Impact of Ascites Volume on Clinical Outcomes in Ovarian Cancer: A Cohort Study

Overview

Journal Gynecol Oncol

Date 2017 Jun 19

PMID 28624153

Citations 39

Authors

J Brian Szender

Tiffany Emmons

Sarah Belliotti

Danielle Dickson

Aalia Khan

Kayla Morrell

A N M Nazmul Khan

Kelly L Singel

Paul C Mayor

Kirsten B Moysich

Kunle Odunsi

Brahm H Segal

Kevin H Eng

Affiliations

Soon will be listed here.

Abstract

Objectives: To investigate the impact of ascites volume on ovarian cancer outcomes.

Methods: Clinicopathologic features of a cohort of patients with ovarian cancer were obtained from a curated database at a single institution. Progression free survival (PFS) and overall survival (OS) were recorded. Ascites volume at primary surgery was dichotomized at 2000mL and comparisons for high and low volume ascites were made. Additionally, to elucidate interactions between ascites and ovarian tumor progression, we evaluated the effect of intraperitoneal administrations of murine cell-free ascites versus saline in a syngeneic mouse model of epithelial ovarian cancer.

Results: Out of 685 patients identified, 58% had ascites present at the time of initial surgery. Considering the volume of ascites continuously, each liter of ascites was associated with shorter PFS (HR=1.12, 95% CI: 1.07-1.17) and OS (HR=1.12, 95%CI: 1.07-1.17). Patients with ascites greater than the median of 2000mL had significantly shorter PFS (14.5months vs. 22.7months; p<0.001) and OS (27.7months vs. 42.9months; p<0.001). After adjusting for stage, presence of ascites was inversely associated with ability to achieve optimal cytoreductive surgery. Consistent with these correlative results in patients, intraperitoneal administrations of murine cell-free ascites accelerated ovarian cancer progression in mice.

Conclusions: The volume of ascites at initial diagnosis of ovarian cancer correlated with worse PFS and OS. The effect of large volume on prognosis is likely to be in part related to reduced likelihood for complete resection of tumor (R0). If these findings are confirmed in independent studies, consideration should be made to add the presence of large volume ascites at diagnosis to the staging criteria for ovarian cancer.

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References

Kuhn W, Rutke S, Spathe K, Schmalfeldt B, Florack G, von Hundelshausen B . Neoadjuvant chemotherapy followed by tumor debulking prolongs survival for patients with poor prognosis in International Federation of Gynecology and Obstetrics Stage IIIC ovarian carcinoma. Cancer. 2001; 92(10):2585-91. DOI: 10.1002/1097-0142(20011115)92:10<2585::aid-cncr1611>3.0.co;2-#. View

Zhang L, Conejo-Garcia J, Katsaros D, Gimotty P, Massobrio M, Regnani G . Intratumoral T cells, recurrence, and survival in epithelial ovarian cancer. N Engl J Med. 2003; 348(3):203-13. DOI: 10.1056/NEJMoa020177. View

Harris P, Taylor R, Thielke R, Payne J, Gonzalez N, Conde J . Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2008; 42(2):377-81. PMC: 2700030. DOI: 10.1016/j.jbi.2008.08.010. View

Khan A, Kolomeyevskaya N, Singel K, Grimm M, Moysich K, Daudi S . Targeting myeloid cells in the tumor microenvironment enhances vaccine efficacy in murine epithelial ovarian cancer. Oncotarget. 2015; 6(13):11310-26. PMC: 4484458. DOI: 10.18632/oncotarget.3597. View

Obermajer N, Muthuswamy R, Odunsi K, Edwards R, Kalinski P . PGE(2)-induced CXCL12 production and CXCR4 expression controls the accumulation of human MDSCs in ovarian cancer environment. Cancer Res. 2011; 71(24):7463-70. PMC: 4993027. DOI: 10.1158/0008-5472.CAN-11-2449. View

Aust S, Pils D . Epithelial ovarian cancer - more data, more questions?. Wien Med Wochenschr. 2014; 164(21-22):479-86. DOI: 10.1007/s10354-014-0323-8. View

