Surgical Oncology

Post‑NACT WB‑DWI/MRI accurately predicts complete IDS and survival in advanced ovarian cancer

In 105 women with non‑primary resectable ovarian cancer after NACT, WB‑DWI/MRI predicted complete resection at IDS with 97.3% sensitivity and 83.9% specificity. Overall accuracy for predicting complete resection was 93.3%, and in 69 patients WB‑DWI/MRI outperformed CT (91.3% vs 72.5% accuracy). MRI‑based prediction of complete resection and actual complete resection were independently associated with longer progression‑free and overall survival. Serum CA‑125 and MRI‑based resectability remained significant for progression‑free survival in multivariable analyses. WB‑DWI/MRI after NACT can therefore inform operability, survival counseling, and selection for IDS versus alternative strategies. 1

Pre‑op circulating tumor cells stratify surgical and chemo response risk in HGSOC

In 56 women with FIGO IIIC–IV HGSOC, pre‑operative CTCs were detected in 48.2% and were absent in benign controls. Pre‑operative CTC positivity was strongly associated with suboptimal cytoreduction (OR 15.6; 95% CI 2.97–127.0) and worse platinum response. CTC‑positive patients had shorter progression‑free and overall survival, and more frequent lymph‑node metastases. In multivariable analyses, pre‑operative CTCs remained an independent surrogate for incomplete debulking, platinum resistance, and poor survival. Post‑operative CTCs combined with residual tumor were linked to poorer overall survival, supporting perioperative CTCs to guide treatment intensity and counseling. 2

Camrelizumab plus mFOLFOXIRI as radiotherapy‑free neoadjuvant therapy for LARC

This retrospective cohort of 146 clinical stage II–III LARC patients compared neoadjuvant camrelizumab plus mFOLFOXIRI with mFOLFOXIRI alone, without radiotherapy. Among surgical patients, pCR was higher with camrelizumab plus mFOLFOXIRI than with chemotherapy alone (29.8% vs 19.6%). Radiologic objective response rates favored the camrelizumab combination (70.7% vs 53.5%), with lower mean neoadjuvant rectal scores. Disease‑free survival improved with camrelizumab, while overall survival was similar at current follow‑up. Grade 3–4 hematologic and GI toxicities were comparable and no unexpected immune‑related events occurred, supporting feasibility of this radiotherapy‑free approach. 3

Salvage PC‑RPLND yields durable survival in marker‑positive NSGCT

In 107 NSGCT patients undergoing salvage PC‑RPLND with persistently elevated markers after at least one chemotherapy line, 5‑year RFS and OS were 54% and 68%. Histology at PC‑RPLND showed viable GCT in 47.7%, post‑pubertal teratoma in 32.7%, fibro‑necrotic tissue in 11.4%, and somatic malignancy in 8.4%. Post‑pubertal teratoma had excellent 5‑year outcomes (OS 96%, RFS 77%), whereas somatic malignancy and fibro‑necrotic tissue predicted markedly worse RFS. Larger residual mass size, more advanced stage, and additional chemotherapy lines were associated with higher relapse risk and poorer survival. These data support considering PC‑RPLND, even as first‑line salvage, particularly when teratoma or somatic malignancy is suspected pre‑operatively. 4