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Rassy E, Assi T, Boussios S, Kattan J, Smith-Gagen J, Pavlidis N. Narrative review on serous primary peritoneal carcinoma of unknown primary site: four questions to be answered. Ann Transl Med 2020; 8:1709. [PMID: 33490221 PMCID: PMC7812188 DOI: 10.21037/atm-20-941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Serous peritoneal papillary carcinoma (SPPC) represents a particular cancer of unknown primary (CUP) entity that arises in the peritoneal surface lining the abdomen and pelvis without a discriminative primary tumor site. In this review, we discuss the validity of SPPC as a distinct entity. Clinically, patients with SPPC are older, have higher parity and later menarche, are more often obese and probably have poorer survival compared to those with primary ovarian cancer. Pathologically, SPPC is more anaplastic and multifocal, unlike primary ovarian cancer which is commonly unifocal. Biologically, it presents a higher expression of proliferative signals and similar cell cycle and DNA repair protein expression. These differences hint towards SPPC and primary ovarian cancer being as a spectrum of disease. Patients with SPPC are traditionally managed similarly to stage III–IV ovarian cancer. The recommended approach integrates aggressive cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, and systemic chemotherapy to remove the macroscopic tumor, eradicate the microscopic residual disease, and control the microscopic metastasis. However, the available evidence lacks proper randomized or prospective studies on SPPC and is limited to retrospective series. The diligent identification of SPPC is warranted to design specific clinical trials that eventually evaluate the impact of the new therapeutics on this distinct entity.
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Affiliation(s)
- Elie Rassy
- Department of Cancer Medicine, Gustave Roussy Institut, Villejuif, France.,Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Tarek Assi
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Stergios Boussios
- Medway NHS Foundation Trust, Gillingham, Kent, UK.,AELIA Organization, 9th Km Thessaloniki-Thermi, Thessaloniki, Greece
| | - Joseph Kattan
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Julie Smith-Gagen
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
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Jacob F, Marchetti RL, Kind AB, Russell K, Schoetzau A, Heinzelmann-Schwarz VA. High-grade serous peritoneal cancer follows a high stromal response signature and shows worse outcome than ovarian cancer. Mol Oncol 2020; 15:91-103. [PMID: 33016563 PMCID: PMC7782088 DOI: 10.1002/1878-0261.12811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/02/2020] [Accepted: 09/29/2020] [Indexed: 11/17/2022] Open
Abstract
In the era of personalized medicine, where transition from organ‐based to individualized genetic diagnosis takes place, the tailoring of treatment in cancer becomes increasingly important. This is particularly true for high‐grade, advanced FIGO stage serous adenocarcinomas of the ovary (OC), fallopian tube (TC), and peritoneum (PC), which are currently all treated identically. We analyzed three independent patient cohorts using histopathologically classified diagnosis and various molecular approaches (transcriptomics, immunohistochemistry, next‐generation sequencing, fluorescent and chromogenic in situ hybridization). Using multivariate Cox regression model, we found that PC is more aggressive compared with advanced‐stage OC independent of residual disease as shown by an earlier relapse‐free survival in two large cohorts (HR: 2.63, CI: 1.59–4.37, P < 0.001, and HR: 1.66, CI: 1.04–2.63, P < 0.033). In line with these findings, transcriptomic data revealed differentially expressed gene signatures identifying PC as high stromal response tumors. The third independent cohort (n = 4054) showed a distinction between these cancer types for markers suggested to be predictive for chemotherapy drug response. Our findings add additional evidence that ovarian and peritoneal cancers are epidemiologically and molecularly distinct diseases. Moreover, our data also suggest consideration of the tumor‐sampling site for future diagnosis and treatment decisions.
