Surgical approach and maintenance therapy in advanced low-grade serous ovarian cancer: Insights from the French ESME...

Low-grade serous ovarian cancer is a rare sub-type characterized by indolent growth, limited therapeutic options, and relative chemoresistance. This study aimed to describe management patterns, survival outcomes, and the efficacy of systemic therapies in a large cohort of patients with low-grade serous ovarian carcinoma treated across 18 French comprehensive cancer centers.

Using data from the Epidemiological Strategy and Medical Economics ovarian cancer database (NCT03275298), patients with International Federation of Gynecology and Obstetrics (FIGO) stage III to IV low-grade serous ovarian carcinoma diagnosed between 2011 and 2024 were examined. Clinical outcomes, overall survival, and progression-free survival were assessed, along with treatment-related factors affecting survival, including surgical management and bevacizumab administration. Univariable and multi-variable analyses were conducted using Kaplan-Meier estimates and Cox proportional hazards models.

Among 230 patients with low-grade serous ovarian carcinoma (median age 55.5 years [range; 19.8-88.2]), 171 (74.3%) and 59 (25.7%) had FIGO stage III and IV diseases, respectively. Primary debulking surgery was performed in 128 (55.6%), platinum-based chemotherapy was given to 223 (97%), and bevacizumab was administered to 79 (34.3%) patients. The median follow-up period was 73.6 months (95% confidence interval [CI] 69.9 to 80.0). Patients who underwent primary debulking surgery had the longest median progression-free survival (35.2 months, 95% CI 26.5 to 48.1) and overall survival (146 months, 95% CI 110.4 to not reached). Multi-variable analyses identified FIGO stage and primary debulking surgery as key prognostic factors for overall survival, whereas age and bevacizumab use were not significantly associated with outcomes.

This real-world study underscores the prognostic relevance of surgical approach and disease stage in low-grade serous ovarian carcinoma. Continued investigation is warranted to define the optimal integration of emerging systemic therapies and improve outcomes in this rare malignancy.