原发性卵巢黏液性癌的临床特征分析

目的:探讨原发性卵巢黏液性癌的临床特点,寻求恰当的治疗策略。方法:回顾分析24例卵巢黏液性癌和108例非黏液性癌患者的年龄、手术病理分期、残留病灶、化疗反应率,比较生存情况,分析影响预后的因素。结果:黏液性癌患者FIGO分期早(P=0.001)、肿瘤分级低(P=0.000)。两组患者的年龄没有差异,Ⅲ～Ⅳ期患者的手术满意率无差异(P=0.453)。黏液性癌组与非黏液性癌组初治时对紫杉醇+卡铂的化疗反应率无差异(63.2%vs 85.2%,P=0.212),黏液性癌组的耐药病例似乎与肿瘤分期、手术满意度无关,而且复发后耐药率明显升高至60%。黏液性癌组和非黏液性癌组患者的总体中位无进展生存期(PFS)(22个月vs 17个月,P=0.393)和中位总生存期(OS)(22个月vs 37.5个月,P=0.670)无差异。Ⅰ～Ⅱ期黏液性癌与非黏液性癌两组患者中位PFS(37.5个月vs 44个月,P=0.304)和OS(49个月vs 45个月,P=0.621)亦无差异。满意肿瘤细胞减灭术后的Ⅲ～Ⅳ期患者,黏液性癌组中位PFS比非黏液性癌组短(12个月vs27个月,P=0.003),中位OS也缩短(18个月vs 45个月,P=0.044);不满意肿瘤细胞减灭术后的Ⅲ～Ⅳ期患者两组中位PFS(7.5个月vs 16个月,P=0.533)和中位OS(18个月vs 33个月,P=0.192)无统计学差异。Cox多因素回归分析结果提示,影响患者无进展生存期的因素包括肿瘤病理类型、FIGO分期和手术满意度;而影响总生存期的因素只有手术满意度。结论:卵巢黏液性癌是上皮癌的一个独立类型,晚期黏液性癌患者比非黏液性癌预后差,化疗耐药可能是预后差的原因,需要筛选有效的化疗方案。     

Ovarialkarzinom

Ovarian cancer is the sixth most common form of cancer in women in Germany. The main prognostic factors are the stage of the disease at the time of diagnosis as well as the quality of therapy. In early ovarian cancer meticulous staging of the entire abdominal cavity in addition to resection of the primary tumor and all visible tumor manifestations are required. In patients with early ovarian cancer International Federation of Gynecology and Obstetrics (FIGO) stage I-IIA, with the exception of FIGO stage IA, platinum-based chemotherapy is indicated. In cases of advanced ovarian cancer the patient prognosis is essentially determined by the extent of tumor mass reduction at the time of primary surgery. Patients with complete tumor resection have a significantly longer survival time compared to patients with residual tumor mass at the end of surgical treatment (median 5 years). Following surgery a combination of carboplatin with paclitaxel is the standard chemotherapeutic regimen. In FIGO stage IIIB–IV addition of bevacizumab to standard chemotherapy is an option.     

Pure-type clear cell carcinoma of the ovary as a distinct histological type and improved survival in patients treated with paclitaxel-platinum-based chemotherapy in pure-type advanced disease

OBJECTIVE: The aim was to compare survival in pure and mixed-type advanced clear cell ovarian carcinoma and to determine the benefits among patients with pure advanced clear cell ovarian carcinoma treated in paclitaxel-platinum-based chemotherapy in comparison with those treated in conventional platinum-based chemotherapy after primary surgery. METHODS: Between 1994 and 2001, 31 women with stage III and IV pure clear cell ovarian carcinoma and nine patients with stage III and IV mixed-type clear cell carcinoma were identified from the tumor registry of six institutions. All patients underwent cytoreductive surgery followed by conventional platinum-based chemotherapy or paclitaxel and platinum-based chemotherapy. RESULTS: The median survival of women with pure clear cell carcinoma was 11 months, compared to 48+ months for those with mixed-type clear cell carcinoma (P = 0.003). Overall, for women with pure clear cell carcinoma, 35% had clinically complete responses to chemotherapy. For women with pure clear cell carcinoma treated with paclitaxel-platinum-based chemotherapy, the median survival was significantly longer than for those treated with conventional platinum-based chemotherapy (16.26 vs. 10.75 months, P = 0.045; with optimal cytoreduction, 40.95 vs. 9.02 months, P = 0.028). Univariate analysis showed paclitaxel-platinum-based treatment was the only favorable prognostic factor for women with advanced pure clear cell ovarian carcinoma (P = 0.05). CONCLUSIONS: Patients with advanced pure clear cell ovarian carcinoma have poorer prognoses than those with the mixed type. Paclitaxel-platinum-based chemotherapy improved survival among our patients with advanced pure clear cell carcinoma, especially for those with optimal cytoreduction.     