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Affiliation(s)
- Francis Jacob
- Ovarian Cancer Research, Department of Biomedicine, University Hospital Basel, University of Basel, Switzerland
| | - Rosa Lina Marchetti
- Department of Gynecology and Gynecological Oncology, Hospital for Women, University Hospital Basel, Switzerland
| | - André B Kind
- Department of Gynecology and Gynecological Oncology, Hospital for Women, University Hospital Basel, Switzerland
| | | | - Andreas Schoetzau
- Ovarian Cancer Research, Department of Biomedicine, University Hospital Basel, University of Basel, Switzerland
| | - Viola A Heinzelmann-Schwarz
- Ovarian Cancer Research, Department of Biomedicine, University Hospital Basel, University of Basel, Switzerland.,Department of Gynecology and Gynecological Oncology, Hospital for Women, University Hospital Basel, Switzerland
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Fortner RT, Rice MS, Knutsen SF, Orlich MJ, Visvanathan K, Patel AV, Gaudet MM, Tjønneland A, Kvaskoff M, Kaaks R, Trichopolou A, Pala V, Onland-Moret NC, Gram IT, Amiano P, Idahl A, Allen NE, Weiderpass E, Poynter JN, Robien K, Giles GG, Milne RL, Setiawan VW, Merritt MA, van den Brandt PA, Zeleniuch-Jacquotte A, Arslan AA, O'Brien KM, Sandler DP, Wolk A, Håkansson N, Harris HR, Trabert B, Wentzensen N, Tworoger SS, Schouten LJ. Ovarian Cancer Risk Factor Associations by Primary Anatomic Site: The Ovarian Cancer Cohort Consortium. Cancer Epidemiol Biomarkers Prev 2020; 29:2010-2018. [PMID: 32732252 PMCID: PMC7541500 DOI: 10.1158/1055-9965.epi-20-0354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/13/2020] [Accepted: 07/27/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Epithelial ovarian, fallopian tube, and primary peritoneal cancers have shared developmental pathways. Few studies have prospectively examined heterogeneity in risk factor associations across these three anatomic sites. METHODS We identified 3,738 ovarian, 337 peritoneal, and 176 fallopian tube incident cancer cases in 891,731 women from 15 prospective cohorts in the Ovarian Cancer Cohort Consortium. Associations between 18 putative risk factors and risk of ovarian, peritoneal, and fallopian tube cancer, overall and for serous and high-grade serous tumors, were evaluated using competing risks Cox proportional hazards regression. Heterogeneity was assessed by likelihood ratio tests. RESULTS Most associations did not vary by tumor site (P het ≥ 0.05). Associations between first pregnancy (P het = 0.04), tubal ligation (P het = 0.01), and early-adult (age 18-21 years) body mass index (BMI; P het = 0.02) and risk differed between ovarian and peritoneal cancers. The association between early-adult BMI and risk further differed between peritoneal and fallopian tube cancer (P het = 0.03). First pregnancy and tubal ligation were inversely associated with ovarian, but not peritoneal, cancer. Higher early-adult BMI was associated with higher risk of peritoneal, but not ovarian or fallopian tube, cancer. Patterns were generally similar when restricted to serous and high-grade serous cases. CONCLUSIONS Ovarian, fallopian tube, and primary peritoneal cancers appear to have both shared and distinct etiologic pathways, although most risk factors appear to have similar associations by anatomic site. IMPACT Further studies on the mechanisms underlying the differences in risk profiles may provide insights regarding the developmental origins of tumors arising in the peritoneal cavity and inform prevention efforts.
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Affiliation(s)
- Renée T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Megan S Rice
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Synnove F Knutsen
- School of Public Health, Loma Linda University, Loma Linda, California
| | - Michael J Orlich
- School of Public Health, Loma Linda University, Loma Linda, California
| | - Kala Visvanathan
- Johns Hopkins Bloomberg School of Public Health and School of Medicine, Baltimore, Maryland
| | - Alpa V Patel
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
| | - Mia M Gaudet
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
| | - Anne Tjønneland
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Marina Kvaskoff
- CESP, Fac. de médecine-Univ. Paris-Sud, Fac. de médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Valeria Pala
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Inger T Gram
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Pilar Amiano
- Public Health División of Gipuzkoa, BioDonostia Research Institute, San-Sebastian-Donostia, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Annika Idahl
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Naomi E Allen
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | | | - Jenny N Poynter
- Division of Pediatric Epidemiology and Clinical Research, University of Minnesota, Minneapolis, Minnesota
| | - Kim Robien
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | | | - Melissa A Merritt
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Piet A van den Brandt
- Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | | | - Alan A Arslan
- New York University School of Medicine, New York, New York
| | - Katie M O'Brien
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, Durham, North Carolina
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, Durham, North Carolina
| | - Alicja Wolk
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Niclas Håkansson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Holly R Harris
- Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Washington, DC
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Washington, DC
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Leo J Schouten
- Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands.
