Ezrin immunoreactivity in relation to survival in serous ovarian carcinoma patients

OBJECTIVE: Ezrin is a membrane-cytoskeleton linker protein, which regulates cell polarity and signaling. Increased ezrin expression in astrocytomas and uveal melanomas is correlated with unfavorable prognostic factors and reduced patient survival. We investigated ezrin IR in normal ovarian surface epithelium and serous ovarian carcinomas, and its relation with clinical parameters and patient outcome. METHODS: Tissue microarray blocks were constructed of all serous ovarian carcinoma tissue samples removed at a primary operation in Helsinki University Central Hospital between 1964 and 1999 and of healthy ovarian tissue samples. Ezrin expression was assessed by indirect immunohistochemistry using a monoclonal 3C12 ezrin antibody. Tissue samples (n = 440) were scored for the intensity of ezrin immunoreactivity, and the scores were compared with patient age, the stage and grade of disease, and disease outcome. RESULTS: Healthy ovarian epithelium showed strong polarized ezrin immunoreactivity. In serous ovarian carcinoma, the reactivity varied from strong (15.0% of samples) to moderate (57.3%) or weak/negative (27.7%) and the subcellular distribution was typically diffuse. Weak or negative expression of ezrin was associated with shorter survival (P = 0.027) but also with an advanced age of the patients (P = 0.0001), and a higher histological grade of the disease (P = 0.032). In Cox multivariate survival analysis, ezrin immunoreactivity had no independent effect on survival, when controlling for the stage and grade of the disease, and patient age. CONCLUSIONS: In contrast with astrocytomas and uveal melanomas, negative or weak ezrin immunoreactivity in serous ovarian carcinoma correlates with poor patient outcome.     

卵巢浆液性癌B7-H4的表达及临床病理意义

目的:探讨B7-H4在卵巢上皮性肿瘤浆液性癌中的表达及其临床病理意义。方法:用逆转录聚合酶链反应(RT-PCR)技术及免疫组织化学染色的方法检测6例良性卵巢上皮性肿瘤、10例交界性卵巢上皮性肿瘤、41例卵巢浆液性癌、5例内膜样癌、2例透明细胞癌和10例粘液性癌标本中B7-H4 mRNA及蛋白表达,并结合临床病理资料对其中41例卵巢浆液性癌中B7-H4蛋白的表达进行分析。结果:B7-H4 mRNA在74例卵巢上皮性肿瘤中均有表达,B7-H4蛋白在良性卵巢上皮性肿瘤、交界性卵巢上皮性肿瘤、恶性卵巢上皮性肿瘤中的表达阳性比例分别为2/6、6/10、52/58,恶性标本阳性率明显高于非恶性标本,差异有统计学意义(P<0.05);58例恶性卵巢上皮性癌标本中浆液性癌、内膜样癌、透明细胞癌、黏液性癌的B7-H4蛋白阳性比例分别为41/41、5/5、2/2、4/10,前三种病理类型B7-H4蛋白阳性率明显高于最后一种,且差异有统计学意义(P<0.05);41例卵巢浆液性癌标本中B7-H4蛋白阳性细胞比例在<10%,>10%~50%,>50~80%,>80~100%4组中的分布差异无显著性(P>0.05),且其蛋白表达与临床分期及病理分级有关(P<0.05),而与患者年龄、腹水细胞学、淋巴结转移无关(P>0.05)。结论:B7-H4在卵巢浆液性癌的高表达及其与临床分级分期的关系,提示其可能与肿瘤发生发展有关,可为卵巢恶性肿瘤诊断及治疗提供靶位点。     

Oncogene expression in ovarian cancer: a pilot study of c-myc oncoprotein in serous papillary ovarian cancer

The nuclear-associated protein product of the c-myc gene, p62c-myc, was assayed simultaneously with total DNA using flow cytometry in nuclei extracted from archival biopsies of serous papillary carcinoma of the ovary. The oncoprotein was probed with a synthetic peptide-induced mouse monoclonal antibody which was subsequently labeled with a fluorescent rabbit anti-mouse immunoglobulin and DNA was assayed using the nucleic acid fluorochrome propidium iodide. Serous papillary ovarian carcinoma expressed significantly higher p62c-myc levels compared with normal ovary (P less than 0.00003 Mann-Whitney U test). Biopsies classified as "borderline" low-potential malignancy exhibited levels between normal ovary and carcinoma. The difference between normal and "borderline" was significant at P less than 0.003, but no difference between "borderline" and frankly invasive biopsies was observed, P = 0.149. There was no difference among the histological grades of carcinomas. All normal ovaries had diploid DNA content as did 5/6 cases of "borderline" malignancy. The majority of cases of carcinoma, 28/36, were aneuploid. There was a statistically significant difference in the distribution of aneuploidy, P less than 0.005, between invasive carcinomas and those classified as "borderline" low-potential malignancy.     

