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BackgroundMalignant transformation in endometriosis was first described by Sampson in 1925. There is now sufficient evidence of its association specifically with endometrioid (EOC) and clear cell ovarian cancer (CCOC). Whether endometriosis-associated ovarian cancer (EAOC) is a distinct clinicopathological entity from non-endometriosis-associated ovarian cancer (NEAOC) remains uncertain.ObjectivesThis study aimed to assess the impact of endometriosis on clinical characteristics and survival outcomes in EOC and CCOC.MethodsThis is a retrospective single-institution analysis of patients diagnosed with CCOC AND EOC between 2010 and 2021. Demographic and clinical presentation data were obtained from medical records. Patients were followed up till March 2023. Statistical analysis was done using the IBM SPSS Statistics 20 Windows.ResultsOf the 77 cases of CCOC and EOC ovary, 38 had histopathologically proven endometriosis. There was no difference in age (51.62 and 50.05 years, respectively), body mass index, parity, menopausal status and CA 125 levels at presentation. Ascites was more frequent in the absence of endometriosis (30% versus 8.1%, p = 0.015). However, this did not translate to a statistical difference in the stage, with the majority presenting in the early stage. (94% versus 83%). All 78 patients underwent primary cytoreduction with equal rates of optimal resection.There was no difference in the mean disease-free interval between EAOC and NEAOC (107.6 and 109.4 months, p 0.484). Recurrences were predominantly pelvic in both groups. The disease-specific survival was 111.7 and 120.1 months, respectively, with and without endometriosis. This was however not statistically significant (p 0.751).ConclusionIn the Indian population, endometriosis did not have any impact on the age at presentation, CA 125 levels, stage of the disease and survival outcomes in EOC and CCOC ovary.

Introduction/BackgroundUpto 80% of advanced ovarian cancer usually recur irrespective of the primary treatment.The main objective was to determine the most common method of detecting first recurrence.MethodologyIt was a single institution retrospective study between 2015-June 2023 .210 consecutive epithelial ovarian cancer patients who have documented remission after completing adjuvant chemotherapy and diagnosed with first recurrence were included in the study.Primary mode of detection was defined as the method which first led to further investigations or start treatment.ResultsMost common method of detection was elevated Ca 125 ( 59%) followed by symptoms (21.4%). Imaging was the first mode of detection in 32( 15.2%) cases and physical examination finding in only 9(4.3%) cases.Out of 210 cases, 14 cases had biochemical recurrence without any symptoms, physical findings and imaging findings. Hence a total 194 cases were analyzed for site of recurrence.Most common site of recurrence was peritoneum followed by pelvis. When the site of recurrence with method of detection was compared, we found that all cases with pelvic or peritoneal recurrence had raised Ca 125 as the first method to detect recurrence which was statistically significant (p value =0.008 and 0.002 respectively ).Bloating and pain in the abdomen was the most common symptom and was associated with peritoneal recurrence.Nodular mass felt in the vault/pelvis was the most common physical finding which was associated with per vaginal bleeding and was found to have pelvic recurrence.All the patients had an average of 7(1–23) visits to the hospital before being detected with first recurrence.The mean distance traveled by the patients to reach the hospital was 146 km ( 237–1774).ConclusionThis study suggests that the initial recurrence is most commonly identified through elevated CA 125 levels and symptoms, raising concerns about the effectiveness of existing surveillance practices.DisclosuresNil.

ObjectivesThis study aimed to assess the impact of endometriosis on clinical characteristics and survival outcomes in Endometrioid (EC) and clear cell (CCC) ovarian carcinoma.MethodsThis study investigated 78 cases of EC and CCC diagnosed between 2010 and 2021. Demographic and clinical presentation data were obtained from medical records. Patients were followed up till March 2022.ResultsOf the 78 cases of CCC and EC ovary, 38 had histopathologically proven endometriosis, ovary being the most common site. There was no difference in mean age (50.97 and 50.05 years), BMI, parity, menopausal status and CA 125 levels at presentation. Ascites was more frequent in the absence of endometriosis (30% vs 8%, p=0.020). However, this did not translate to a statistical difference in the stage, with majority presenting in early stage. (94% vs 83%). Progesterone receptor positivity on IHC was more likely in the presence of endometriosis (47% vs 18%, p=0.005). All 78 patients underwent primary cytoreduction with equal rates of optimal resection (97% and 98%). 74% with endometriosis and 83% without received adjuvant chemotherapy. 13% and 15% respectively received radiation, all of whom had CCC. There was no difference in the disease free interval (93.4 vs 97.3 months, p =0.587) and overall survival (100.2 vs 106.6 months, p= 0.716) in the patients with and without endometriosis. Recurrences were predominantly pelvic in both groups.ConclusionsIn the Indian population, endometriosis did not have any impact on the age at presentation, CA 125 levels, stage of the disease and survival out comes in EC and CCC ovary.