Prognostic significance of microvessel density and vascular endothelial growth factor expression in advanced ovarian serous carcinoma

The aim of the study was to test the prognostic value of the microvessel density (MVD) within the tumor and the vascular endothelial growth factor (VEGF) expression on clinical response to chemotherapy, on brief disease-free interval, and on cause-specific survival in advanced ovarian serous carcinoma. We evaluated 83 ovarian carcinomas homogeneous for stage, type and grade histologic, surgical, and chemotherapeutic treatment. Brief disease-free interval and cause-specific survival rates (Kaplan-Meier method) were compared using the log-rank test. A multivariate analysis (Cox-proportional hazards model) was used to determine the independent effect of each variable on prognosis. Overall 60 and 120 months cause-specific survival rates were 27.7% and 2.4%, respectively. The brief disease-free interval rate was 66.2%. In univariate analysis, VEGF (P = 0.0001 and P = 0.016), MVD (P < 0.0005), and the FIGO stage IIIC even more than FIGO stage IIIA (P = 0.01 and P < 0.0005, respectively) were associated with survival and brief disease-free interval, and the residual tumor was associated with survival (P = 0.021). In multivariate analysis, the factors that were independent predictors of survival were MVD (P < 0.0005), VEGF (P = 0.027), and the FIGO stage IIIC even more than FIGO stage IIIA (P = 0.013). Moreover, MVD was an independent predictor also of brief disease relapse (P = 0.001). Both MVD and VEGF were correlated with clinical response to chemotherapy (P = 0.01 and P = 0.037). Our data suggest that MVD and VEGF may have prognostic significance in advanced ovarian serous carcinoma.     

Does the interval from primary surgery to chemotherapy influence progression-free survival in ovarian cancer?

OBJECTIVES: The objective of this study was to determine whether the length of the interval from primary surgery to commencement of chemotherapy has any direct effect on progression-free survival in ovarian cancer. METHODS: The progression-free survival of 472 patients enrolled in four trials who had all received platinum-containing chemotherapy (either in combination with a taxane or cyclophospamide) was subjected to univariate analysis. Dividing subjects into those above and below the median interval from surgery to chemotherapy formed two groups for analysis. The analysis was stratified by study and arm/cohort within study to remove any possible influence of the different studies and study doses. Multivariate analysis was then performed including stage, bulk of residual disease, and performance status as well as interval to starting chemotherapy. RESULTS: The median interval from surgery to chemotherapy was 22 days (range 7-100). Univariate analysis of the above median and below median groups showed worse progression-free survival for those with earlier treatment (hazard ratio 0.84, P = 0.14, 95% CI 0.67-1.06); however, those treated earlier tended to have bulkier residual disease (>2 cm; P = 0.006). When multivariate analysis was performed incorporating residual disease status, FIGO stage, and performance status, the hazard rate ratio for interval to surgery was 0.99 (P = 0.91, 95% CI 0.79-1.24). CONCLUSIONS: This study suggests that the interval from surgery to commencement of chemotherapy is not an independent prognostic factor for progression-free survival.     

Prognostic significance of tumor ploidy in patients with advanced ovarian carcinoma

Fresh tumor specimens obtained from 53 consecutive patients with FIGO Stage III ovarian carcinoma were analyzed by flow cytometry. All patients were treated by a standard protocol: maximal tumor excision and cisplatin/cyclophosphamide/adriamycin chemotherapy, and followed-up for at least 24 months. Thirty-two percent of tumors were diploid (DNA index = 1.00) and 68% aneuploid (DNA index greater than 1.00), with more aneuploid tumors being associated with larger residual tumor and poor cellular differentiation. Patients with diploid tumors were found to survive significantly better than those with aneuploid tumors, in terms of survival rate (65% versus 31%), median survival time (33 months versus 13 months), and mean disease-free interval (17.8 months versus 8.2 months). The influence of the amount of residual tumor after primary surgery on survival was only significant in patients with diploid tumors. Our results support previous findings that tumor ploidy is an important prognostic indicator in ovarian cancer. We found aneuploidy to be associated with a poorer clinical outcome in Stage III disease, regardless of the amount of residual tumor after primary surgery and the degree of cellular differentiation.     