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Deraco M, Sinukumar S, Salcedo-Hernández RA, Rajendra VJ, Baratti D, Guaglio M, Nizri E, Kusamura S. Clinico-pathological outcomes after total parietal peritonectomy, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in advanced serous papillary peritoneal carcinoma submitted to neoadjuvant systemic chemotherapy- largest single institute experience. Eur J Surg Oncol 2019; 45:2103-2108. [PMID: 31230982 DOI: 10.1016/j.ejso.2019.06.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/05/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Serous papillary peritoneal carcinoma (SPPC) is a rare clinical entity. Based on the understanding of the pattern of spread, its multifocality, polyclonality and the high frequency of diffuse, widespread peritoneal metastasis, a robust rationale for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for SPPC exists. Herein we report the clinical outcomes of SPPC patients treated with neoadjuvant systemic chemotherapy (NACT) followed by CRS including total parietal peritonectomy and HIPEC. METHODS Clinico-pathological data of 22 patients of serous papillary peritoneal carcinoma (SPPC) was retrospectively analyzed from a prospectively maintained database from June 2000 to July 2017. Patients were treated with CRS, total parietal peritonectomy and HIPEC with cisplatin (42 mg/L of perfusate) and doxorubicin (15 mg/L of perfusate) after NACT. Survival curves were calculated from the date of surgery. RESULTS 22 patients underwent CRS, total parietal peritonectomy and HIPEC. The median age was 62 years (Range 47-72). On histological evaluation, 18/30 (60%) parietal peritonectomy specimens showed microscopic disease, when no disease was evident macroscopically at surgical exploration. Grade III-IV surgical complications were recorded in 4/22 (18%) patients. There was no postoperative mortality. At a median follow up of 12 months, the five-year overall survival (OS) was 64.9%. The median OS was not reached. Median progression-free survival was 32.9 months and progression-free survival at 5 years was 33.2%. CONCLUSION CRS with total peritonectomy + HIPEC after NACT, presents as a promising treatment modality for SPPC, and could be associated with good survival results in patients with SPPC.
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Affiliation(s)
- Marcello Deraco
- Peritoneal Surface Malignancy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori Milano, via Venezian 1, Milan, MI, CAP 20133, Italy.
| | - Snita Sinukumar
- Department of Surgical Oncology, Jehangir Hospital, Sassoon Road, Pune, 411001, Maharashtra, India.
| | | | - Vinayakumar J Rajendra
- Department of Surgical oncology, All India Insitute of medical sciences, Ansari Nagar, New Delhi, Delhi, 110029, India.
| | - Dario Baratti
- Peritoneal Surface Malignancy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori Milano, via Venezian 1, Milan, MI, CAP 20133, Italy.
| | - Marcello Guaglio
- Peritoneal Surface Malignancy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori Milano, via Venezian 1, Milan, MI, CAP 20133, Italy.
| | - Eran Nizri
- Department of Surgery A, Tel-Aviv Sourasky Medical Center and Sackler Fcaulty of Medicine, Tel Aviv, Israel.
| | - Shigeki Kusamura
- Peritoneal Surface Malignancy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori Milano, via Venezian 1, Milan, MI, CAP 20133, Italy.