ObjectivesLaparoscopic pelvic SLNB using ICG, is a viable option, especially in LMICs where access to robot or its prohibitive cost are limiting factors. We looked into the feasibility, detection rate and location of sentinel nodes in laparoscopic staging for carcinoma endometrium using real time ICG fluorescence mapping of SLN.MethodsIn this single institution study,50 patients with endometrial cancer who underwent laparoscopic staging with SLNB from April 2021 to March 2022, were included.ResultsMean age was 55 years, and mean BMI- 29 kg/m2(range 21–39.5). 8(16%) patients had high risk histopathology with p53 positivity in preoperative endometrial biopsy. 8(16%) patients had >50% MI on MRI. Overall sentinel detection rate was 88% with bilateral sentinel detection rate being 86%. Most common location for first sentinel node was external iliac (46.59%), followed by obturator (26.1%), internal iliac (25%) and common iliac(2.27%). Mean number of nodes removed were 2 on either side. For the 6 patients with bilateral failed mapping, pelvic lymphadenectomy was done. One patient with unilateral sentinel detection had side specific hemipelvic lymphadenectomy. Mean duration of surgery was 82.5 min. 84% patients had Stage IA disease.7(14%) patients had stage IB disease. 1(2%) patient was Stage II. 80% patients were Low risk. 16% were high intermediate/high risk. No nodes were positive on ultrastaging.ConclusionsLaparoscopic staging with SLNB using ICG is a practicable approach for uterine limited disease on preoperative evaluation. It extends the benefits of minimally invasive surgery to these patients, while overcoming the limitations of prohibitive cost or availability of expensive equipment.

Introduction/BackgroundThis single centre study aims to assess clinical behaviour, treatment patterns and clinical outcomes of patients with advanced endometrial cancer (AEC).MethodologyThis retrospective study assessed patients who reported to Amrita Institute of Medical Sciences, Kochi in the 10-year period from January 2011-December 2020.Patients with AEC (Stage IIIB - IVB according to FIGO 2009), any histology, having at least 2 documented visits and having received at least one cycle of chemotherapy were included. Demographic,pathological and clinical parameters were calculated in terms of mean, median and percentages.Overall survival (OS) was analyzed using Kaplan-Meier curve.ResultsEighty-two patients met the inclusion criteria. Majority of patients presented with stage IVB disease (46.3%).Endometroid histology was seen in 41.5% while serous and other subtypes were found in 39% and 19.5% respectively. Primary debulking surgery (PDS) was done in 59.8% cases while 40.2% cases received neo-adjuvant chemotherapy (NACT).Ten percent patients had sub-optimal resection in PDS group versus 0% in NACT+ Interval debulking surgery (IDS). Median follow up duration of the cohort was 48 months.The median OS was 48 months in endometroid subtype, 39 months in serous and 33 months in other histologies. Median OS in patients with ER/PR positive and p53 positive disease were 44 months and 38 months respectively. Overall, 25.6% patients had recurrences and 20% patients had disease progression.Patients with sub-optimal resection had disease progression in 60% cases. Second line treatment was given to 35.3% patients with most common being combined platinum agents.Other drugs used in second line and beyond included non-platinum, hormonal or targeted therapy agents.ConclusionPatients with endometroid endometrial cancer have a better prognosis as compared to serous carcinoma and other histologies.Patients with endocrine receptor positive disease performed better than p53 positive disease.Patients with stage IVB disease respond to NACT allowing an interval optimal debulking. Sub-optimal resection leads to poorer outcomes.DisclosuresNone.