卵巢正常大小的原发性卵巢上皮性癌综合的临床特点与预后 …

目的 探讨卵巢正常大小的 性卵巢上皮性癌综合征的临床特点及预后因素。方法 对１０例患者的病例资料采用回顾性分析方法。结果 本病多发生于５０岁以上,占８０％;以腹胀、食欲差为首发症状,占９０％;就诊晚,易误诊,误诊率４０％;卵巢均正常大小,盆腹腔有广泛种植,局部聚集成块,占７０％;术后残留灶直径〈２．０ｍｃ患者的生存时间高于术后残留灶直径≥６个者生存时间明显高于疗程数〈６个者（Ｐ〈０．０５）。本组患     

血清CA125半衰期判定卵巢上皮性癌预后的价值

目的 探讨血清ＣＡ１２５半衰期在卵巢上皮性癌中的预后价值。方法 回顾性分析３０例卵巢上皮性癌患者在化疗过程中血清ＣＡ１２５半衰期值（ｔ１／２）与生存时间的关系。结果 血清ＣＡ１２５半衰期值（ｔ１／２）≤２０天组的中位生存时间为３６个月，ｔ１／２〉２０天组中完全缓解率为２７．３％，两者存在极显著差异（ｐ＝０．００１）。多因素生存分析表明：ＣＡ１２５半衰期和细胞分级、残余瘤灶大小均是独立的预后因素。结     

Skin metastases in ovarian carcinoma: a report of nine cases and a review of the literature

OBJECTIVE: Cutaneous involvement is unusual at presentation and during the course of ovarian carcinoma. The aim of the present study was to determine the incidence, clinicopathologic characteristics and prognostic factors of skin metastases in ovarian cancer patients. METHODS: A retrospective chart review was conducted on 220 patients with epithelial ovarian carcinoma treated at our unit between 1991 and 2001. Pertinent clinical information, pathologic data, treatment, and prognostic factors for survival following documentation of skin metastases were collected. Survival time was calculated from the time of diagnosis of ovarian cancer and from the time of diagnosis of the cutaneous metastasis. RESULTS: FIGO stage at the time of ovarian cancer diagnosis was stage III = five patients (56%), and stage I and stage IV = two patients each (22%). Most patients had serous papillary cystoadenocarcinoma of the ovary (78%), and one each had endometrioid and mucinous carcinomas (12%). Seven patients (78%) had poorly differentiated tumors. Only one patient had a skin metastasis at the time of ovarian cancer diagnosis; in the remaining patients the average time of appearance of skin metastases after the diagnosis of ovarian cancer was 23.4 +/- 12 months (range 4 to 37). The diameter of the skin lesions ranged between 0.5 and 3 cm. Three patients had a single skin nodule, while six had multiple skin lesions. Eight patients (89%) have died of disease and median survival after diagnosis of the skin metastases was 4 months (range 2 to 65). One patient (Cases 1) is alive without tumor 4 months after diagnosis of the skin metastases. Overall survival after diagnosis of skin metastasis from ovarian cancer was 4 months (range 2 to 65). CONCLUSION: Skin involvement is a late complication that occurs rarely in ovarian cancer patients. Prognosis after skin metastases is poor and the most important prognostic factor associated with survival is the interval time between diagnosis of ovarian cancer and documentation of cutaneous involvement.     