Prognostic role of E-cadherin in patients with advanced serous ovarian cancer

Purpose

To analyse correlation between expression of E-cadherin and clinical and pathological features and overall survival in advanced-stage serous ovarian carcinoma.

Methods

The expression of E-cadherin was analysed immunohistochemically in formalin-fixed, paraffin-embedded samples from 54 patients with advanced-stage serous ovarian cancer and related to clinicopathological characteristics and patients survival. The clinicopathological characteristics included the stage according to the International Federation of Gynecology and Obstetrics (FIGO), tumour differentiation, number of mitoses per 10 high-power fields (HPF), residual tumour size, and vascular invasion. Only patients with serous ovarian cancer FIGO stages III–IV were included. Overall survival (OS) was defined as time from surgery to the last follow-up date on 01.10.2010. OS was evaluated using Kaplan–Meier method, and log-rank test was used to asses the differences between the positive and E-cadherin negative group. Multivariate analysis was completed using the Cox proportional hazard regression model.

Results

E-cadherin immunoreactivity was not associated with FIGO stage, tumour grade, number of mitotic figures per 10 HPF, residual tumour volume or vascular invasion. Negative E-cadherin expression significantly predicted shorter OS (p < 0.001). The multivariate analyses showed that negative E-cadherin (p < 0.001), FIGO stage (p = 0.012) and residual tumour size >1 cm after the initial cytoreductive surgery (p < 0.001) were predictors of shorter OS.

Conclusion

Negative E-cadherin expression like presence of residual tumour after primary cytoreductive surgery and higher FIGO stage seem to predict unfavourable clinical outcome in patients with advanced-stage serous ovarian cancer. Negative expression of E-cadherin was shown to be a significant independent predictor of poorer OS. E-cadherin as marker has prognostic value.     

血小板增多与上皮性卵巢癌临床病理及生存预后的相关性研究

目的:研究术前血小板(PLT)与卵巢癌临床病理和预后的相关性。方法:回顾分析2009年1月至2013年3月于同济大学附属第一妇婴保健院行手术治疗的171例卵巢癌、218例卵巢良性上皮性肿瘤和59例交界性肿瘤患者的临床资料,分析PLT计数与患者年龄、病理类型、临床分期、细胞分级、CA125水平等临床病理因素之间的关系,同时分析比较卵巢癌伴或不伴PLT增多以及化疗后PLT变化对患者生存的影响。结果:卵巢癌患者术前PLT计数平均值为248.0×109/L,显著高于良性及交界性肿瘤(188.3×109/L和206.9×109/L,P0.0001)。171例卵巢癌患者中20例(11.7%)合并血小板增多(PLT≥350×109/L),卵巢癌合并PLT增多的患者中晚期比例高(P=0.030),更易发生大网膜(P=0.006)、腹膜(P=0.016)、膈下腹膜(P=0.018)转移,达到满意肿瘤减灭术比例较低(P=0.010)。卵巢癌患者的术前PLT与CA125值呈正相关(P=0.049)。患者术前PLT计数分别为≥232.2×109/L、208.5×109/L和327.5×109/L时,可依次最大程度预测卵巢癌减灭手术不满意、疾病处于晚期及总体预后不良。卵巢癌合并PLT增多及术前PLT与3周期化疗后PLT比值大于2的患者的生存时间明显缩短(P0.0001,P=0.006)。结论:卵巢癌患者术前PLT计数显著高于良性及交界性卵巢肿瘤。合并PLT增多的患者晚期肿瘤及多脏器转移比例显著增高,满意肿瘤减灭术比例低。PLT增多及化疗后PLT较术前显著下降是卵巢癌的不良预后指标。     