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6
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Anugraham M, Jacob F, Everest-Dass AV, Schoetzau A, Nixdorf S, Hacker NF, Fink D, Heinzelmann-Schwarz V, Packer NH. Tissue glycomics distinguish tumour sites in women with advanced serous adenocarcinoma. Mol Oncol 2017; 11:1595-1615. [PMID: 28853212 PMCID: PMC5663998 DOI: 10.1002/1878-0261.12134] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 08/06/2017] [Accepted: 08/11/2017] [Indexed: 11/08/2022] Open
Abstract
In the era of precision medicine, the tailoring of cancer treatment is increasingly important as we transition from organ‐based diagnosis towards a more comprehensive and patient‐centric molecular diagnosis. This is particularly the case for high‐grade serous adenocarcinomas of the ovary and peritoneum, which are commonly diagnosed at an advanced stage, and collectively treated and managed similarly. We characterized the N‐ and O‐glycome of serous ovarian (OC) and peritoneal cancer (PC) tissues using PGC‐LC‐ESI‐IT‐MS/MS profiling and validated the discriminatory glycans and their corresponding glyco‐gene expression levels using cell lines and transcriptomic data from 232 patients. Overall, the N‐ and O‐glycan repertoires of both cancer types were found to comprise mostly of α2,6‐sialylated glycan structures, with the majority of N‐glycans displaying the biantennary mono‐ and disialylation as well as bisecting‐type biantennary glycans. The MS profiling by PGC‐LC also revealed several glycan structural isomers that corresponded to LacdiNAc‐type (GalNAcβ1‐4GlcNAc) motifs that were unique to the serous ovarian cancers and that correlated with elevated gene expression of B4GALNT3 and B4GALNT4 in patients with serous cancer. Statistical evaluation of the discriminatory glycans also revealed 13 N‐ and 3 O‐glycans (P < 0.05) that significantly discriminated tumour‐sampling sites, with LacdiNAc‐type N‐glycans (m/z 1205.02− and m/z 1059.42−) being associated with ovarian‐derived cancer tissue and bisecting GlcNAc‐type (m/z 994.92−) and branched N‐glycans (m/z 1294.02− and m/z 1148.42−) upregulated at the metastatic sites. Hence, we demonstrate for the first time that OC and PC display distinct molecular signatures at both their glycomic and transcriptomic levels. These signatures may have potential utility for the development of accurate diagnosis and personalized treatments.
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Affiliation(s)
- Merrina Anugraham
- Department of Chemistry & Biomolecular Sciences, Biomolecular Discovery & Design Research Centre, Faculty of Science and Engineering, Macquarie University, North Ryde, NSW, Australia.,Glyco-oncology, Ovarian Cancer Research, Department of Biomedicine, University Hospital Basel, University of Basel, Switzerland
| | - Francis Jacob
- Glyco-oncology, Ovarian Cancer Research, Department of Biomedicine, University Hospital Basel, University of Basel, Switzerland
| | - Arun V Everest-Dass
- Department of Chemistry & Biomolecular Sciences, Biomolecular Discovery & Design Research Centre, Faculty of Science and Engineering, Macquarie University, North Ryde, NSW, Australia.,Australian Research Council Centre of Excellence in Nanoscale Biophotonics, Macquarie University, North Ryde, NSW, Australia.,Glycomics Institute, Griffith University, Gold Coast, Queensland, Australia
| | - Andreas Schoetzau
- Ovarian Cancer Research, Department of Biomedicine, University Hospital Basel, University of Basel, Switzerland
| | - Sheri Nixdorf
- Gynecological Research, Adult Cancer Program, Lowy Cancer Research Centre, University of New South Wales, Sydney, Australia
| | - Neville F Hacker
- Royal Hospital for Women, Gynecological Cancer Centre, School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Daniel Fink
- Department of Gynecology, University Hospital Zurich, Switzerland
| | - Viola Heinzelmann-Schwarz