卵巢浆液性腺癌预后评分模型的建立及应用

目的通过分析卵巢浆液性腺癌的预后相关因素,建立其预后评分模型,并应用于临床预测患者的生存概率。方法对北京大学人民医院104例卵巢浆液性腺癌患者的临床病理资料进行回顾性分析。Kaplan-meier单因素生存分析筛选预后相关因素;COX单因素和多因素回归分析确定各预后相关因素内分层因素及各预后相关因素的风险系数;Pearson等级相关分析剔除各预后相关因素间的相互影响。根据上述两个风险系数对各预后相关因素进行评分,建立预后评分模型,据此预测患者的生存概率。结果单因素生存分析显示,手术病理分期（P=0、0029）、病理分级（P=0．0054）、术后残留灶直径（P=0．0000）、淋巴结转移（P=0．0000）以及化疗情况（P=0．0000）是卵巢浆液性腺癌的预后相关因素。Pearson等级相关分析显示,手术病理分期对预后的影响最大,随后依次为化疗、淋巴结转移、病理分级以及术后残留灶直径（其独立风险系数分别为1．3392、0．9206、0．7071、0．6004、0．4985）。根据预后风险系数对各预后相关因素进行评分,得到了卵巢浆液性腺癌的预后评分模型。通过该模型量化了化疗和术后残留灶直径这两个可变因素对患者生存概率的影响。随着预后评分的增加,患者的生存概率降低。结论通过筛选影响预后的相关因素,建立卵巢浆液性腺癌的预后评分模型。该模型可以量化预后相关因素,尤其是化疗和残留灶直径这两个指标,预测患者的生存概率,为临床工作提供了一种科学判断预后的方法。     

Salvage chemotherapy for ovarian cancer recurrence: weekly cisplatin in combination with epirubicin or etoposide

From December 1986 to April 1990, 40 consecutive ovarian cancer patients who relapsed after response to cisplatin-based chemotherapy regimens were treated with seven courses of weekly cisplatin, in combination with epirubicin or etoposide. The overall response rate obtained with the intensive schedule was 60% and the complete response rate was 25%; median duration of response was 7 months and median survival time, 13.5 months. Responsive cases seem to have longer survival; a prognostic factor for response to salvage treatment and longer survival is the disease-free interval after the first-line chemotherapy. Weekly cisplatin as intensive treatment was very well tolerated and showed acceptable toxicity in both the combination protocols with epirubicin or etoposide.     

Advanced ovarian cancer patients with no evidence of disease after platinum-based chemotherapy: retrospective analysis of the role of second-look.

From 1981 to 1992, 230 previously chemotherapy-untreated epithelial ovarian cancer patients (Stages IIb-III or IV) received platinum-based polychemotherapy at our Division. In this presentation, time to progression and overall survival rates were retrospectively analyzed in 89 epithelial ovarian cancer patients (stage IIb, c - III or IV) with no clinical evidence of disease (clinical complete remission--CCR--in 26 patients with postsurgical residual tumor > or = 2 cm, and no clinical evidence of disease--NED--in 63 patients with post-surgical residual tumor < 2 cm) after first-line platinum-containing chemotherapy. After at least 6 courses of chemotherapy, 62 patients (group A) were submitted to second-look (SL) laparotomy (n=47) or laparoscopy (n=15); 27 patients (group B) did not undergo second-look surgery because of patient refusal, the surgeon's decision or clinical contro-indications to surgery. Groups A and B were comparable in terms of post-surgical residual tumor (< 2 cm: 71% vs 70%), median Performance Status (WHO: 1) and median age (56 vs 57 yrs). FIGO stage IIb, c was more frequent in group B (26% vs 18%--p=0.004). In 9/18 (50%) patients with clinical CR and in 31/44 (70%) NED patients no residual tumor was confirmed at SL (pathological CR--pCR). After a median follow-up of 10 years (range 5-16 years), 72% (64/89) of patients relapsed and 65% (58/89) died. Survival was significantly longer in patients with pCR (median survival 76 months vs 32, 29 and 16 months for patients with pPR, pNC or pPD, respectively, p=0.0001). Multivariate analysis identifies pCR as the only significant prognostic factor exerting an influence on survival after second-look laparotomy (p=0.0000). This study confirms that the second-look can provide an important prognostic evaluation in patients without evidence of disease after chemotherapy for ovarian cancer stages III-IV.     

