Relationship of Preoperative Serous CA125 with Clinicopathological Features and Prognosis in Patients with Epithelial Ovarian Cancer
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[Purpose] To investigate the relationship of preoperative serous CA125 with clinicopathological features and prognosis in patients with epithelial ovarian carcinoma.[Methods] The relationship of preoperative serous CA125 with histologic type,grade,FIGO stage,ascites and survival in 279 cases with epithelial ovarian carcinoma were analyzed retrospectively.[Results] The median CA125 value for all 279 patients was 339.2 U/ml(range 3.6～20 220.0U/ml).Preoperative serous CA125 in serous carcinoma was significantly higher than that in non-serous carcinoma(P0.05).For non-serous carcinoma with different histologic types,preoperative serous CA125 in mucinous /clear cell carcinoma was significantly lower than that in serous carcinoma(P0.01),and no significant difference was found between other types of non-serous carcinoma.Preoperative serous CA125 in early stage(stage Ⅰ) patient was significantly lower than that in advanced stage(stage Ⅱ～Ⅳ) patient(P=0.000).For non-mucinous/clear cell carcinoma patient,lower serous CA125 was usually associated with early disease and fairly good prognosis.As compared,higher serous CA125 was usually connected with advanced diseases,among which those with highest CA125 level displayed better survival than those with intermediate CA125 level.[Conclusion] Preoperative serous CA125 might reflect the tumor load for serous and other non-mucinous/clear cell carcinoma in epithelial ovarian carcinoma.Keywords:
Serous carcinoma
Clear cell carcinoma
Cystadenocarcinoma
Serous membrane
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Introduction: To examined survival outcome by histological subtypes in de novo stage IV epithelial ovarian cancer (EOC). Methods: Between 2004 and 2015, patients with stage IV EOC were included using the Surveillance, Epidemiology, and End Results program. The effects of histological subtypes on overall survival (OS) were assessed using Kaplan-Meier and multivariable Cox regression analyses. Results: We identified 5,953 patients including 5,351 (89.9%), 249 (4.2%), 145 (2.4%), and 208 (3.4%) patients with high-grade serous, endometrioid, mucinous, and clear cell subtypes, respectively. The 5-year OS rates were 28.1, 38.6, 14.2, and 18.8% in patients with high-grade serous, endometrioid, mucinous, and 18.8% clear cell subtypes, respectively, (p < 0.001). Multivariate analyses indicated that histological subtype was an independent predictor of OS. Using the high-grade serous subtype as a reference, OS was comparable for the endometrioid subtype (hazard ratio (HR) 0.915, 95% confidence interval) (CI 0.772-1.085, p = 0.305), but significantly lower for mucinous (HR 3.292, 95% CI 2.701-4.011, p < 0.001) and clear cell subtypes (HR 1.820, 95% CI 1.546-2.141, p < 0.001). Patients with no residual tumor had better OS in the high-grade serous and endometrioid subtypes compared to patients with residual tumors. However, the residual tumor size was not a prognostic factor for OS in mucinous and clear cell carcinoma. Conclusions: Our study suggest a markedly mortality rate in patients with stage IV mucinous and clear cell carcinoma, but better survival in patients with high-grade serous and endometrioid subtypes. Aggressive radical surgery to leave no residual disease would improve survival for high-grade serous and endometrioid carcinoma. More studies are needed to assess the value of aggressive radical surgery in patients with mucinous and clear cell subtypes.