Kelleher Jr R, Balu-Iyer S, Loyall J, Sacca A, Shenoy G, Peng P . Extracellular Vesicles Present in Human Ovarian Tumor Microenvironments Induce a Phosphatidylserine-Dependent Arrest in the T-cell Signaling Cascade. Cancer Immunol Res. 2015; 3(11):1269-78. PMC: 4636911. DOI: 10.1158/2326-6066.CIR-15-0086. View

Gil M, Komorowski M, Seshadri M, Rokita H, McGray A, Opyrchal M . CXCL12/CXCR4 blockade by oncolytic virotherapy inhibits ovarian cancer growth by decreasing immunosuppression and targeting cancer-initiating cells. J Immunol. 2014; 193(10):5327-37. PMC: 4225176. DOI: 10.4049/jimmunol.1400201. View

Zhang T, Ma Z, Wang R, Wang Y, Wang S, Cheng Z . Thrombin facilitates invasion of ovarian cancer along peritoneum by inducing monocyte differentiation toward tumor-associated macrophage-like cells. Cancer Immunol Immunother. 2010; 59(7):1097-108. PMC: 11030270. DOI: 10.1007/s00262-010-0836-y. View

10.

Marie Tran Janco J, Glaser G, Kim B, McGree M, Weaver A, Cliby W . Development of a prediction model for residual disease in newly diagnosed advanced ovarian cancer. Gynecol Oncol. 2015; 138(1):70-7. DOI: 10.1016/j.ygyno.2015.04.013. View

11.

Curiel T, Coukos G, Zou L, Alvarez X, Cheng P, Mottram P . Specific recruitment of regulatory T cells in ovarian carcinoma fosters immune privilege and predicts reduced survival. Nat Med. 2004; 10(9):942-9. DOI: 10.1038/nm1093. View

12.

Lane D, Matte I, Rancourt C, Piche A . Prognostic significance of IL-6 and IL-8 ascites levels in ovarian cancer patients. BMC Cancer. 2011; 11:210. PMC: 3118896. DOI: 10.1186/1471-2407-11-210. View

13.

Schorge J, McCann C, Carmen M . Surgical debulking of ovarian cancer: what difference does it make?. Rev Obstet Gynecol. 2011; 3(3):111-7. PMC: 3046749. View

14.

Naldini A, Morena E, Belotti D, Carraro F, Allavena P, Giavazzi R . Identification of thrombin-like activity in ovarian cancer associated ascites and modulation of multiple cytokine networks. Thromb Haemost. 2011; 106(4):705-11. DOI: 10.1160/TH11-05-0311. View

15.

Lo C, Chen M, Hsiao M, Wang S, Chen C, Hsiao S . IL-6 trans-signaling in formation and progression of malignant ascites in ovarian cancer. Cancer Res. 2010; 71(2):424-34. DOI: 10.1158/0008-5472.CAN-10-1496. View

16.

White R, Chew H, Zhou H, Parikh-Patel A, Harris D, Harvey D . Incidence of venous thromboembolism in the year before the diagnosis of cancer in 528,693 adults. Arch Intern Med. 2005; 165(15):1782-7. DOI: 10.1001/archinte.165.15.1782. View

17.

Biskup K, Braicu E, Sehouli J, Tauber R, Blanchard V . The ascites N-glycome of epithelial ovarian cancer patients. J Proteomics. 2017; 157:33-39. DOI: 10.1016/j.jprot.2017.02.001. View

18.

Kolomeyevskaya N, Eng K, Khan A, Grzankowski K, Singel K, Moysich K . Cytokine profiling of ascites at primary surgery identifies an interaction of tumor necrosis factor-α and interleukin-6 in predicting reduced progression-free survival in epithelial ovarian cancer. Gynecol Oncol. 2015; 138(2):352-7. PMC: 4522366. DOI: 10.1016/j.ygyno.2015.05.009. View

19.

Cho M, Bottsford-Miller J, Vasquez H, Stone R, Zand B, Kroll M . Platelets increase the proliferation of ovarian cancer cells. Blood. 2012; 120(24):4869-72. PMC: 3520623. DOI: 10.1182/blood-2012-06-438598. View

20.

Chew H, Wun T, Harvey D, Zhou H, White R . Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med. 2006; 166(4):458-64. DOI: 10.1001/archinte.166.4.458. View