Surgical resection of solitary brain metastasis from ovarian carcinoma: an analysis of 22 cases

OBJECTIVE: Central nervous system (CNS) involvement is considered an uncommon complication in patients with ovarian carcinoma. The aim of this study was to evaluate prognostic factors for survival following surgical resection of brain metastases in patients with ovarian carcinoma. METHODS: A retrospective chart review was conducted on 22 patients who had been submitted to neurosurgical resection of a solitary brain metastasis from ovarian carcinoma. RESULTS: Eighteen lesions were cerebral, 4 were cerebellar. CNS was the only site of disease in 9 patients, 9 patients had CNS and abdominopelvic disease, and 4 also had concomitant extraperitoneal dissemination. Following surgery, 17 received whole-brain radiotherapy and 5 received systemic chemotherapy. Median survival from diagnosis of cerebral metastasis for the entire series was 16 months (range, 4-41 months). Extracranial disease at the time of CNS metastasis and time interval between diagnosis of ovarian cancer and CNS involvement manifestation were the only factors significantly affecting survival. CONCLUSIONS: Neurosurgical resection of brain metastasis from ovarian carcinoma is indicated in solitary lesions in the absence of systemic disease. The role of chemotherapy and stereotactic radiosurgery should be investigated.     

The effect of centralization of primary surgery on survival in ovarian cancer patients

OBJECTIVE: To examine the effect of centralized surgery on overall survival in patients with ovarian cancer and, in particular, patients with advanced disease (stage III/IV). METHODS: In a historical prospective study design, patients referred from community hospitals to a teaching hospital for primary surgery during the 2-year period, 1995-1997, were included as cases. For each referred case, two controls, matched for International Federation of Gynecology and Obstetrics (FIGO) stage and age, were selected among patients who had had primary surgery at the referral hospitals (nonteaching) in the years, 1992-1995. Kaplan-Meier survival curves were computed and tested statistically by the log rank test. Cox proportional hazard model was applied for estimation of prognostic factors of survival. RESULTS: There was no difference in postoperative mortality for stage I/II patients by level of care (community hospitals versus teaching hospital). However, for advanced stage disease (III + IV), the controls had significantly shorter crude survival than patients who had been operated on at the teaching hospital (5-year survival: 4% versus 26%; median survival: 12 months versus 21 months) (P=.01). Multivariable analyses showed that completed chemotherapy and size of residual tumor after primary surgery were independent prognostic factors of survival. Patients optimally operated on at the teaching hospital had significantly lower risk of death compared with all other groups, independently of chemotherapy. This indicates that the extent of cytoreductive surgery and the overall management undertaken in the teaching hospital are significant predictors of improved survival. CONCLUSION: Centralization of primary ovarian cancer surgery in one health region in Norway has improved survival for patients with advanced disease. Patients with apparent advanced ovarian cancer should be referred to a subspecialty unit for primary surgery, and every effort should be made to attain as complete cytoreduction as possible.     

The prognostic significance of the immunohistochemical expression of p53, bcl-2, c-erb B-2 and cathepsin-D in ovarian cancer patients receiving platinum with cyclophosphamide or paclitaxel chemotherapy

PURPOSE: To evaluate the prognostic significance of the immunohistochemical expression of p53, bcl-2, c-erbB-2 and cathepsin-D in epithelial ovarian cancer (EOC). METHODS: We analyzed 100 patients with ovarian carcinoma, FIGO Stage IC-IV who underwent primary cytoreductive surgery and received adjuvant chemotherapy with cyclophosphamide and a platinum analogue (CP) (n = 46) or paclitaxel and a platinum analogue (TP) (n = 54). Immunohistochemical expression was studied on paraffin-embedded tissue from the primary tumor. RESULTS: After a median follow-up of 55 months median progression-free survival (PFS) and overall survival (OS) were 16 and 41 months, respectively. Positive bcl-2 staining and absence of cathepsin-D expression were associated with an increased complete response rate in the CP group (p = 0.011 and p = 0.003) but not in the TP group. PFS and OS were not associated with the expression of any of the markers studied. FIGO stage (p = 0.006) and histology (p = 0.047) were the only independent prognostic factors for survival. CONCLUSION: Bcl-2 and cathepsin D expression are associated with response to CP but not TP chemotherapy. P53, bcl-2, c-erb B-2 and cathepsin D expression was not correlated with PFS and OS in our study.     