- Ovarian Cancer Research, Department of Biomedicine, University Hospital Basel, University of Basel, Switzerland.,Hospital for Women, Department of Gynecology and Gynecological Oncology, University Hospital Basel, University of Basel, Switzerland
| | - Nicolle H Packer
- Department of Chemistry & Biomolecular Sciences, Biomolecular Discovery & Design Research Centre, Faculty of Science and Engineering, Macquarie University, North Ryde, NSW, Australia.,Australian Research Council Centre of Excellence in Nanoscale Biophotonics, Macquarie University, North Ryde, NSW, Australia.,Glycomics Institute, Griffith University, Gold Coast, Queensland, Australia
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Rottmann M, Burges A, Mahner S, Anthuber C, Beck T, Grab D, Schnelzer A, Kiechle M, Mayr D, Pölcher M, Schubert-Fritschle G, Engel J. Cancer of the ovary, fallopian tube, and peritoneum: a population-based comparison of the prognostic factors and outcomes. J Cancer Res Clin Oncol 2017; 143:1833-1844. [DOI: 10.1007/s00432-017-2422-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 04/11/2017] [Indexed: 12/26/2022]
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Soleymani majd H, Ismail L, Hardern K, Ferrari F, Kehoe S. Comparison of survival outcome of patients with primary peritoneal and fallopian tube carcinoma treated with neoadjuvant chemotherapy versus primary debulking surgery. J OBSTET GYNAECOL 2016; 37:89-92. [DOI: 10.1080/01443615.2016.1225029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Lamiese Ismail
- Department of Obstetrics & Gynaecology, John Radcliffe Hospital, Oxford, UK
| | | | - Federico Ferrari
- Department of Gynaecological Oncology, Churchill Hospital, Headington, Oxford, UK
| | - Sean Kehoe
- Institute of Cancer and Genomic sciences, University of Birmingham, Edgbaston, Birmingham, UK
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Dahm-Kähler P, Borgfeldt C, Holmberg E, Staf C, Falconer H, Bjurberg M, Kjölhede P, Rosenberg P, Stålberg K, Högberg T, Åvall-Lundqvist E. Population-based study of survival for women with serous cancer of the ovary, fallopian tube, peritoneum or undesignated origin - on behalf of the Swedish gynecological cancer group (SweGCG). Gynecol Oncol 2016; 144:167-173. [PMID: 27817932 DOI: 10.1016/j.ygyno.2016.10.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/19/2016] [Accepted: 10/24/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to determine survival outcome in patients with serous cancer in the ovary, fallopian tube, peritoneum and of undesignated origin. METHODS Nation-wide population-based study of women≥18years with histologically verified non-uterine serous cancer, included in the Swedish Quality Registry for primary cancer of the ovary, fallopian tube and peritoneum diagnosed 2009-2013. Relative survival (RS) was estimated using the Ederer II method. Simple and multivariable analyses were estimated by Poisson regression models. RESULTS Of 5627 women identified, 1246 (22%) had borderline tumors and 4381 had malignant tumors. In total, 2359 women had serous cancer; 71% originated in the ovary (OC), 9% in the fallopian tube (FTC), 9% in the peritoneum (PPC) and 11% at an undesignated primary site (UPS). Estimated RS at 5-years was 37%; for FTC 54%, 40% for OC, 34% for PPC and 13% for UPS. In multivariable regression analyses restricted to women who had undergone primary or interval debulking surgery for OC, FTC and PPC, site of origin was not independently associated with survival. Significant associations with worse survival were found for advanced stages (RR 2.63, P<0.001), moderate (RR 1.90, P<0.047) and poor differentiation (RR 2.20, P<0.009), neoadjuvant chemotherapy (RR1.33, P<0.022), residual tumor (RR 2.65, P<0.001) and platinum single (2.34, P<0.001) compared to platinum combination chemotherapy. CONCLUSION Survival was poorer for serous cancer at UPS than for ovarian, fallopian tube and peritoneal cancer. Serous cancer at UPS needs to be addressed when reporting and comparing survival rates of ovarian cancer.