Introduction In clinically advanced ovarian cancer, staging laparoscopy (S-LPS) can be a useful tool to accurately identify patients who can undergo complete cytoreduction from those who are more suitable for NACT (Neoadjuvant chemotherapy). Aim To study the usefulness of S-LPS as a diagnostic tool for triaging advanced ovarian cancer to surgery/NACT and to study the correlation between the laparoscopic predictive index value (PIV) and CT-PCI (CT based peritoneal cancer index). Methods Single institution retrospective cohort study conducted in a tertiary care oncology center from Jan 2021–November 2022. All patients who underwent S-LPS to determine primary resectability using the Fagotti score before triaging to CRS (Cytoreductive surgery)/NACT were included (CRS group/ no CRS group). The CT scans were retrospectively reviewed, and scored by an experienced radiologist who was blinded to the operative findings, and the correlation between CT PCI score and Fagotti’s score was studied. Results Out of the 225 patients treated for ovarian cancer in our department for ovarian cancer in the study period, 40 patients underwent S-LPS and were included for the study. Out of these, 19 patients were found to be eligible for CRS based on the Fagotti score, all of whom had optimal cytoreduction. 21 were found to be ineligible for CRS, for whom biopsy was taken and these patients were sent for NACT. Ascites > 500 ml was the only factor found to be significantly associated with the no CRS group. For intra-rater reliability between CT scores and PIV in CRS group, the agreement was− 0.178 (− 0.012, 0.368) indicating very low reliability. In the no CRS group, the agreement was − 0.092 (− 0.24, 0.06) suggesting no reliability. Conclusion Laparoscopy is an underutilized but useful tool in clinically advanced cases of carcinoma ovary/primary peritoneal carcinoma to triage patients who have an over/underestimation of disease by CT scan/CA − 125 levels. Correlation between CT PCI and Fagotti’s PIV was not very reliable.

Introduction/BackgroundThis study aims to determine the association of hematological indices like Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Albumin Globulin Ratio (AGR) with Overall Survival (OS) in cervical cancer patients treated with Concurrent Chemo-Radiotherapy (CCRT).MethodologyThis study was conducted retrospectively between January 2016 till December 2019 in Amrita Institute of Medical Sciences. Patients with any stage who received definitive radiotherapy and/or chemotherapy and followed up-to at least 2 years post treatment were included. Receiver Operating Characteristic curves were used to determine the cut-off values for hematological indices. Kaplan-Meier analysis was done to calculate Overall Survival (OS), Progression-Free survival (PFS) and Recurrence-Free Survival (RFS).ResultsA total of 123 patients were included. Mean age was 68 years. Majority of the patients presented with stage IIB (n=48, 39%). Squamous cell histology was seen in 94 patients (76.4%). Ninety-nine patients (81.4%) were treated with CCRT and 24 patients (19.6%) with only RT. Seven patients (5.6%) had disease progression and 17 patients (13.8%) experienced recurrences. With a median follow-up of 56 months, 5-year OS was 67.3 months, PFS was 84.8 months and RFS was 77.8 months. AGR (p = 0.001), NLR (p = 0.0001) and PLR (p = 0.001) were found significantly associated with OS, NLR (p= 0.002) and AGR (p = 0.001) significantly affected RFS while only PLR (p = 0.02) significantly affected PFS on univariate analysis. NLR significantly impacted OS (p = 0.003) and RFS (p = 0.03) on multi-variate analysis.ConclusionThis study reflects that NLR has a profound effect on the prognosis of cervical cancer patients treated with CCRT. Thus, pre-treatment hematological indices may be used as predictive markers for determining clinical outcomes in cervical cancer patients planned for upfront CCRT.DisclosuresNone.

