344 Comparison of clinical pathological and survival outcomes between serous and non-serous ovarian cancer
Houyem MansouriInès ZemniOlfa JaïdaneM ChemlaliJamel Ben HassounaM HechicheRiadh CharguiKhaled Rahal
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Abstract:
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.Keywords:
Debulking
Serous carcinoma
Serous cystadenocarcinoma
Clear cell carcinoma
Lymphadenectomy
A review of literature comparing the survival of patients with clear cell carcinoma of the ovary to patients with serous carcinoma reveals divided opinions. No studies of statistical significance have demonstrated worse survival in a cohort of patients with clear cell carcinoma matched stage for stage with patients with serous carcinoma of the ovary. The purpose of this study was to compare survival in a cohort of clear cell carcinoma patients to a cohort of serous carcinoma patients matched for stage, age, treatment, and cytoreduction.All cases of clear cell carcinoma and serous carcinoma of the ovary operated on by the gynecology oncology service from January 1, 1981 to December 31, 1989 were evaluated for patient age, length of survival and level of primary cytoreduction, as well as FIGO stage and histology.Twenty-two patients with clear cell carcinoma found in the years noted were compared to a cohort of 22 patients with serous carcinoma matched for stage (I, 18.2%; II, 9.1%; III, 63.6%; IV, 9.1%), age (clear cell carcinoma 58 years, serous carcinoma 60 years (p = 0.330)), and level of primary cytoreduction (optimal in 63.6% of both clear cell carcinoma and serous carcinoma cohorts and non-optimal in 36.4% of both groups). Survival in the clear cell carcinoma cohort (16 months) was worse than in the serous carcinoma cohort (36 months) (p = 0.045).Patients with clear cell carcinoma have a significantly worse prognosis than patients with serous carcinoma when matched for age, stage, and level of primary cytoreduction.
Serous carcinoma
Clear cell carcinoma
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Interval debulking and neoadjuvant chemotherapy have been used in management of advanced epithelial ovarian cancer for many years in order to achieve optimal residual disease and reduce surgical morbidity. The present study was conducted to evaluate the outcomes of advanced ovarian cancer patients treated with these two approaches prior to cytoreductive surgery in Chiang Mai University Hospital between January 2001 and December 2006. The medical records of 29 patients who met the criteria were retrospectively reviewed. Most had stage IIIC serous cystadenocarcinomas. We found that the 5 year progression free survival and overall survival were 10% and 22% while the median values were 13 months and 34 months, respectively. Multivariate analysis showed that a suboptimal residual tumor volume was a statistically significant adverse prognostic factor for overall survival. In conclusion, interval debulking surgery and neoadjuvant chemotherapy before cytoreductive surgery lead to a more favorable outcome with advanced epithelial ovarian cancers.
Debulking
Serous cystadenocarcinoma
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Serous carcinoma and clear cell carcinomas account for 10% and 3% of endometrial cancers but are responsible for 39% and 8% of cancer deaths, respectively. In this study, we aimed to compare serous carcinoma and clear cell carcinoma regarding the surgico-pathologic and clinical characteristics, and survival, and to detect factors that affected recurrence and survival.We retrospectively analyzed patients with clear cell and serous endometrial cancer who underwent surgery between January 1993 and December 2013 in our clinic. We used Kaplan-Meier estimator to analyze survival.The tumor type in 49 patients was clear cell carcinomas and was serous uterine carcinoma in 51 patients. Advanced stage (stage III and IV) disease was present in 42% of the patients in the clear cell group, whereas this rate was 62% in the serous group (p=0.044). Lymph node metastasis was detected in 37% of the patients with clear cell carcinomas and 51% of the patients with serous carcinoma (p=0.17). The adjuvant therapies used did not differ significantly between the groups (p=0.192). The groups had similar recurrence patterns. Five-year progression-free survival and the 5-year overall survival were 60.6% and 85.8%, 45.5% and 67.8% in the patients with clear cell carcinomas and serous tumor, respectively.With the exception that more advanced stages were observed in patients with serous carcinoma endometrial cancers at presentation, the surgico-pathologic features, recurrence rates and patterns, and survival rates did not differ significantly between the groups with clear cell carcinoma and serous carcinoma endometrial cancers.