Ghrelin and obestatin expression in serous ovarian tumours

Objective: To investigate ghrelin and obestatin expression in serous ovarian tumours. Materials and methods: Preparations of deparaffinized blocks obtained from the pathology archives of a total of 47 previously diagnosed cases of benign serous tumour (n?=?20), borderline serous tumour (n?=?7) and malignant serous tumour (n?=?20) were subjected to immunohistochemical examination to find out ghrelin and obestatin expressions. Results: Mean ghrelin expressions decreased significantly in the benign group, relative to the malignant group (p?<?0.05), while there was no significant change in mean obestatin expression. It was established that rates of preparations with moderate and severe ghrelin and obestatin expression displayed a significant increase from benign to malignant ones (p?<?0.05). Conclusion: The fact that rates of preparations with severe expression correlated with an increase in malignancy suggests that ghrelin and obestatin may be effective in the malignant transformation in at least some cases.     

Alpha1B adrenoceptor expression is a marker of reduced survival and increased tumor recurrence in patients with endometrioid ovarian cancer

AIM: To investigate the expression patterns of different adrenoceptor isoforms in ovarian cancer and their association with survival and tumor recurrence. METHODS: The protein expression levels of α1B, α2C and β2 adrenoceptor were assessed in unselected ovarian cancer using immunohistochemistry on microarrayed archival tissue samples. A database containing clinical and pathology parameters and follow-up was used to investigate the association between adrenoceptor isoform expression with ovarian specific survival and tumor recurrence, using univariate and multivariate statistical analysis. RESULTS: Expression of α1B showed an association with reduced ovarian specific survival (P = 0.05; CI: 1.00-1.49) and increased tumor recurrence (P = 0.021, CI: 1.04-1.69) in the whole patient group. On sub-analysis the expression of α1B in endometrioid cancers (χ² = 5.867, P = 0.015) was found to predict reduced ovarian specific survival and increased tumor recurrence independently of tumor grade, clinical stage and chemotherapy. An association with clinical outcome was not seen for α2C or β2 AR. CONCLUSION: Alpha1B adrenoceptor protein was found to predict increased risk of tumor recurrence and reduced mortality in patients with endometrioid type ovarian cancer and should be investigated as a biomarker for identifying patients at increased risk of disease progression. Furthermore, α adrenergic receptor antagonists with α1B selectivity should be investigated as a possible adjuvant therapy for treating patients with endometrioid cancer. Proof of principle could be tested in a retrospective population study.     

浆液性卵巢癌治疗后远期生存列线图预测模型的构建和验证

目的:构建并验证浆液性卵巢癌远期生存概率的列线图,为卵巢癌患者提供个性化的治疗建议和随访策略.方法:共有6957例来自SEER数据库的患者被纳入训练组;外部验证组数据来自于1244例患者的临床资料.基于Cox回归模型构建列线图,使用一致性指数、受试者操作特征曲线、校准图进行验证.绘制Kaplan-Meier曲线比较不同...     

Thrombospondin-1 expression in epithelial ovarian carcinoma: association with p53 status, tumor angiogenesis, and survival in platinum-treated patients

OBJECTIVE: The aim of this study was to analyze FIGO Stage IIIc endometrial cancer (EC) patients to better define clinicopathologic associations, patterns of failure, and survival. METHODS: Charts were abstracted from EC patients with lymph node metastasis from 1989 to 1998. Data on clinicopathologic variables, adjuvant treatment, site of first recurrence, and survival were collected. Associations between variables were tested by chi(2) and Wilcoxon rank sums. Survival analyses were performed by the Kaplan-Meier method, and multiple regression analysis was done by the Cox proportional hazards model. RESULTS: From 607 EC patients evaluated, 47 (8%) were identified with FIGO Stage IIIc disease. All 47 underwent hysterectomy and pelvic lymph node (PLN) sampling, and 42/47 had para-aortic lymph node (PALN) sampling. Stage IIIc disease was defined by positive PLN alone in 38%, positive PLN and PALN in 41%, and positive PALN alone in 17%. Twelve of 47 also had positive peritoneal cytology and/or adnexal metastases. Grade III tumors were present in 56% and >50% myometrial invasion in 61%. No association between depth of invasion (DOI) and grade was seen, however. Nearly 1/3 of cases had papillary serous or clear cell histology. Postoperative adjuvant treatment included whole abdominal radiation (36%), pelvic radiation with (19%) and without (17%) extended field, chemotherapy (17%), and oral progestins (11%). The 3-year and 5-year survival estimates for all patients were 77 and 65%, respectively. At a median follow-up of 37 months, 5 patients are alive with disease, and 10 are dead of disease. A distant site of first recurrence was most common (21%), followed by pelvic failure (9%). Only 1 patient has had an abdominal recurrence. Univariate predictors of survival included age, DOI, and extranodal disease, but not grade, histology, or PALN involvement. For the 12 patients with nodal disease and positive cytology and/or adnexa, 3-year survival was 39% versus 93% for those patients without evidence of extranodal disease. In a multivariate analysis only DOI was an independent predictor of survival (P = 0.03). CONCLUSIONS: Once lymph node involvement occurs, the importance of additional extranodal disease increases. Consideration of substaging Stage IIIc patients based on positive adnexa or cytology is supported by the data. The extent which adjuvant treatments contributed to the 77% 3-year survival remains to be defined. The patterns of failure suggest a possible role for combined modalities in future treatments.     