The influence of age and co-morbidity on treatment and prognosis of ovarian cancer: a population-based study

OBJECTIVES: With the rising mean age, more patients will have one or more other serious diseases at the time of diagnosis of ovarian cancer (co-morbidity). In this study, the independent effects of age and co-morbidity on the application of treatment guidelines and prognosis were evaluated. METHODS: All patients with epithelial ovarian cancer diagnosed between 1995 and 2001 in the southern part of The Netherlands (N = 1116) were included. RESULTS: The prevalence of co-morbidity increased from 34% of the age group <70 to 63% of the older age group. Eighty-three percent of the patients with FIGO stage II or stage III younger than 70 years underwent the advised treatment (combination of surgery and chemotherapy) compared to only 45% of the patients aged 70 or older. In a multivariable analysis age, FIGO stage, presence of co-morbidity, and year of diagnosis seemed to be independent predictors of receiving the advised treatment. In multivariable analyses age 70 + (HR = 1.3, 95% CI = 1.03-1.7) and the use of both surgery and chemotherapy (HR = 0.4, 95% CI = 0.3-0.6, reference is only surgery) were independent prognostic factors for overall survival. CONCLUSIONS: Even in the absence of co-morbidity, standard combination therapy was prescribed significantly less often for elderly patients with FIGO II or III ovarian cancer. Age and combined treatment of surgery and platinum-based chemotherapy were independent prognostic factors. Co-morbidity did not seem to have a prognostic effect.     

The growth factor receptors HER-2/neu and EGFR, their relationship, and their effects on the prognosis in early stage (FIGO I-II) epithelial ovarian carcinoma

Abstract. Skirnisdóttir I, Sorbe B, Seidal T. The growth factor receptors HER-2/neu and EGFR, their relationship, and their effects on the prognosis in early stage (FIGO I–II) epithelial ovarian carcinoma.
Epithelial ovarian cancer is a heterogeneous disease and many biologic and molecular factors are important for its development and progression, including growth rate, metastatic potential, chemo- and radiosensitivity, and prognosis. Even in the early stages (FIGO I–II), many questions persist about the biologic behavior, optimal treatment, and prognosis.
In a series of 106 patients with epithelial ovarian cancers in FIGO stages IA-IIC, a number of known prognostic factors (age, FIGO stage, histopathologic type, and tumor grade) were studied in relation to two important growth factor receptors for oncogenesis (HER-2/neu and EGFR). Immunohistochemical techniques were used. All patients received adjuvant radiotherapy 4–6 weeks after the primary surgery. In a univariate analysis, the expression of the HER-2/neu receptor was not associated with any of the clinicopathologic factors studied or survival status. Positive EGFR staining was associated with poor survival in a univariate analysis. Co-expression of HER-2/neu and EGFR was most frequently seen in serous tumors and positive staining for HER-2/neu alone was associated with mucinous tumors. Both endometrioid and clear cell tumors belonged to the largest subgroup with concomitant negativity for both HER-2/neu and EGFR. In a multivariate Cox analysis, the tumor grade and EGFR status of the tumors were independent and significant prognostic factors. A therapeutic strategy for epithelial ovarian cancer might be to decrease EGFR expression by gene therapy in combination with adjuvant radiotherapy or chemotherapy.     

Platinum-based neoadjuvant chemotherapy and interval surgical cytoreduction for advanced ovarian cancer: a meta-analysis

OBJECTIVE: To determine the overall survival and relative effect of multiple prognostic variables in cohorts of patients with advanced-stage ovarian cancer treated with platinum-based neoadjuvant chemotherapy in lieu of primary cytoreductive surgery. METHODS: Twenty-two cohorts of patients with Stage III and IV ovarian cancer (835 patients) were identified from articles in MEDLINE (1989-2005). Linear regression models, with weighted correlation calculations, were used to assess the effect on median survival time of the proportion of each cohort undergoing maximum interval cytoreduction, proportion of patients with Stage IV disease, median number of pre-operative chemotherapy cycles, median age, and year of publication. RESULTS: The mean weighted median overall survival time for all cohorts was 24.5 months. The weighted mean proportion of patients in each cohort undergoing maximal interval cytoreduction was 65.0%. Each 10% increase in maximal cytoreduction was associated with a 1.9 month increase in median survival time (p=0.027). Median overall survival was positively correlated with platinum-taxane chemotherapy (p<0.001) and increasing year of publication (p=0.004) and negatively correlated with the proportion of Stage IV disease (p=0.002). Each incremental increase in pre-operative chemotherapy cycles was associated with a decrease in median survival time of 4.1 months (p=0.046). CONCLUSIONS: Neoadjuvant chemotherapy in lieu of primary cytoreduction is associated with inferior overall survival compared to initial surgery. Increasing percent maximal cytoreduction is positively associated with median cohort survival; however, the negative survival effect of increasing number of chemotherapy cycles prior to interval surgery suggests that definitive operative intervention should be undertaken as early in the treatment program as possible.     

