Clinicopathologic analysis of early-stage sporadic ovarian carcinoma Journal Article


Authors: Leitao, M. M. Jr; Boyd, J.; Hummer, A.; Olvera, N.; Arroyo, C. D.; Venkatraman, E.; Baergen, R. N.; Dizon, D. S.; Barakat, R. R.; Soslow, R. A.
Article Title: Clinicopathologic analysis of early-stage sporadic ovarian carcinoma
Abstract: The reported experience with early-stage (FIGO stage I/II) ovarian carcinoma (OC) is limited given that the majority of women with OC are diagnosed at an advanced stage. There has not been an extensive review of these tumors, and since the pathologic criteria differentiating invasive and borderline tumors have evolved over time, the issue of whether a proportion of these tumors should be reclassified has not been addressed. We identified patients with stage I/II invasive OC who underwent primary surgical management at Memorial Sloan-Kettering Cancer Center from 1980 to 2000. Patients known to have a BRCA mutation or a family history of breast/ovarian cancer were excluded. Hematoxylin and eosin slide review, blinded to clinical outcomes, using current diagnostic criteria for ovarian carcinomas and borderline ovarian tumors, was performed. Progression-free survival (PFS) and disease-specific survival (DSS) were estimated and compared. Hematoxylin and eosin slides were reviewed for 140 of the 145 patients identified. The diagnosis was changed to borderline (low malignant potential) in 41 cases (29.3%). Twenty-nine (70.7%) of 41 changes in diagnosis involved endometrioid and mucinous tumors. This was attributable to the application of recently revised criteria for distinguishing borderline tumors from carcinomas. None of the originally diagnosed clear cell carcinomas was reclassified as borderline. The distribution of histologic subtypes among the 94 carcinomas included 26 serous (27.7%), 25 clear cell (26.6%), 22 endometrioid (23.4%), 10 mixed (10.6%), 6 mucinous (6.4%), 2 malignant Brenner (2.1%), and 3 adenocarcinomas, not otherwise specified (3.2%). Adjuvant therapy was given to 84 (89.4%) of the 94 patients with carcinomas. The 5-year PFS and DSS were significantly greater for the group of cases that was reclassified as borderline (4.5% vs. 26.2% progressed [P = 0.006]; 4.5% vs. 25.6% died [P = 0.003]). The 5-year PFS and DSS were significantly worse for carcinomas with a TP53 mutation (22.6% vs. 41.2% progressed [P = 0.04]; 21.7% vs. 24.7% died [P = 0.04]). There were no statistically significant differences in outcome between stages I versus II, tumor grades, clear cell histology versus other, and stage IC preoperative versus intraoperative rupture. We concluded that a large number of cases originally diagnosed as early-stage sporadic OC were borderline tumors. Clear cell histology does not confer a worse prognosis compared with other histologies. The presence of a TP53 mutation was an adverse prognostic indicator.
Keywords: adult; cancer survival; controlled study; human tissue; aged; aged, 80 and over; disease-free survival; middle aged; survival analysis; unclassified drug; gene mutation; major clinical study; histopathology; review; cancer staging; endometrioid carcinoma; neoplasm staging; cancer grading; adenocarcinoma; ovarian neoplasms; disease association; neoplasm recurrence, local; diagnosis, differential; gene product; preoperative period; intraoperative period; family history; breast carcinoma; carcinoma; ovary carcinoma; mixed tumor; eosin; hematoxylin; clear cell carcinoma; mucinous carcinoma; borderline tumors; single-blind method; prognostic variables; brenner tumor; humans; prognosis; human; female; early-stage invasive ovarian cancer; sporadic ovarian cancer; tp53 gene mutation; brca protein
Journal Title: American Journal of Surgical Pathology
Volume: 28
Issue: 2
ISSN: 0147-5185
Publisher: Lippincott Williams & Wilkins  
Date Published: 2004-02-01
Start Page: 147
End Page: 159
Language: English
DOI: 10.1097/00000478-200402000-00001
PROVIDER: scopus
PUBMED: 15043303
DOI/URL:
Notes: Am. J. Surg. Pathol. -- Cited By (since 1996):51 -- Export Date: 16 June 2014 -- CODEN: AJSPD -- Source: Scopus
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MSK Authors
  1. Venkatraman Ennapadam Seshan
    382 Seshan
  2. Amanda J Hummer
    60 Hummer
  3. Richard R Barakat
    629 Barakat
  4. Don S Dizon
    21 Dizon
  5. Mario Leitao
    575 Leitao
  6. Jeffrey Boyd
    112 Boyd
  7. Robert Soslow
    797 Soslow
  8. Crispinita D Arroyo
    30 Arroyo
  9. Narciso Olvera
    73 Olvera