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Affiliation(s)
- Pernilla Dahm-Kähler
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
| | - Christer Borgfeldt
- Department of Obstetrics and Gynecology, Skane University Hospital, Lund University, Lund, Sweden
| | - Erik Holmberg
- Regional Cancer Center Western Sweden, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Christian Staf
- Regional Cancer Center Western Sweden, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Falconer
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Maria Bjurberg
- Department of Clinical Sciences, Skane University Hospital, Lund, Sweden
| | - Preben Kjölhede
- Department of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Per Rosenberg
- Department of Oncology, University Hospital Linköping, Linköping, Sweden
| | - Karin Stålberg
- Department of Women's and Children's health Uppsala University, Uppsala, Sweden
| | - Thomas Högberg
- Department of Cancer Epidemiology, Lund University, Lund, Sweden
| | - Elisabeth Åvall-Lundqvist
- Department of Oncology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
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Gao B, Lindemann K, Anderson L, Fereday S, Hung J, Alsop K, Tothill RW, Gebski V, Kennedy C, Balleine RL, Harnett PR, Bowtell DDL, DeFazio A. Serous ovarian and primary peritoneal cancers: A comparative analysis of clinico-pathological features, molecular subtypes and treatment outcome. Gynecol Oncol 2016; 142:458-64. [PMID: 27444035 DOI: 10.1016/j.ygyno.2016.06.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/23/2016] [Accepted: 06/30/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Primary peritoneal cancer is rare and considered equivalent to stage III/IV ovarian cancer, but questions remain concerning its underlying biology, prognosis and optimal management. METHODS Clinico-pathological and treatment details of primary peritoneal (n=120) and ovarian cancer (n=635) were obtained on women recruited to the Australian Ovarian Cancer Study. Log-rank test was used to compare survival and cox proportional hazards models were fitted to obtain hazard ratios and 95% confidence intervals, both unadjusted and adjusted for age, grade, FIGO stage, residual disease and treatment with neoadjuvant chemotherapy. Molecular subtype was determined by gene expression profiling using published data. RESULTS Compared with advanced serous ovarian cancer, primary peritoneal cancer patients were older (mean age 65.5 vs. 60.2years, p<0.001), more often treated with neoadjuvant chemotherapy (38.4% vs. 11.4%, p<0.001). Gene expression profiling classified a substantially higher proportion of primary peritoneal carcinomas as C1 (mesenchymal, reactive stromal infiltration) subtype (70.6% vs. 32.1%, p=0.029), which was associated with lower complete surgical resection rate. Women with primary peritoneal cancer had significantly shorter progression-free (11.6 vs. 13.6months, p=0.007) and overall survival (31.7 vs. 39.8months, p=0.012). In multivariate analysis, residual disease and neoadjuvant chemotherapy were both independently associated with increased risk of progression and death. CONCLUSIONS Primary peritoneal cancer patients were more frequently treated with neoadjuvant chemotherapy and had inferior survival. Different tumor biology characterized by activated stromal fibrosis in primary peritoneal cancer may underlie the differences in treatment and clinical outcome.
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Affiliation(s)
- Bo Gao
- Crown Princess Mary Cancer Care Centre, Westmead Hospital, Sydney, NSW, Australia; The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Kristina Lindemann
- Crown Princess Mary Cancer Care Centre, Westmead Hospital, Sydney, NSW, Australia; NHMRC Clinical Trials Centre, Sydney, NSW, Australia; Department of Gynecological Cancer, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | | | - Sian Fereday
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jillian Hung
- The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia; Department of Gynecological Oncology, Westmead Hospital, Sydney, NSW, Australia
| | - Kathryn Alsop
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - Val Gebski
- NHMRC Clinical Trials Centre, Sydney, NSW, Australia
| | - Catherine Kennedy
- The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia; Department of Gynecological Oncology, Westmead Hospital, Sydney, NSW, Australia
| | - Rosemary L Balleine
- The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia; Pathology West ICPMR, Westmead, NSW, Australia
| | | | - Paul R Harnett
- Crown Princess Mary Cancer Care Centre, Westmead Hospital, Sydney, NSW, Australia; The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - David D L Bowtell
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Department of Pathology, University of Melbourne, Melbourne, Victoria, Australia; Department of Biochemistry and Molecular Biology, University of Melbourne, Melbourne, Victoria, Australia; Ovarian Cancer Action Research Centre, Department of Surgery and Cancer, Imperial College London, UK; The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Anna DeFazio
- The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia; Department of Gynecological Oncology, Westmead Hospital, Sydney, NSW, Australia.