Clear cell carcinoma
Serous carcinoma
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Clear cell carcinoma
Serous carcinoma
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Objectives
To compare the clinical-pathological features and survival outcomes of women with serous and non-serous epithelial ovarian cancer.Methods
Retrospective study of 151 patients staged surgically in Salah Azaiez Tunisian cancer center, between 2000 and 2010.Results
We performed primary debulking surgery in 128 patients (84.8%) and 23 patients (15.2%) underwent and interval debulking surgery.Maximal cytoreduction (R0) was achieved in 67 of patients (44.4%),39 patients had a residual disease ≤1 cm (25.8%) and 45 patients had a residual disease >1 cm (28.8%).Lymphadenectomy was performed in 57% of cases.The histological type was clearly established for all women:109 cases of serous carcinomas (72.2%) and 71 non-serous tumors (14 endometrioid,12 mucinous,7 clear cell carcinomas,2 malignant Brenner tumors,6 undifferentiated and one case of seromucinous carcinoma).The comparison of serous (SEOC) to non-serous tumor types (NSEOC) by univariate analysis showed that SEOC were associated to higher serum level of CA 125 exceeding 1000UI/ml (47.7% vs 19%,p=0.001), higher quantity of ascites exceeding 1 litre (40.4% vs 21.4%,p=0.029) with more frequent cacinomatosis in the upper abdomen (48.6% vs 21.4%,p=0.002) and more residual disease R1/R2 (65.1% vs 31%,p<0.0001),bilateral tumors (74.1% vs 45.2%,p=0.001),advanced FIGO stage III-IV (88.1% vs 50%,p<0.0001),pelvic lymph metastasis (LNM) (11.7% vs 4.2%) as well as paraaortic LNM (16.7% vs 8.3%,p=0.012),higher LN ratio (12.57±21.96 vs1.77±5.62,p=0.01) and lymphovascular invasion (43.1% vs 9.5%,p<0.0001). NSEOC were associated to higher rates of 5-years overall survival (31.3% vs 54.2%,p=0.006) and recurrence free survival (31.8% vs 64.6%,p=0.002).Conclusion
The management of EOC should take into account differences between histological subtypes.Debulking
Serous carcinoma
Serous cystadenocarcinoma
Clear cell carcinoma
Lymphadenectomy
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Objectives Uterine papillary serous carcinoma (UPSC) is a highly aggressive subtype of endometrial carcinoma. Histopathologically, it resembles the pattern of serous papillary carcinoma of the ovary. Cancer antigen 125 (CA-125) is the most widely used biomarker in epithelial ovarian carcinoma. Its use in UPSC evaluation has yet to be determined. The purpose of this study was to investigate the significance of preoperative serum CA-125 as a prognostic factor in patients with UPSC. Methods The study cohort included all women with UPSC operated in our institution between January 2002 and June 2016. All patients underwent complete surgical staging. Preoperative CA-125 was reviewed and correlated with clinical and pathological parameters. Results Sixty-one women met the study criteria. Median preoperative CA-125 was found to be significantly associated with disease stage. Patients with disease stages I to IV had median preoperative CA-125 levels of 12.15, 19.6, 22.6, and 177.5 U/mL ( P < 0.0001) respectively. Levels of CA-125 were significantly associated with positive cytology ( P < 0.0001), omental disease ( P < 0.0001), pelvic or para-aortic lymph node metastasis ( P < 0.0001), and adnexal involvement ( P < 0.0001). The optimal cutoff that provided the best sensitivity and specificity for omental and parametrial involvement as well as positive cytology was 57.5 U/mL. For adnexal and lymph node involvement, the optimal cutoff value was 41.8 U/mL. Conclusions In patients with UPSC, preoperative CA-125 level correlates with known prognostic parameters of endometrial carcinoma and is associated with extrauterine involvement. These data should stimulate the need for further evaluation of the role of CA-125 in predicting recurrence and survival in UPSC.
Serous carcinoma
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Extraovarian peritoneal serous papillary carcinoma (EPSPC) is both histologically and clinically similar to stage III-IV ovarian papillary serous carcinoma (OPSC). The purpose of this study is to investigate the clinical findings, treatment, and outcome of EPSPC patients compared with stage III-IV OPSC patients.The data of 12 EPSPC patients and 45 stage III-IV OPSC patients were retrospectively reviewed, comparing the characteristics on clinical presentation and treatment, sensitivity to first-line chemotherapy agents and survival.By analysis of patients' characteristics, presenting signs and symptoms, type and extent of surgery, tumor response to first-line chemotherapy, recurrence-free interval, recurrence site and serum CA-125 levels, no significant difference was observed between the EPSPC patients and stage III-IV OPSC controls. The prevailing presenting symptoms were abdominal mass and ascites. The mainstay of treatment was debulking surgery followed by adjuvant platinum-based chemotherapy. The complete clinical response of stage III-IV OPSC was 91.8% compared with 25.0% for women with EPSPC (P < 0.01).The clinical and surgical characteristics of EPSPC are similar to those of stage III-IV OPSC. When the same treatment strategy is applied, similar response and survival are expected in either condition.
Debulking
Carboplatin
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Objective To compare clinicopathological characteristics and survival rates between patients with primary ovarian mucinous carcinoma and those with primary ovarian serous carcinoma. Methods This retrospective study reviewed archival tumour specimens, originally diagnosed as primary ovarian mucinous carcinoma, using refined histological criteria. All patients were contacted to establish survival status. Clinicopathological characteristics and patient survival data were compared with a group of control patients with primary ovarian serous carcinoma. Results Of the 33 patients originally diagnosed with primary ovarian mucinous carcinoma, this diagnosis was only confirmed in 18. Primary ovarian mucinous carcinoma was more commonly associated with early International Federation of Gynecology and Obstetrics tumour stages and low-grade histology than primary ovarian serous carcinoma. Patients with primary ovarian mucinous carcinoma had a significantly higher overall 5-year survival rate than those with primary ovarian serous carcinoma (12/12 [100%] versus 14/24 [58%]). Kaplan–Meier survival plots demonstrated that patients with primary ovarian mucinous carcinoma had a survival advantage over patients with primary ovarian serous carcinoma. Conclusions Primary ovarian mucinous carcinomas are frequently low-grade, stage I tumours and have an excellent prognosis.