Assessment of the AgNORs count in serous ovarian cancer

OBJECTIVE: The survival rate of patients with ovarian cancer strongly depends on staging and grading. The next potential, independent prognostic factor might be the amount of nucleolar organizer regions (AgNORs) in cancer cells. DESIGN: To assess the relationship between AgNORs count in serous ovarian cancer and grading, the size of primary tumor, the evaluation of peritoneal fluid and clinical staging. MATERIAL AND METHODS: 69 women who underwent surgical procedure due to serous ovarian cancer between 1998-2002 were included into the study. In each case the clinical and histopathological assessment of neoplastic disease was made. In all cases the specimens were prepared according to the method described by Howell and Ploton. In cancer cells the mean number of AgNORs per nucleus (mAgNOR) and the mean percentage of nuclei with five or more AgNORs per nucleus (pAgNOR) were counted. RESULTS: The mAgNOR in cancer cells varied from 3.22 to 7.19 (mean 4.31+/-0.81), and the pAgNOR varied from 5% to 84% (mean 39.74+/-20.58%). According to the grading of cancers it was as follows: 3.74+/-0.25 and 22.12+/-10.03 in G1 tumors, 4.13+/-0.56 and 35.52+/-13.94 in G2 tumors, and 4.75+/-0.92 and 52.26+/-20.65 in G3 tumors. All the differences were statistically significant. We did not find any correlation between the size of primary tumor and mAgNOR as well as pAgNOR. There were no correlations between the presence as well as the amount of ascitic fluid, and mAgNOR as well as pAgNOR. The positive correlation between the presence of cancer cells in peritoneal fluid and pAgNOR, but not mAgNOR was found. The values of mAgNOR and pAgNOR in clinical stages were respectively: 3.94+/-0.44 and 27.11+/-15.71 for stage I, 4.14+/-0.62 and 39.25+/-22.53 for stage II, 4.27+/-0.79 and 38.76+/-19.79 for stage III, 4.55+/-0.92 and 46.42+/-20.71 for FIGO stage IV. The positive correlations between staging and mAgNOR as well as pAgNOR were found. CONCLUSIONS: The number of AgNORs per cell is one of the sensitive methods in the assessment of ovarian cancer agressiveness and positively correlates with grading and staging of the disease.     

Clinicopathological correlation of endocan expression and survival in epithelial ovarian cancer

Introduction

Endothelial-cell-specific molecule-1 or endocan is a proteoglycan with tumorigenic activity through both its glycan and protein cores. Endocan mRNA is identified as one of the most significant molecular signatures defining a poor prognosis in lung, breast, kidney, and hepatocellular cancer.

Objective

To assess the clinical value of endocan expression in ovarian cancer tissues in association with other prognostic factors and its impact on overall survival.

Setting

Oncology unit of Zagazig University Hospitals, Egypt.

Study design

Prospective observational cohort.

Patients and methods

One hundred primary ovarian cancer patients were recruited as study group, another 100 patients undergoing hysterectomy and oophorectomy due to uterine fibroid were the control group. Angiogenesis was determined by immunohistochemical staining, using anti-endocan, and anti vascular endothelial growth factor (VEGF) monoclonal antibodies.