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11
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Gershenson DM, Bodurka DC, Lu KH, Nathan LC, Milojevic L, Wong KK, Malpica A, Sun CC. Impact of Age and Primary Disease Site on Outcome in Women With Low-Grade Serous Carcinoma of the Ovary or Peritoneum: Results of a Large Single-Institution Registry of a Rare Tumor. J Clin Oncol 2015. [PMID: 26195696 DOI: 10.1200/jco.2015.61.0873] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Low-grade serous carcinoma of the ovary (LGSOC) or peritoneum (LGSPC) is a rare subtype of ovarian or peritoneal cancer characterized by young age at diagnosis and relative resistance to chemotherapy. The purpose of this study is to report our updated experience with women diagnosed with LGSOC or LGSPC to assess the validity of our original observations. PATIENTS AND METHODS Eligibility criteria for patients from our database were: stage I to IV LGSOC or LGSPC, original diagnosis before January 2012, and adequate clinical information. All patients were included in progression-free survival, overall survival, and multivariable Cox regression analyses. A subset analysis was performed among patients with stage II to IV low-grade serous carcinoma treated with primary surgery followed by platinum-based chemotherapy. RESULTS We identified 350 eligible patients. Median progression-free survival was 28.1 months; median overall survival was 101.7 months. In the multivariable analysis, compared with women age ≤ 35 years, those diagnosed at age > 35 years had a 43% reduction in likelihood of dying (hazard ratio, 0.53; 95% CI, 0.37 to 0.74; P < .001). Having disease present at completion of primary therapy was associated with a 1.78 increased hazard of dying compared with being clinically disease free (P < .001). Similar trends were noted in the smaller patient cohort. In this cohort, women with LGSPC had a 41% decreased chance of dying (hazard ratio, 0.59; 95% CI, 0.36 to 0.98; P = .04) compared with those with LGSOC. CONCLUSION Women age < 35 years with low-grade serous carcinoma and those with persistent disease at completion of primary therapy have the worst outcomes. Patients with LGSPC seem to have a better prognosis than those with LGSOC.
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Affiliation(s)
- David M Gershenson
- All authors: University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Diane C Bodurka
- All authors: University of Texas MD Anderson Cancer Center, Houston, TX
| | - Karen H Lu
- All authors: University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lisa C Nathan
- All authors: University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Kwong K Wong
- All authors: University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anais Malpica
- All authors: University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charlotte C Sun
- All authors: University of Texas MD Anderson Cancer Center, Houston, TX
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12
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Pounds R, Kehoe S. When is it safe to omit surgery in primary peritoneal cancer with small volume disease? Curr Oncol Rep 2015; 17:36. [PMID: 26045131 DOI: 10.1007/s11912-015-0463-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary peritoneal cancer (PPC) is considered a very rare condition, with mesotheliomas deemed the only true PPC when considering the cellular content and embryological derivation of the peritoneum. However, in women, PPC are seen in much greater abundance than that in men and the type of cancer detected is often that of a serous epithelial carcinoma, histologically similar to serous ovarian carcinomas. The management is also similar, i.e. surgery and platin-based chemotherapy. The definition clinically of PPC is that of widespread carcinomatosis with normal-sized ovaries. The carcinomatosis is often extensive, and the only bulk disease may be within the omentum and achieving complete clearance of all disease at primary surgery unlikely. Thus, the concept of using chemotherapy as the main strategy is a reasonable approach and may well be the best single therapeutic option in some patients. This paper reviews the data on PPC and how this approach could be assessed.
