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Clinical and Pathologic Features of Patients with Rare Ovarian Tumors: Multi-Center Review of 167 Patients by the Anatolian Society of Medical Oncology

  • Bilici, Ahmet (Department of Medical Oncology, Medical Faculty, Istanbul Medipol University) ;
  • Inanc, Mevlude (Erciyes University, Medical Faculty) ;
  • Ulas, Arife (Dr. Abdurrahman Yurtarslan Oncology Education and Research Hospital) ;
  • Akman, Tulay (Dokuz Eylul University, Medical Faculty) ;
  • Seker, Mesut (Dr. Lutfi Kirdar Kartal Education and Research Hospital) ;
  • Babacan, Nalan Akgul (Ankara Numune Education and Research Hospital) ;
  • Inal, Ali (Dicle University, Medical Faculty) ;
  • Bal, Oznur (Dr. Abdurrahman Yurtarslan Oncology Education and Research Hospital) ;
  • Koral, Lokman (Selcuk University, Meram Medical Faculty) ;
  • Sevinc, Alper (Medical Faculty, Gaziantep University) ;
  • Tufan, Gulnihal (Gazi University, Medical Faculty) ;
  • Elkiran, Emin Tamer (Medical Faculty, Inonu University) ;
  • Ustaalioglu, Bala Basak Oven (Dr. Lutfi Kirdar Kartal Education and Research Hospital) ;
  • Yavuzsen, Tugba (Dokuz Eylul University, Medical Faculty) ;
  • Alkis, Necati (Dr. Abdurrahman Yurtarslan Oncology Education and Research Hospital) ;
  • Ozkan, Metin (Erciyes University, Medical Faculty) ;
  • Gumus, Mahmut (Dr. Lutfi Kirdar Kartal Education and Research Hospital)
  • Published : 2013.11.30

Abstract

Background: Non-epithelial malignant ovarian tumors and clear cell carcinomas, Brenner tumors, transitional cell tumors, and carcinoid tumors of the ovary are rare ovarian tumors (ROTs). In this study, our aim was to determine the clinicopathological features of ROT patients and prognostic factors associated with survival. Materials and Methods: A total of 167 patients with ROT who underwent initial surgery were retrospectively analyzed. Prognostic factors that may influence the survival of patients were evaluated by univariate and multivariate analyses. Results: Of 167 patients, 75 (44.9%) were diagnosed with germ-cell tumors (GCT) and 68 (40.7%) with sex cord-stromal tumors (SCST); the remaining 24 had other rare ovarian histologies. Significant differences were found between ROT groups with respect to age at diagnosis, tumor localization, initial surgery type, tumor size, tumor grade, and FIGO stage. Three-year progression-free survival (PFS) rates and median PFS intervals for patients with other ROT were worse than those of patients with GCT and SCST (41.8% vs 79.6% vs 77.1% and 30.2 vs 72 vs 150 months, respectively; p=0.01). Moreover, the 3-year overall survival (OS) rates and median OS times for patients with both GCT and SCST were better as compared to patients with other ROT, but these differences were not statistically significant (87.7% vs 88.8% vs 73.9% and 170 vs 122 vs 91 months, respectively; p=0.20). In the univariate analysis, tumor localization (p<0.001), FIGO stage (p<0.001), and tumor grade (p=0.04) were significant prognostic factors for PFS. For OS, the univariate analysis indicated that tumor localization (p=0.01), FIGO stage (p=0.001), and recurrence (p<0.001) were important prognostic indicators. Multivariate analysis showed that FIGO stage for PFS (p=0.001, HR: 0.11) and the presence of recurrence (p=0.02, HR: 0.54) for OS were independent prognostic factors. Conclusions: ROTs should be evaluated separately from epithelial ovarian cancers because of their different biological features and natural history. Due to the rarity of these tumors, determination of relevant prognostic factors as a group may help as a guide for more appropriate adjuvant or recurrent therapies for ROTs.

Keywords

Rare ovarian tumors;overall survival;progression-free survival;prognostic factors

