{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:44:47Z","timestamp":1760150687029,"version":"build-2065373602"},"reference-count":25,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,12,28]],"date-time":"2023-12-28T00:00:00Z","timestamp":1703721600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001871","name":"Funda\u00e7\u00e3o para a Ci\u00eancia e Tecnologia","doi-asserted-by":"publisher","award":["PTDC\/BTM-SAL\/3796\/2021"],"award-info":[{"award-number":["PTDC\/BTM-SAL\/3796\/2021"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Champalimaud Foundation","award":["PTDC\/BTM-SAL\/3796\/2021"],"award-info":[{"award-number":["PTDC\/BTM-SAL\/3796\/2021"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>(1) Background: Relapsed HGSOC with ascites and\/or pleural effusion is a poor-prognostic population and poorly represented in clinical studies. We questioned if these patients are worth treating. In other words, if these patients received the most effective treatment, would it change the course of this disease? To our knowledge this is the first real-life study to evaluate this question in this low-survival population. (2) Methods: To tackle this question we performed a retrospective, multi-centric, real-life study, that reviewed relapsed HGSOC patients with ascites and\/or pleural effusion. Our rationale was to compare the OS of two groups of patients: responders, i.e., patients who had an imagological response to treatment (complete\/partial response\/stable disease, RECIST criteria) versus non-responders (no response\/progression upon treatment). We evaluated the predictive value of clinical variables that are available in a real-life setting (e.g., staging, chemotherapy, surgery, platinum-sensitivity). Multivariate logistic regression and survival analysis was conducted. A two-step cluster analysis SPSS tool was used for subgroup analysis. Platinum sensitivity\/resistance was also analyzed, as well as multivariate and cluster analysis. (3) Results: We included 57 patients, 41.4% first line responders and 59.6% non-responders. The median OS of responders was 23 months versus 8 months in non-responders (p &lt; 0.001). This difference was verified in platinum-sensitive (mOS 28 months vs. 8 months, p &lt; 0.001) and platinum-resistant populations (mOS 16 months vs. 7 months, p &lt; 0.001). Thirty-one patients reached the second line, of which only 10.3% responded to treatment. Three patients out of thirty-one who did not respond in the first line of relapse, responded in the second line. In the second line, the mOS for the responders\u2019 group vs. non-responders was 31 months versus 13 months (p = 0.02). The two step cluster analysis tool found two different subgroups with different prognoses based on overall response rate, according to consolidation chemotherapy, neoadjuvant chemotherapy, FIGO staging and surgical treatment. Cluster analysis showed that even patients with standard clinical and treatment variables associated with poor prognosis might achieve treatment response (the opposite being also true). (4) Conclusions: Our data clearly show that relapsed HGSOC patients benefit from treatment. If given an effective treatment upfront, this can lead to a ~3 times increase in mOS for these patients. Moreover, this was irrespective of patient disease and treatment characteristics. Our results highlight the urgent need for a sensitivity test to tailor treatments and improve efficacy rates in a personalized manner.<\/jats:p>","DOI":"10.3390\/cancers16010162","type":"journal-article","created":{"date-parts":[[2023,12,28]],"date-time":"2023-12-28T11:44:57Z","timestamp":1703763897000},"page":"162","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Relapsed Ovarian Cancer Patients with Ascites and\/or Pleural Effusion Still Benefit from Treatment: A Real-Life Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0923-2356","authenticated-orcid":false,"given":"Mariana","family":"Rebord\u00e3o-Pires","sequence":"first","affiliation":[{"name":"Medical Oncology Unit, Instituto Portugu\u00eas De Oncologia De Coimbra Francisco Gentil, 3000-075 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5119-822X","authenticated-orcid":false,"given":"Marta F.","family":"Estrada","sequence":"additional","affiliation":[{"name":"Cancer Development and Innate Immune Evasion Laboratory, Champalimaud Foundation, 1400-038 