Differences in tumor behavior between serous and non-serous ovarian carcinoma, focus on distribution of stage, laterality and survival

Purpose: To determine the differences in tumor behavior between ovarian serous and non-serous carcinoma. Materials and Methods: We retrospectively collected the medical records of patients with epithelial ovarian cancer at our hospital from January 2010 to December 2015. We compared the clinicopathological behavior and survival between serous and non-serous carcinoma. Kaplan-Meier and Cox regression methods were used to analyze risk factors on survival. Results: A total of 268 patients were included, of whom 38.1% had serous carcinoma. The patients with serous carcinoma had significantly more advanced disease including extra-ovarian disease (89.2% vs. 34.3%), abdominal disease (69.6% vs. 22.9%), lymph node metastasis (39.2% vs. 14.4%), para-aortic lymph node involvement (17.7% vs. 5.4%), and FIGO Stage III/IV disease (78.4% vs. 28.3%). In addition, serous carcinoma tended to involve bilateral ovaries (65.7% vs. 22.3%). However, in FIGO Stage III/IV disease, serous carcinoma had a better overall survival than non-serous type (HR 0.469, 95% CI = 0.268-0.882, p = 0.008). Conclusions: Although serous carcinoma presented more metastasis, it appeared to have better survival when compared to non-serous type in advanced stage disease.

Ovarian cancer; Tumor behavior; Serous carcinoma

[1] Taiwan Cancer Registry [database online]: “Health Promotion Administration, Ministry of Health and Welfare”, 2017, updated May 8, 2017. Available at: http://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=269&pid=7330

[2] Chen V.W., Ruiz B., Killeen J.L., Coté T.R., Wu X.C., Correa C.N.: “Pathology and classification of ovarian tumors”. Cancer, 2003, 97, 2631.

[3] Bell D.A.: “Origins and molecular pathology of ovarian cancer”: Modern. Pathol., 2005; 18, S19.

[4] Kurian A.W., Balise R.R., McGuire V., Whittemore A.S.: “Histologic types of epithelial ovarian cancer: have they different risk factors?” Gynecol. Oncol., 2005, 96, 520.

[5] Prat J.: “New insights into ovarian cancer pathology”. Ann. Oncol., 2012; 23, 111.

[6] Chiang Y.C., Chen C.A., Chiang C.J., Hsu T.H., Lin M.C., You S.L., et al.: “Trends in incidence and survival outcome of epithelial ovarian cancer: 30-year national population-based registry in Taiwan”. J. Gynecol. Oncol., 2013, 24, 342.

[7] Sung P.L., Chang Y.H., Chao K.C., Chuang C.M., Task Force on Systematic Review and Meta-analysis of Ovarian Cancer: “Global distribution pattern of histological subtypes of epithelial ovarian cancer: A database analysis and systematic review”. Gynecol. Oncol., 2014; 133, 147.

[8] Takeshima N., Hirai Y., Umayahara K., Fujiwara K., Takizawa K., Hasumi K.: “Lymph node metastasis in ovarian cancer: difference between serous and non-serous primary tumors”. Gynecol. Oncol., 2005, 99, 427.

[9] Roger N., Zafrani Y., Uzan C., Gouy S., Rey A., Pautier P., et al.: “Should Pelvic and Para-aortic Lymphadenectomy Be Different Depending on Histological Subtype in Epithelial Ovarian Cancer?’ Ann. Surg. Oncol., 2008, 15, 333.

[10] Berek J.S., Crum C. & Friedlander M.: “FIGO cancer reports 2015: Cancer of the ovary, fallopian tube, and peritoneum”. Int.J. Gynecol. Obstet., 2015, 131, S111.

[11] Kaku T., Ogawa S., Kawano Y., Ohishi Y., Kobayashi H., Hirakawa T., Nakano H.: “Histological classification of ovarian cancer”. Med. Electron. Microsc., 2003, 36, 9.

[12] Köbel M., Kalloger S.E., Huntsman D.G., Santos J.L., Swenerton K.D., Seidman J.D., Gilks C.B.: “Differences in tumor type in lowstage versus high-stage ovarian carcinomas”. Int. J. Gynecol. Pathol., 2010, 29, 203.

[13] Bergamini A., Candiani M., Taccagni G., Rabaiotti E., Viganò R., De Marzi P., et al.: “Different patterns of disease spread between advanced-stage type I and II epithelial ovarian cancer”. Gynecol. Obstet. Invest., 2016, 81, 10.

[14] Boger-Megiddo I., Weiss N.S.: “Histologic subtypes and laterality of primary epithelial ovarian tumors”. Gynecol. Oncol. 2005, 97, 80.

[15] Malkasian G.D. Jr., Melton L.J. 3rd., O’Brien P.C., Greene M.H.: “Prognostic significance of histologic classification and grading of epithelial malignancies of the ovary”. Am. J. Obstet. Gynecol., 1984, 149, 274.

[16] Makar A.P., Baekelandt M., Tropé C.G., Kristensen G.B.: “The Prognostic Significance of Residual Disease, FIGO Substage, Tumor Histology, and Grade in Patients with FIGO Stage III Ovarian Cancer”. Gynecol. Oncol., 1995, 56, 175.

[17] Brun J.L., Feyler A., Chêne G., Saurel J., Brun G., Hocké C.: “LongTerm Results and Prognostic Factors in Patients with Epithelial Ovarian Cancer”. Gynecol. Oncol., 2000, 78, 21.

[18] Cloven N.G., Kyshtoobayeva A., Burger R.A., Yu I.R., Fruehauf J.P.: “In vitro chemoresistance and biomarker profiles are unique for histologic subtypes of epithelial ovarian cancer”. Gynecol. Oncol., 2004, 92, 160.