References

  1. Ayhan A, Salman MC, Velipasaoglu M, et al (2009). Prognostic factors in adult granulosa cell tumors of the ovary: a retrospective analysis of 80 cases. J Gynecol Oncol, 20, 158-63. https://doi.org/10.3802/jgo.2009.20.3.158
  2. Cicin I, Eralp Y, Saip P, et al (2009). Malignant ovarian germ cell tumors: a single-institution experience. Am J Clin Oncol, 32, 191-6. https://doi.org/10.1097/COC.0b013e3181841f2e
  3. Colombo N, Parma G, Zanagnolo V, et al (2007). Management of ovarian stromal cell tumors. J Clin Oncol, 25, 2944-51. https://doi.org/10.1200/JCO.2007.11.1005
  4. Colombo N, Peiretti M, Garbi A, et al (2012). Non-epithelial ovarian cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 7, 20-6.
  5. Cronje HS, Niemand I, Bam RH, et al (1999). Review of the granulosa-theca cell tumors from the emil Novak ovarian tumor registry. Am J Obstet Gynecol, 180, 323-7. https://doi.org/10.1016/S0002-9378(99)70207-3
  6. Fotopoulou C, Savvatis K, Braicu EI, et al (2010). Adult granulosa cell tumors of the ovary: tumor dissemination pattern at primary and recurrent situation, surgical outcome. Gynecol Oncol, 119, 285-90. https://doi.org/10.1016/j.ygyno.2010.06.031
  7. Garcia AA, Morrow CP (1999). Stromal tumors of the ovary. In: Raghavan D, Brecher M, Johnson DH, Meropol NJ, Moots PL, Thigpen JT, editos. Textbook of Uncommon Cancer. New-York: John Wiley & Sons, 661-9.
  8. Gershenson DM (2007). Management of ovarian germ cell tumors. J Clin Oncol, 25, 2938-43. https://doi.org/10.1200/JCO.2007.10.8738
  9. Jamieson S, Fuller PJ (2008). Management of granulosa cell tumour of the ovary. Curr Opin Oncol, 20, 560-4. https://doi.org/10.1097/CCO.0b013e328306316f
  10. Karimi Zarchi M, Mousavi A, Gilani MM, et al (2011). Fertility sparing treatments in young patients with gynecological cancers: Iranian experience and literature review. Asian Pac J Cancer Prev, 12, 1887-92.
  11. Koulouris CR, Penson RT (2009). Ovarian stromal and germ cell tumors. Semin Oncol, 36, 126-36. https://doi.org/10.1053/j.seminoncol.2008.12.004
  12. Li W, Wu X, Fang C, et al (2009). Prognostic factors in adult granulosa cell tumor of the ovary. Saudi Med J, 30, 247-52.
  13. Matei D, Brown J, Frazier L (2013). Updates in the management of ovarian germ cell tumors. Am Soc Clin Oncol Educ Book, 2013, 210-6.
  14. Parkinson CA, Hatcher HM, Ajithkumar TV (2011). Management of malignant ovarian germ cell tumors. Obstet Gynecol Surv, 66, 507-14. https://doi.org/10.1097/OGX.0b013e318234ede9
  15. Pautier P, Lhomme C, Culine S, et al (1997). Adult granulosa-cell tumor of the ovary: a retrospective study of 45 cases. Int J Gynecol Cancer, 7, 58-65. https://doi.org/10.1046/j.1525-1438.1997.00417.x
  16. Penson RT, Dizon DS, Birrer MJ (2013). Clear cell cancer of the ovary. Curr Opin Oncol, 25, 553-7. https://doi.org/10.1097/CCO.0b013e328363e0c7
  17. Quirk JT, Natarajan N (2005). Ovarian cancer incidence in the United States, 1992-1999. Gynecol Oncol, 97, 519-23. https://doi.org/10.1016/j.ygyno.2005.02.007
  18. Ray-Coquard I, Weber B, Lotz JP, et al (2010). Management of rare ovarian cancers: the experience of the French website “Observatory for rare malignant tumours of the ovaries” by the GINECO group: interim analysis of the first 100 patients. Gynecol Oncol, 119, 53-9. https://doi.org/10.1016/j.ygyno.2010.05.023
  19. Schumer ST, Cannistra SA (2003). Granulosa cell tumor of the ovary. J Clin Oncol, 21, 1180-9. https://doi.org/10.1200/JCO.2003.10.019
  20. Suri A, Carter EB, Horowitz N, Denslow S, Gehrig PA (2013). Factors associated with an increased risk of recurrence in women with ovarian granulosa cell tumors. Gynecol Oncol, 131, 321-4. https://doi.org/10.1016/j.ygyno.2013.08.013
  21. Takeuchi T, Ohishi Y, Imamura H, et al (2013). Ovarian transitional cell carcinoma represents a poorly differentiated form of high-grade serous or endometrioid adenocarcinoma. Am J Surg Pathol, 37, 1091-9. https://doi.org/10.1097/PAS.0b013e3182834d41
  22. Young RH (2005). Sex cord-stromal tumors of the ovary and testis: their similarities and differences with consideration of selected problems. Mod Pathol, 18, 81-98. https://doi.org/10.1038/modpathol.3800311
  23. Zhang M, Cheung MK, Shin JY, et al (2007). Prognostic factors responsible for survival in sex cord stromal tumors of the ovary--an analysis of 376 women. Gynecol Oncol, 104, 396-400. https://doi.org/10.1016/j.ygyno.2006.08.032

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