Lisboa, Portugal"}]},{"given":"Ant\u00f3nio","family":"Gomes","sequence":"additional","affiliation":[{"name":"Surgery Unit, Hospital Vila Franca de Xira, 2600-153 Vila Franca de Xira, Portugal"}]},{"given":"Filipa","family":"Silva","sequence":"additional","affiliation":[{"name":"Gynecology Unit, Champalimaud Foundation, 1400-038 Lisboa, Portugal"}]},{"given":"Carlota","family":"Baptista","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Hospital Beatriz \u00c2ngelo, 2674-514 Loures, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5503-1021","authenticated-orcid":false,"given":"Maria Jo\u00e3o","family":"Ramos","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Centro Hospitalar Universit\u00e1rio de Santo Ant\u00f3nio, 4099-001 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5368-2410","authenticated-orcid":false,"given":"Ana","family":"Fortuna","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Centro Hospitalar do Algarve, 8500-338 Portim\u00e3o, Portugal"}]},{"given":"Pedro","family":"Sim\u00f5es","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Hospital Beatriz \u00c2ngelo, 2674-514 Loures, Portugal"}]},{"given":"Gabriela","family":"Sousa","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Instituto Portugu\u00eas De Oncologia De Coimbra Francisco Gentil, 3000-075 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9410-4772","authenticated-orcid":false,"given":"Ana","family":"Marreiros","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Biomedical Sciences, University of Algarve, 8005-139 Faro, Portugal"},{"name":"Algarve Biomedical Center Research Institute, University of Algarve, 8005-139 Faro, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5550-2428","authenticated-orcid":false,"given":"Rita","family":"Fior","sequence":"additional","affiliation":[{"name":"Cancer Development and Innate Immune Evasion Laboratory, Champalimaud Foundation, 1400-038 Lisboa, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1007\/s12094-020-02545-x","article-title":"SEOM clinical guideline in ovarian cancer (2020)","volume":"23","author":"Redondo","year":"2021","journal-title":"Clin. Transl. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1056\/NEJMoa0908806","article-title":"Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer","volume":"363","author":"Vergote","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_3","first-page":"CD005343","article-title":"Chemotherapy versus surgery for initial treatment in advanced ovarian epithelial cancer","volume":"2012","author":"Morrison","year":"2012","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.ejca.2020.02.020","article-title":"Comparison of survival between primary debulking surgery and neoadjuvant chemotherapy for stage III\/IV ovarian, tubal and peritoneal cancers in phase III randomised trial","volume":"130","author":"Onda","year":"2020","journal-title":"Eur. J. Cancer"},{"key":"ref_5","first-page":"45","article-title":"Update on first-line treatment of advanced ovarian carcinoma","volume":"5","author":"Kemp","year":"2013","journal-title":"Int. J. Womens Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1186\/s40064-016-2660-0","article-title":"Management of relapsed ovarian cancer: A review","volume":"5","author":"Giornelli","year":"2016","journal-title":"Springerplus"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"256","DOI":"10.3389\/fonc.2013.00256","article-title":"Getting to know ovarian cancer ascites: Opportunities for targeted therapy-based translational research","volume":"3","author":"Ahmed","year":"2013","journal-title":"Front. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1097\/IGC.0b013e31821bb8aa","article-title":"Clinical trials in recurrent ovarian cancer","volume":"21","author":"Friedlander","year":"2011","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S12","DOI":"10.1053\/j.seminoncol.2006.03.012","article-title":"Management of platinum-sensitive recurrent ovarian cancer","volume":"33","author":"Pfisterer","year":"2006","journal-title":"Semin. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"972","DOI":"10.6004\/jnccn.2022.0047","article-title":"NCCN guidelines\u00ae insights: Ovarian cancer, version 3.2022: Featured updates to the NCCN guidelines","volume":"20","author":"Armstrong","year":"2022","journal-title":"J. Natl. Compr. Canc. Netw."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1038\/s41416-020-0875-x","article-title":"The untapped potential of ascites in ovarian cancer research and treatment","volume":"123","author":"Ford","year":"2020","journal-title":"Br. J. Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1111\/cas.12987","article-title":"Ascites modulates cancer cell behavior, contributing to tumor heterogeneity in ovarian cancer","volume":"107","author":"Kim","year":"2016","journal-title":"Cancer Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/s00408-011-9283-6","article-title":"Tumor type influences the effectiveness of pleurodesis in malignant effusions","volume":"189","author":"Bielsa","year":"2011","journal-title":"Lung"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2099","DOI":"10.1016\/S0140-6736(03)13718-X","article-title":"Paclitaxel plus platinum-based chemotherapy versus conventional platinum-based chemotherapy in women with relapsed ovarian cancer: The ICON4\/AGO-OVAR-2.2 trial","volume":"361","author":"Parmar","year":"2003","journal-title":"Lancet"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"4699","DOI":"10.1200\/JCO.2006.06.0913","article-title":"Gemcitabine plus carboplatin compared with carboplatin in patients with platinum-sensitive recurrent ovarian cancer: An intergroup trial of the AGO-OVAR, the NCIC CTG, and the EORTC GCG","volume":"24","author":"Pfisterer","year":"2006","journal-title":"J. Clin. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3323","DOI":"10.1200\/JCO.2009.25.7519","article-title":"Pegylated liposomal Doxorubicin and Carboplatin compared with Paclitaxel and Carboplatin for patients with platinum-sensitive ovarian cancer in late relapse","volume":"28","author":"Wagner","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"vi24","DOI":"10.1093\/annonc\/mdt333","article-title":"Newly diagnosed and relapsed epithelial ovarian carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"24","author":"Ledermann","year":"2013","journal-title":"Ann. Oncol."},{"key":"ref_18","first-page":"201618389","article-title":"Single-cell functional and chemosensitive profiling of combinatorial colorectal therapy in zebrafish xenografts","volume":"34","author":"Fior","year":"2017","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e415","DOI":"10.1002\/cpz1.415","article-title":"Zebrafish Patient-Derived Avatars from Digestive Cancers for Anti-cancer Therapy Screening","volume":"2","author":"Costa","year":"2022","journal-title":"Curr. Protoc."},{"doi-asserted-by":"crossref","unstructured":"Costa, B., Estrada, M.F., Mendes, R.V., and Fior, R. (2020). Zebrafish Avatars towards Personalized Medicine\u2014A Comparative Review between Avatar Models. Cells, 9.","key":"ref_20","DOI":"10.3390\/cells9020293"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"11153","DOI":"10.1038\/s41598-019-47578-7","article-title":"Prospective Validation of an Ex Vivo, Patient-Derived 3D Spheroid Model for Response Predictions in Newly Diagnosed Ovarian Cancer","volume":"9","author":"Shuford","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1038\/s41591-021-01398-3","article-title":"An ex vivo tumor fragment platform to dissect response to PD-1 blockade in cancer","volume":"27","author":"Voabil","year":"2021","journal-title":"Nat. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2605","DOI":"10.1093\/annonc\/mds203","article-title":"The impact of second to sixth line therapy on survival of relapsed ovarian cancer after primary taxane\/platinum-based therapy","volume":"23","author":"Hanker","year":"2012","journal-title":"Ann. Oncol."},{"key":"ref_24","first-page":"CD006910","article-title":"Pegylated liposomal doxorubicin for relapsed epithelial ovarian cancer","volume":"2013","author":"Lawrie","year":"2013","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1016\/j.ygyno.2019.09.026","article-title":"Gemcitabine for recurrent ovarian cancer\u2014A systematic review and meta-analysis","volume":"155","author":"Berg","year":"2019","journal-title":"Gynecol. Oncol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/1\/162\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:43:44Z","timestamp":1760132624000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/1\/162"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,28]]},"references-count":25,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["cancers16010162"],"URL":"https:\/\/doi.org\/10.3390\/cancers16010162","relation":{},"ISSN":["2072-6694"],"issn-type":[{"type":"electronic","value":"2072-6694"}],"subject":[],"published":{"date-parts":[[2023,12,28]]}}}