Mucinous carcinoma
Serous carcinoma
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Serous carcinoma
Grading (engineering)
Lymphovascular invasion
Atypia
Nuclear atypia
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PURPOSE To compare the clinical-pathological features of women with serous and non-serous ovarian tumors and to identify the factors associated with survival. METHODS In this reconstructed cohort study, 152 women with ovarian carcinoma, who attended medical consultations between 1993 and 2008 and who were followed-up until 2010 were included. The histological type was clearly established for all women: 81 serous carcinomas and 71 non-serous tumors (17 endometrioid, 44 mucinous and 10 clear cell carcinomas). The crude and adjusted odds ratios (OR), with the respective 95% confidence intervals (95%CI), were calculated for the clinical and pathological features, comparing serous and non-serous histological types. The Hazard Ratios (HR) with 95%CI was calculated for overall survival, considering the clinical and pathological features. RESULTS Comparison of serous to non-serous tumor types by univariate analysis revealed that serous tumors were more frequently found in postmenopausal women, and were predominantly high histological grade (G2 and G3), advanced stage, with CA125>250 U/mL, and with positive peritoneal cytology. After multivariate regression, the only association remaining was that of high histological grade with serous tumors (adjusted OR 15.1; 95%CI 2.9-77.9). We observed 58 deaths from the disease. There was no difference in overall survival between women with serous carcinoma and women with non-serous carcinoma (HR 0.4; 95%CI 0.1 - 1.1). It was observed that women aged 50 years or less (HR 0.4; 95%CI 0.1-0.9) and those who were in menacne (HR 0.3; 95%CI 0.1-0.9) had a longer survival compared respectively to those above 50 years of age and menopaused. High histological grade (G2 and G3) (p<0.01), stages II-IV (p<0.008) and positive cytology (p<0.001) were significantly associated with worse prognosis. CA125 and the presence of ascites did not correlate with survival. Survival was poor when the disease was diagnosed in stages II to IV and compared to stage I (log-rank p<0.01) regardless of histological type (serous and non-serous). CONCLUSIONS The proportion of high histological grade (G2 and G3) was significantly higher among serous than non-serous carcinomas. Serous and non-serous histological types were not related to overall survival.
Serous carcinoma
Univariate analysis
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Objective To explore the clinical characteristics of serous adenocarcinoma. Methods Fifty four cases of serous adenocarcinoma were analysed in terms of age,histological fetures,stage,pathological grade,survival time and prognosis factor by statistical software. Results Of the 54 patients,24 had stage Ⅰ and 6 had stage Ⅱ diseases,and 23 had stage Ⅲ diseases,only 1 had stage Ⅳ.The overall median survival time of the patients was 84 months,and the 5-year survival rate was 76.92%.Most of the patients at diagnosis of serous adenocarcinoma were in the menopause stage(85%).In multivariate analysis,the absence of lymphovascular space invasion(P=0.021) remained as independent prognostic factors for improved survival time. Conclusions Serous adenocarcinoma is recognized as a virulent histologic subtype of endometrial cancer.It has a propensity for intra-abdominal spread and distant metastases.A preoperative diagnosis of serous adenocarcinoma staging procedure is advocated.
Serous carcinoma
Lymphovascular invasion
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To study the clinical characteristics of clear cell carcinoma of the ovary.Forty three patients with clear cell carcinoma of the ovary and 51 patients with serous adenocarcinoma of the ovary who were admitted in Peking Union Medical College Hospital between 1984 to 2000 were analyzed retrospectively, and their chemosensitivities and the survival rates were compared.The percentage of early stage patients in the clear cell carcinoma of the ovary and the serous adenocarcinoma of the ovary was 14.4% and 3.8% respectively, the difference was significant (P < 0.005). In the late stage patients who underwent satisfactory cytoreductive surgery, the chemo-resistant rate (88.9%) in the clear cell carcinoma of the ovary was significantly higher than that (57.1%) of the serous adenocarcinoma of the ovary (P < 0.02), the 1-year survival rate (79.0%) in the clear cell carcinoma of the ovary was significantly lower than that (96.2%) of the serous adenocarcinoma of the ovary (P < 0.01). In the late stage patients who underwent unsatisfactory cytoreductive surgery, the chemo-resistant rate and the survival rate had no significant difference between the clear cell carcinoma of the ovary and the serous adenocarcinoma of the ovary (P > 0.05).There are more early stage patients with clear cell carcinoma of the ovary. We should conduct auxiliary therapy and close follow up to them after surgery. Clear cell carcinoma of the ovary is chemo-resistant to platinum-based chemotherapy and has poor prognosis.
Serous carcinoma
Clear cell carcinoma
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