Serous carcinoma
Clear cell carcinoma
Serous membrane
Adjuvant Therapy
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The clinical and pathological findings in 23 cases of clear cell carcinoma of the ovary treated at Cancer Institute Hospital from January 1951 to September 1987 are discussed. Clear cell carcinoma accounted for 7.1% of all malignant tumors of the ovary. In the last 21 months of the study, the incidence of clear cell carcinoma increased to 23.7 at the institute. This tumor was frequently associated with endometriosis, and the ratio of nulliparous women was as high as 47.8%. Operative findings revealed adhesion of the tumor to surrounding tissues in more than half of the cases. Moreover, rupture of the tumor capsule during operation occurred in 42.1% of the cases. Incidences of clear cell carcinoma by clinical stage were 82.6% for stage I, 8.7% for stage II, 8.7% for stage III, and 0% for stage IV. The incidences of serous carcinoma were 20.8%, 24.2%, 45.8%, and 9.2%, respectively. Histologically, clear cell carcinoma could be divided into solid and tubular types, with the solid type being slightly more frequent. The three-year survival rate for stage I cases was 95.2% for serous carcinoma and 54.5% for clear cell carcinoma, showing a poor prognosis for clear cell carcinoma. When classified by the histologic type of clear cell carcinoma, the three-year survival rate was 50.0% for solid type and 60.0% for tubular type, with no significant difference. For clear cell carcinoma, the prognosis was poor despite even though most cases were stage I.
Clear cell carcinoma
Serous carcinoma
Serous membrane
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Clear cell carcinoma
Serous carcinoma
Clear Cell Adenocarcinoma
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Neoadjuvant chemotherapy followed by interval debulking has become an alternative treatment option for patients with advanced-stage ovarian cancer. The effects of chemotherapy on the histologic features of the tumor have not been well described for ovarian carcinoma, especially related to changes that significantly alter the appearance of the tumor. In this study, we describe a case of ovarian serous carcinoma status-post neoadjuvant chemotherapy that showed exuberant clear cell/foamy change. This unusual morphology raised the possibility of a mixed epithelial carcinoma or a secondary malignancy. Immunohistochemical stains were performed to help distinguish whether the tumor was a serous carcinoma with chemotherapy-induced clear cell change or a distinct clear cell carcinoma of ovarian or extraovarian origin. The clear cell and conventional serous components showed diffuse positivity for CK7, CA125, and ER; however, only the clear cell component was positive for hepatocyte nuclear factor-1beta and only the conventional serous component was positive for WT1. Although there was a slight discrepancy in the staining patterns, given the lack of other typical histologic features of clear cell carcinoma, the unusual clear cell morphology was most likely the result of chemotherapy-induced changes.
Serous carcinoma
Clear cell carcinoma
Debulking
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Objective
The role of selective lymphadenectomy at the time of interval debulking surgery in patients with advanced ovarian cancer remains a topic of debate. This study aimed to evaluate the value of selective lymphadenectomy during interval debulking surgery in patients with radiologic evidence of lymph node metastasis at initial diagnosis that ultimately become negative on imaging after neoadjuvant chemotherapy.Methods
A retrospective analysis including patients with stage IIIC–IV epithelial ovarian cancer and suspicious pelvic or para-aortic lymph node metastasis by imaging at diagnosis that resolved after neoadjuvant chemotherapy. The study was conducted from January 1996 to June 2016 with R0 interval debulking surgery. The patients with disease progression after neoadjuvant chemotherapy were excluded. Suspicious metastatic lymph nodes at initial diagnosis by computed tomography/magnetic resonance imaging were excised by selective lymphadenectomy. Survival curves were constructed by the Kaplan-Meier method, and a multivariate analysis was performed using Cox regression.Results
There were a total of 330 patients included in the analysis. Selective lymphadenectomy of suspicious nodes (Group 1) was performed in 145 patients. Systematic lymphadenectomy (Group 2) was performed in 118 patients. Sixty-seven patients did not undergo lymphadenectomy (Group 3). There were no significant differences in clinicopathologic features among the groups. Median progression-free survival was 28, 30.5, and 22 months in Groups 1, 2, and 3, respectively (log-rank, p=0.049). No-lymphadenectomy was an independent factor affecting progression-free survival (Cox analysis, HR=1.729, 95% CI 1.213 to 2.464, p=0.002), with no difference between Groups 1 and 2 (Cox analysis, HR=1.097, 95% CI 0.815 to 1.478, p=0.541). Median overall survival was 50, 59, and 57 months in Groups 1, 2, and 3, respectively (Cox analysis, p=0.566). Patients who underwent selective lymphadenectomy had lower 1-year frequencies of lower extremity lymphedema and lymphocysts than those with systematic lymphadenectomy (6.2% vs 33.1%, p<0.001, and 6.2 % vs 27.1%, p<0.001, respectively).Conclusions
Extent of lymphadenectomy (systematic or selective) had no significant impact on progression-free survival or overall survival. In addition, the risks of lower extremity lymphedema and lymphocysts were lower in patients who underwent selective lymphadenectomy.Debulking
Lymphadenectomy
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Serous carcinoma
Clear cell carcinoma
Gynecologic oncology
Not Otherwise Specified
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Serous carcinoma
Clear cell carcinoma
Exploratory laparotomy
Adjuvant Therapy
Serous cystadenocarcinoma
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