Results

Endocan was expressed in endothelium of ovarian cancer tissue specimens in all patients with no expression in endothelium of normal ovarian tissue in the control group. VEGF was also expressed in endothelium of all specimens of ovarian cancer tissue, compared with 70 % expression in normal ovarian tissue specimens in the control group. A significant association was found between endocan-microvessel density (MVD) and tumor histology, tumor size, staging, and grading. No significant association was found between VEGF expression and any of the clinicopathological variables. Overall survival of patients was inversely associated with endocan-MVD (P < 0.01). Multivariate analysis showed that endocan-MVD was an independent prognostic marker for overall survival of epithelial ovarian cancer (P < 0.01).

Conclusion

Endocan could be a reliable marker to predict the survival in epithelial ovarian cancer patients.     

卵巢浆液性囊腺癌中MTS_1/p16基因突变及其蛋白表达的研究

目的：探讨抑癌基困MTS1／p16在人卵巢浆液性囊腺癌发生发展中的作用。方法：应用免疫组化检测10例正常卵巢组织,20例浆液性囊腺瘤,20例交界性策液性囊腺瘤,65例浆液性囊腺癌及有癌转移的阳性盆腔淋巴结中p16基因蛋白表达,用PCR－SSCP分析10例浆液性囊腺癌中有无p16基因第1、2外显子的突变。结果：正常卵巢、浆液性囊腺瘤、交界性浆液性囊腺瘤、浆液性囊腺癌及有癌转移的盆腔淋巴结中,p16基因蛋白表达阳性率分别为60％、55％、55％、12．3％、0％;10例浆液性囊腺癌均未发现p16基因第1、2外显子的突变。结论：p16基因功能失活可能与卵巢癌发生、发展相关,p16基因表达的检测可能成为判断浆液性卵巢肿瘤恶性度及预后的指标;浆液性卵巢癌p16基因突变率较低,可进一步扩大检测范围并作进一步研究。     

Frequency of serous tubal intraepithelial carcinoma (STIC) in patients with high grade serous ovarian cancer

ObjectiveSerous tubal intraepithelial carcinoma (STIC) is a known precursor of high-grade serous ovarian cancer (HGSOC). This study aimed to evaluate the proportion of STIC in patients with HGSOC and analyze the STIC-related prognosis in patients with HGSOC.Materials and methodsAll pathology reports at our institution that included bilateral salpingectomies of patients with HGSOC from January 2013 to December 2018 were reviewed by two experienced pathologists. The specimens from the ovaries and the salpinx including fimbria were examined. We analyzed the correlation between STIC and HGSOC and compared the clinical characteristics and STIC-related prognostic outcomes in patients with HGSOC.ResultsEleven of the 76 cases were STIC. BRCA mutations were found in 16.9% of patients with HGSOC. STIC was observed in 30.0% of patients with BRCA mutations and in 14.3% of patients without BRCA mutations. The incidence of STIC in patients with BRCA mutations was approximately twice that in patients without BRCA mutations; however, the difference was not statistically significant (P = 0.231). Further, the 5-year survival rate of patients without STIC appeared to be high; nevertheless, the difference was not statistically significant (59.7% vs. 47.4%, P = 0.633). Moreover, there was no significant difference in disease-free survival rate according to STIC (36.4% vs. 33.1%, P = 0.956).ConclusionSTIC was identified in patients with HGSOC, and STIC incidence was prominent in HGSOC related to BRCA mutation. Although low frequency, STIC was detected in patients without BRCA mutation. Therefore, prophylactic salpingectomy may be useful for prevention of HGSOC.     

A phase II trial of weekly docetaxel in patients with platinum-resistant epithelial ovarian, primary peritoneal serous cancer, or fallopian tube cancer