Introduction/BackgroundThe updated 2014 WHO Classification of Tumors of Female Reproductive Organs recognizes low and high grade endometrial stromal sarcoma (HGESS). HGESS is rare and it is unclear whether specific subtypes differ in prognosis.MethodologyHGESS patients treated from 2015 till 2022 were analysed for demographics, disease characteristics, treatment details and outcome.ResultsHGESS was reported in 18 patients. Median age was 57(IQR 48–67); postmenopausal= 12; most common presenting symptom- vaginal bleeding= 15; mean tumor size in stage IA= 3.9cm(2.5–5), stage IB= 9.2cm(7–10.2), stage III-IV= 10cm(3.7–25). Hysterectomy with salpingo-oophorectomy: robotic= 3, laparoscopic= 1, open= 13 and no surgery= 1. Stage IA= 3, Stage IB= 7, Stage IIIC= 1, Stage IVA= 1, Stage IVB= 6. In addition to Cyclin D1 positivity, focal CD10 positivity was seen in 10 cases along with SMA(n=3),desmin(n=2) and caldesmon(n=1). Adjuvant therapy included observation (Stage IA=2, IB=4), radiotherapy and systemic therapy with ifosfamide plus adriamycin (Stage IA= 1, IB= 3). Systemic therapy was given in IIIC= 1, IVA= 1, IVB= 6 (Vemurafenib in 1, 2nd line Rucaparib in 1). Adjuvant therapy in Stage I High ESS was given before 2019, after which observation was adopted. Median OS of 20 months(95% CI 6–34). At last follow-up stage IA patients are disease free and alive, 3 out of 7 stage IB expired with relapse in lungs (pazopanib for 5 months), abdominal wall (palliative care for 1 month) and unknown site confirmed on telephonic follow-up. In Stage III & IV, 1 out of 8 patients is alive. 2-year PFS of Stage IA= 100%, Stage IB= 57.1%, Stage III & IV= 0%. Median follow-up for alive patients was 38 months(IQR 29–48).ConclusionTo our knowledge this is the largest series of HGESS reported from India. Stage IB and higher tumors have a poor prognosis and require newer therapeutic strategies to improve outcome.DisclosuresNone.

A 50-year-old woman with a history of adult granulosa cell tumor (AGCT) of the right ovary was under follow-up after undergoing several surgeries, including a total abdominal hysterectomy with bilateral salpingo-oophorectomy. She was initially diagnosed eight years ago and remained disease-free for 52 months. However, she later experienced a recurrence, indicated by elevated inhibin B levels (58 ng/mL) and the presence of peritoneal soft tissue tumors. Following secondary debulking surgery, histopathology confirmed recurrent granulosa cell tumor (GCT). Although she was advised to undergo hormonal therapy, she was lost to follow-up. After 21 months, she returned with an increased inhibin B level of 82 ng/mL, but imaging showed no signs of recurrence. Following a disease-free interval (DFI) of 23 months, an abdominal lump was discovered, prompting tertiary debulking surgery. During this procedure, cystic lesions were excised, and a large defect in the rectus sheath was repaired using a left rectus abdominis flap, followed by the placement of a mesh. Postsurgery, she received adjuvant chemotherapy consisting of paclitaxel and carboplatin. She had a favorable recovery with no complications during the postoperative period. At the six-month follow-up, her wound had healed well, and she was doing well overall. Isolated recurrent AGCT on the abdominal wall is a very rare presentation and can be managed using debulking surgery, with a multidisciplinary team playing a crucial role.

Introduction In cervical cancer treatment, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and albumin-globulin ratio (AGR) are being studied as potential prognostic markers for predicting the effectiveness of concurrent chemoradiotherapy (CCRT). This study aims to investigate the relationship between these biomarkers and survival outcomes in cervical cancer patients undergoing CCRT. Materials and methods This retrospective study was conducted at Amrita Institute of Medical Sciences between January 2016 and December 2019. It included patients at any stage who received definitive CCRT and were followed for at least two years post-treatment. Patients who had initial surgery and those lost to follow-up were excluded. Results The study included 123 patients with a median age of 68. Most patients had stage IIB (39%) and squamous cell carcinoma (76.4%). With a median follow-up of 56 months, the five-year overall survival (OS) was 66.8%, progression-free survival (PFS) was 94%, and recurrence-free survival (RFS) was 81.2%. AGR (p = 0.001), NLR (p = 0.0001), and PLR (p = 0.001) were found to be significantly associated with OS, NLR (p = 0.002) and AGR (p = 0.001) significantly affected RFS, while only PLR (p = 0.02) significantly affected PFS on univariate analysis. NLR significantly impacted OS (p = 0.003) and RFS (p = 0.03) on multivariate analysis. Conclusion The results of our study showed that increased NLR and elevated levels of albumin indicate a higher likelihood of mortality. Furthermore, a higher NLR was linked to an increased probability of recurrence in patients with cervical cancer who received primary treatment with CCRT. Therefore, the identification of predictive biomarkers could significantly improve the assessment of progression risk, aiding in the selection of the most suitable treatment and personalized therapy.