Prognostic factors for survival of ovarian epithelial cancers: apropos of 287 cases

OBJECTIVES: To evaluate survival and assess prognostic factors in patients with epithelial ovarian cancer. METHODS: Retrospective analysis of 287 patients treated between 1975 and 1995. All operations were performed by senior surgeons. Histologic sections were reviewed by the same pathologist. Successive adjuvant chemotherapy regimens are described. Survival was evaluated in 1997. Follow-up lasted 25-260 months (median 90). Statistical methods included Kaplan-Meier survival curves, logrank test and multivariate analysis. RESULTS: The five-year survival rates 76%, 42%, 21% and 6% for patients with stage I, II, III and IV disease, respectively. Age, FIGO stage, cytology of ascites, histologic type and grade, extent of surgery and number of residual tumors were significant prognostic indicators in univariate analysis. Multivariate analysis showed that the risk of mortality was reduced by 57% for patients whose tumor distribution permitted optimal surgery (RR = 0.43, 95% CI [0.29-0.64]; P < 0.001). The risk of mortality according to FIGO stage was 2.8 (95% CI [1.2-6.3]; P = 0.01) for FIGO II, 5.6 (95% CI [2.9-10.8]; P < 0.001) for FIGO III and 10.5 (95% CI [4.9-22.1]; P < 0.001) for FIGO IV in comparison with FIGO I. The risk of mortality for patients treated with alkylating agents, platinum-based combination chemotherapy taxanes or carboplatin plus paclitaxel regimen compared with patients who did not receive treatment was reduced by 47% (95% CI [8%-69%]; P = 0.025), 55% (95% CI [22%-74%]; P = 0.005) and 70% (95% CI [35%-86%]; P = 0.002), respectively. Patients with a serous epithelial carcinoma had a 1.7-fold higher risk of mortality than patients with other histologic types (RR = 1.7, 95% CI [1.1-2.8]; P = 0.02). CONCLUSION: Our study confirms the benefit of cytoreductive surgery and the efficacy of platinum plus paclitaxel first-line chemotherapy, which has recently been recognized as the standard treatment for advanced epithelial ovarian cancer.     

Clinicopathological features of ovarian carcinosarcomas: a single institution experience

OBJECTIVE: The aim of this study was to elucidate the clinicopathological and immunohistochemical prognostic factors of patients with ovarian carcinosarcoma treated with radical surgery and postoperative chemotherapy. METHODS: During a 6-year period, nine patients with ovarian carcinosarcoma were referred to our institution. Tissue blocks were reviewed and sections containing both carcinomatous and sarcomatous elements were stained for epithelial membrane antigen (EMA), vimentin, vascular endothelial growth factor (VEGF), CD45RO, c-erbB-2, p53, CD34, Ki67, S100, estrogen, and progesterone receptors. Histological and immunohistochemical findings as well as clinical characteristics were then correlated with progression-free interval and overall survival. RESULTS: There were four homologous and five heterologous carcinosarcomas. Five patients had early stage disease. Seven of the patients were optimally debulked. All patients were treated with anthracycline-based chemotherapy following surgery. With regard to immunohistochemistry, all specimens were negative for CD34, c-erbB-2, estrogen, and progesterone receptor expression. Five tumors overexpressed p53 and four specimens demonstrated a positive staining for Ki67. Reactivity for VEGF and CD45RO was observed in four and two tumor specimens, respectively. The median overall survival was 32.9 months with no statistical difference between early and advanced stages, while median time to progression was 13.5 months. p53 overexpression demonstrated a trend for better overall survival. CONCLUSIONS: Only p53 overexpression seems to influence overall survival although, due to the small number of patients studied, no safe conclusions can be drawn. Despite the predominance of early stage patients that favorably influenced overall survival, aggressive surgical cytoreduction followed by anthracycline-based treatment were the cornerstone in our multimodality approach.