OBJECTIVE: To determine the activity and tolerability of weekly docetaxel in patients with platinum-resistant mullerian origin tumors. METHODS: Patients with persistent disease, or those recurring less than 6 months after receiving platinum-containing therapy, were eligible for this phase II study. Docetaxel was initially administered at a dose of 40 mg/m(2) on days 1, 8, and 15, with a cycle length of 28 days. This starting dose was subsequently reduced to 30 mg/m(2) due to toxicity. Dexamethasone prophylaxis was administered at a dose of 4 mg PO every 12 hours for 3 doses, starting 12 hours before each dose of docetaxel. RESULTS: Thirty-two patients were enrolled, with a median age of 59 years. The majority of patients received a median of 3 prior regimens, with 45% of the study group having received 4 or more prior regimens. The overall response rate in 29 evaluable patients was 6.9%, with no complete responses. Seventeen percent of patients experienced stable disease. Dose reduction or delay was required in 10 of the first 22 patients enrolled, prompting a reduction in the starting dose to 30 mg/m(2). Hematologic toxicity was generally tolerable, and no patient experienced febrile neutropenia. Non-hematologic toxicity was generally grade 1 in nature, although a combination of multiple low grade toxicities occurring in an individual patient oftentimes mandated dose reduction. CONCLUSIONS: Weekly docetaxel demonstrated modest activity in a heavily pre-treated, platinum-resistant population. A starting docetaxel dose of 30 mg/m(2) would be reasonable for future studies exploring the utility of weekly dosing in less heavily pre-treated patients.     

The impact of c-kit and ki-67 expression on patients prognosis in advanced ovarian serous carcinoma.

The transmembrane-tyrosine-kinase receptor, c-kit, is involved in cell differentiation and has been found to be expressed in normal human cell types and solid tumors. This study was designed to investigate the effects of c-kit expression on: 1) tumor proliferation and apoptosis, and 2) survival in patients with high-grade advanced stage ovarian serous carcinoma (OSC). We identified 118 patients with high-grade advanced stage OSC from our files. Clinical data, including demographics and overall survival, were collected. Immunohistochemical panel consisting of c-kit, ki-67, p53, and bcl-2 was performed. C-kit was categorized as positive if any cytoplasmic or membranous staining pattern was identified. Correlation between c-kit expression and the other markers was performed. Survival analysis was performed using COX proportional hazards regression and Kaplan-Meier test. Of 118 cases, 25 (21.2%) expressed c-kit. Of 93 c-kit-negative tumors, 87.1% had a high proliferation index. High p53 and bcl-2 expression was identified in 96 (81.4%) and 59 (50%) cases respectively. No significant statistical correlation was identified between c-kit and apoptosis markers. Tumors lacking c-kit expression showed a trend toward having high proliferation index, but this did not achieve statistical significance (p = 0.07). Of the seven variables included in the multivariate survival analysis, only c-kit (odds ratio, 2.12; 95% confidence interval, 08-4.17; p = 0.02) and ki-67 (odds ratio, 1.9; 95% confidence interval, 1.1-3.1; p = 0.03) showed an independent statistically significant impact on survival. High-grade advanced stage OSC lacking c-kit expression correlates with poor outcome. Interestingly, cases lacking c-kit expression also showed a trend to have high proliferation index.     

Expression of Cox-2, CD34, Bcl-2, and p53 and survival in patients with primary peritoneal serous carcinoma and primary ovarian serous carcinoma.

The objective of this study was to compare the immunohistochemical profile and clinical course of primary peritoneal serous carcinoma (PPC) and primary ovarian serous carcinoma (OSC). These entities are virtually indistinguishable morphologically, but their differential molecular and clinical features are incompletely characterized. Twenty-nine cases of high-grade, high-stage PPC and 96 cases of stage matched OSCs were compared. PPC was identified based on the criteria proposed by the Gynecologic Oncology Group. The tumors were staged according to International Federation of Gynecology and Obstetrics criteria for ovarian cancer and graded according to World Health Organization criteria. Expression of Cox-2, CD-34, bcl-2, and p53 was compared in the two tumors and correlated with clinical data including stage, age, race, and overall survival. Although the median survival, using Kaplan-Meier test, of patients with OSC (1060 days, 35.3 months) was longer than those with PPC (708 days, 23.6 months) the difference was not statistically significant. However, Cox-2 expression was correlated with microvessel density in PPC (p=0.026) and OSC cases (p=0.005), and high expression of Cox-2 correlated with lower survival rate in OSC cases (p=0.045) but not in PPC cases (p=0.12). These findings, coupled with the morphologic overlap existing between OSC and PPC, support the view that they represent related pathologic entities.     

The road to long-term survival: Surgical approach and longitudinal treatments of long-term survivors of advanced-stage serous ovarian cancer

Objective

It is unclear if the types of surgical procedures performed on long-term survivors (LTS) of high-grade serous ovarian carcinoma (HGSOC) contribute to prolonged survival. In this case-control study we review the surgical procedures performed on LTS and describe their individual longitudinal disease courses.