were included in the analysis. RESULTS: We evaluated 118 stage IIIC/IV patients, with a median age of 63 years (range 19-91); 47.5 % had ascites and 29 % a pleural effusion. Median duration of surgery was 247 min (range 100-540 min). Median surgical complexity score was 10 (range 5-15) consisting of bowel resection (71 %), stoma formation (13.6 %), diaphragmatic stripping/resection (67 %), liver/liver capsule resection (39 %), splenectomy (20 %), resection stomach/lesser sac (26.3 %), pleurectomy (17 %), coeliac trunk/subdiaphragmatic lymphadenectomy (8 %). Total macroscopic tumor clearance rate was 89 %. Major surgical complication rate was 18.6 % (n = 22), with a 28-day and 3-month mortality of 1.7 and 3.4 %, respectively. The anastomotic leak rate was 0.8 %; fistula/bowel perforation 3.4 %; thromboembolism 3.4 % and reoperation 4.2 %. Median intensive care unit and hospital stay were 1.7 (range 0-104) and 8 days (range 4-118), respectively. Four patients (3.3 %) failed to receive chemotherapy within the first 8 postoperative weeks. CONCLUSIONS: Maximal effort cytoreductive surgery for EOC is feasible within a UK setting with acceptable morbidity, low intestinal stoma rates and without clinically relevant delays to postoperative chemotherapy. Careful patient selection, and coordinated multidisciplinary effort appear to be the key for good outcome. Future ev
Meinhold-Heerlein I, Fotopoulou C, Harter P, et al., 2016, The new WHO classification of ovarian, fallopian tube, and primary peritoneal cancer and its clinical implications, ARCHIVES OF GYNECOLOGY AND OBSTETRICS, Vol: 293, Pages: 695-700, ISSN: 0932-0067
Sehouli J, Woopen H, Pavel M, et al., 2016, Neuroendocrine Neoplasms of the Ovary: A Retrospective Study of the North Eastern German Society of Gynecologic Oncology (NOGGO), ANTICANCER RESEARCH, Vol: 36, Pages: 1003-1009, ISSN: 0250-7005
Naik R, Bayne L, Founta C, et al., 2016, Patient Support Groups Identifying Clinical Equipoise in UK Gynaecological Oncology Surgeons as the Basis for Trials in Ultraradical Surgery for Advanced Ovarian Cancer, International Journal of Gynecological Cancer, Vol: 26, Pages: 91-94, ISSN: 1048-891X
Fotopoulou C, El-Balat A, du Bois A, et al., 2015, Systematic pelvic and paraaortic lymphadenectomy in early high-risk or advanced endometrial cancer, ARCHIVES OF GYNECOLOGY AND OBSTETRICS, Vol: 292, Pages: 1321-1327, ISSN: 0932-0067
Kessler M, Hoffmann K, Brinkmann V, et al., 2015, The Notch and Wnt pathways regulate stemness and differentiation in human fallopian tube organoids, NATURE COMMUNICATIONS, Vol: 6, ISSN: 2041-1723
Hunsicker O, Fotopoulou C, Pietzner K, et al., 2015, Hemodynamic Consequences of Malignant Ascites in Epithelial Ovarian Cancer Surgery A Prospective Substudy of a Randomized Controlled Trial, MEDICINE, Vol: 94, ISSN: 0025-7974
Bowtell DD, Boehm S, Ahmed AA, et al., 2015, Rethinking ovarian cancer II: reducing mortality from high-grade serous ovarian cancer, Nature Reviews Cancer, Vol: 15, Pages: 668-679, ISSN: 1474-175X
High-grade serous ovarian cancer (HGSOC) accounts for 70–80% of ovarian cancer deaths, and overall survival has not changed significantly for several decades. In this Opinion article, we outline a set of research priorities that we believe will reduce incidence and improve outcomes for women with this disease. This 'roadmap' for HGSOC was determined after extensive discussions at an Ovarian Cancer Action meeting in January 2015.
Nasser S, Lazaridis A, Jones B, et al., 2015, CORRELATION OF PRE-OPERATIVE CT FINDINGS WITH SURGICAL & HISTOLOGICAL TUMOR DISSEMINATION PATTERNS AT CYTOREDUCTION FOR ADVANCED OVARIAN CANCER: A RETROSPECTIVE EVALUATION, INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER, Vol: 25, Pages: 502-502, ISSN: 1048-891X
Meinhold-Heerlein I, Fotopoulou C, Harter P, et al., 2015, Statement by the Kommission Ovar of the AGO: The New FIGO and WHO Classifications of Ovarian, Fallopian Tube and Primary Peritoneal Cancer, GEBURTSHILFE UND FRAUENHEILKUNDE, Vol: 75, Pages: 1021-1027, ISSN: 0016-5751
Fotopoulou C, Sehouli J, Ewald-Riegler N, et al., 2015, The Value of Serum CA125 in the Diagnosis of Borderline Tumors of the Ovary A Subanalysis of the Prospective Multicenter ROBOT Study, INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER, Vol: 25, Pages: 1248-1252, ISSN: 1048-891X
Matsuo K, Hasegawa K, Yoshino K, et al., 2015, Venous thromboembolism, interleukin-6 and survival outcomes in patients with advanced ovarian clear cell carcinoma, European Journal of Cancer, Vol: 51, Pages: 1978-1988, ISSN: 1879-0852
Background:We compared survival outcomes and risk of venous thromboembolism (VTE) among patients with advanced and early-stage ovarian clear cell carcinoma (OCCC) and serous ovarian carcinoma (SOC), as well as potential links with interleukin-6 (IL-6) levels.Methods:A multicenter case-control study was conducted in 370 patients with OCCC and 938 with SOC. In a subset of 200 cases, pretreatment plasma IL-6 levels were examined.Findings:Patients with advanced OCCC had the highest 2-year cumulative VTE rates (advanced OCCC 43.1%, advanced SOC 16.2%, early-stage OCCC 11.9% and early-stage SOC 6.4%, P < 0.0001) and the highest median levels of IL-6 (advanced OCCC 17.8 pg/mL, advanced SOC 9.0 pg/mL, early-stage OCCC 4.2 pg/mL and early-stage SOC 5.0 pg/mL, P = 0.006). Advanced OCCC (hazard ratio [HR] 3.38, P < 0.0001), thrombocytosis (HR 1.42, P = 0.032) and elevated IL-6 (HR 8.90, P = 0.046) were independent predictors of VTE. In multivariate analysis, patients with advanced OCCC had significantly poorer 5-year progression-free and overall survival rates than those with advanced SOC (P < 0.01), and thrombocytosis was an independent predictor of decreased survival outcomes (P < 0.01). Elevated IL-6 levels led to poorer 2-year progression-free survival rates in patients with OCCC (50% versus 87.5%, HR 4.89, P = 0.016) than in those with SOC (24.9% versus 40.8%, HR 1.40, P = 0.07).Interpretation:Advanced OCCC is associated with an increased incidence of VTE and decreased survival outcomes, which has major implications for clinical management of OCCC.
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