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Affiliation(s)
- Rachel Pounds
- City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, B18 7Q, UK
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13
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Cobb LP, Gaillard S, Wang Y, Shih IM, Secord AA. Adenocarcinoma of Mullerian origin: review of pathogenesis, molecular biology, and emerging treatment paradigms. Gynecol Oncol Res Pract 2015; 2:1. [PMID: 27231561 PMCID: PMC4880836 DOI: 10.1186/s40661-015-0008-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/17/2015] [Indexed: 11/10/2022]
Abstract
Traditionally, epithelial ovarian, tubal, and peritoneal cancers have been viewed as separate entities with disparate origins, pathogenesis, clinical features, and outcomes. Additionally, previous classification systems for ovarian cancer have proposed two primary histologic groups that encompass the standard histologic subtypes. Recent data suggest that these groupings no longer accurately reflect our knowledge surrounding these cancers. In this review, we propose that epithelial ovarian, tubal, and peritoneal carcinomas represent a spectrum of disease that originates in the Mullerian compartment. We will discuss the incidence, classification, origin, molecular determinants, and pathologic analysis of these cancers that support the conclusion they should be collectively referred to as adenocarcinomas of Mullerian origin. As our understanding of the molecular and pathologic profiling of adenocarcinomas of Mullerian origin advances, we anticipate treatment paradigms will shift towards genomic driven therapeutic interventions.
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Affiliation(s)
- Lauren Patterson Cobb
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710 USA
| | - Stephanie Gaillard
- Division of Medical Oncology, Department of Internal Medicine, Duke University Medical Center, Durham, NC 27710 USA
| | - Yihong Wang
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA
| | - Ie-Ming Shih
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA
| | - Angeles Alvarez Secord
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710 USA
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14
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Sørensen RD, Schnack TH, Karlsen MA, Høgdall CK. Serous ovarian, fallopian tube and primary peritoneal cancers: a common disease or separate entities - a systematic review. Gynecol Oncol 2015; 136:571-81. [PMID: 25615934 DOI: 10.1016/j.ygyno.2015.01.534] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 01/06/2015] [Accepted: 01/13/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this systematic review is to analyze data on risk factors, epidemiology, clinicopathology and molecular biology from studies comparing primary peritoneal cancer, fallopian tube cancer and ovarian cancer of serous histology, in order to achieve a greater understanding of whether or not these disorders should be considered as separate entities. METHODS A systematic literature search was conducted in PubMed and MEDLINE. Case-control studies comparing primary serous peritoneal or fallopian tube carcinomas with primary serous ovarian carcinomas or a control group were included. RESULTS Twenty-eight studies were found eligible. Primary peritoneal cancer patients were older, had higher parity, were more often obese and had poorer survival compared to ovarian cancer patients. Differences in protein expression patterns of Her2/neu, estrogen and progestin receptors and frequency of loss of heterozygosity differed between primary peritoneal cancer and primary ovarian cancer patients. No major differences were found between primary fallopian tube cancer and primary ovarian cancer. The proportion of serous tubal intraepithelial carcinomas (STIC) was lower in primary peritoneal cancer and primary ovarian cancer compared to primary fallopian tube cancer. CONCLUSION Except from differences in the proportion of STIC only few differences between primary fallopian tube cancer and primary ovarian cancer have been found. In contrast, observed differences in risk factor profile, clinicopathologic and prognostic factors, as well as in the molecular patterns, indicate that peritoneal cancer and ovarian cancer may be linked to different carcinogenic pathways.
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Affiliation(s)
- Rie D Sørensen
- Gynaecological Clinic, The Juliane Marie Center, Rigshospitalet University Hospital of Copenhagen, Blegdamsvej 9, 2100 København Ø, Denmark.
| | - Tine H Schnack
- Gynaecologic and Obstetric Clinic, Roskilde Sygehus, Køgevej 7-13, 4000 Roskilde, Denmark.
| | - Mona A Karlsen
- Molecular Unit, Department of Pathology, Herlev University Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark.
| | - Claus K Høgdall
- Gynaecological Clinic, The Juliane Marie Center, Rigshospitalet University Hospital of Copenhagen, Blegdamsvej 9, 2100 København Ø, Denmark.
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