A comparative analysis of management and prognosis in stage I and II fallopian tube carcinoma and epithelial ovarian cancer

Abstract

Summary Staging and surgical as well as post-operative treatment of primary Fallopian tube carcinoma (FTC) followed the lines established for primary ovarian cancer (OC). In a nationwide retrospective analysis we were able to find a distinct difference between these two tumours. A total of 262 patients, 68 with FTC and 194 with OC, in stage I and II were included into this study. A univariate as well as a multivariate analysis for survival was performed, including factors such as age, histological type, grading and surgical and adjuvant treatment. A significantly poorer outcome (P = 0.0002) for FTC patients with a 5-year survival of 50.8% compared with 77.5% for OC patients was observed. This finding was persistent and independent of any investigated factor, in univariate as well as multivariate analyses. Therefore, we feel that a more aggressive therapeutic approach to the treatment of FTC even in early stages can be recommended. On the other hand, the retrospective character of our study has to be taken into account.Primary carcinoma of the Fallopian tube (FTC) ranks among the rarest of gynaecological malignancies, with a prevalence reported to be 0.15-1.8% compared with 9.4-15.8% for epithelial ovarian cancer (OC) (Hanton et al., 1966;Dodson et al., 1970;Engeler et al., 1981;Bohme et al., 1992). The average annual incidence of FTC is reported to be 2.9 per million women per year (Pfeiffer, 1989).Since both tumours have their origin in the Mullerian duct, OC and FTC are considered to be closely related (Frick, 1978). Thus, FIGO staging (until September 1991), surgical treatment and post-operative adjuvant therapy of FTC followed the lines established for OC (Hu et al., 1950;Behr et al., 1990;Morris et al., 1990;Pakisch et al., 1990).In most cases 'primary carcinoma of the Fallopian tube' is diagnosed intraoperatively or even as late as in the pathologist's post-operative histological examination; preoperatively, the tumour is mostly diagnosed as 'ovarian carcinoma' or 'malignant process in the adnexa' (Jones, 1965 al., 1993).Data for ovarian carcinoma were received from the University of Vienna (1st and 2nd Departments of Obstetrics and Gynecology) and were collected and analysed by the second author (P.S.) at the University of Vienna, Austria. They involved patients with OC who had been entered into two multicentre studies, from all over Austria. FTC as well as OC patients were followed until the control date, October 1992.Patients with metastatic tumours, with a history of other malignancies and with borderline tumours were excluded from this study.For the staging of Fallopian tube carcinoma a new FIGO classification, founded in Singapore, 1991, was used, whereas for ovarian carcinoma the FIGO classification was applied.

<i>HER-</i><i>2</i> Oncogene Is Not Amplified in Primary Carcinoma of the Fallopian Tube

“…Thus biochemical and biological differences may exist between these tumor types, although they were considered to be closely related in previous studies [1], Thus the amplification of the HER-2 oncogene cannot serve as a tumor marker for the overall survival or for the clinical criteria of tumors of the fallopian tube as in ovarian carcinomas [12]. Further studies are necessary to find out whether the obvious bio logical differences between carcinomas of the fallopian tube and epithelial ovarian cancer are rather due to HER-2 mutations or overexpression than to amplification or whether they are caused by the activation of oncogenes other than HER-2.…”

“…Although there seem to be many clinical [10], histologi cal [1,3], and biochemical [11] similarities between pri mary epithelial ovarian cancer and carcinomas of the fal lopian tube, we could not find any amplifications of the HER-2 oncogene in our samples as we did in ovarian tumors [4], It seems that the HER-2 amplification is not involved in malign transformation and has no effect on tumor progression of the fallopian tube as it has in ovari an and other types of cancer [4][5][6], These data suggest that in the two types of carcinomas tumor development is linked to different mechanisms. Thus biochemical and biological differences may exist between these tumor types, although they were considered to be closely related in previous studies [1], Thus the amplification of the HER-2 oncogene cannot serve as a tumor marker for the overall survival or for the clinical criteria of tumors of the fallopian tube as in ovarian carcinomas [12].…”

“…The annual rate is reported to be 2.9/million women/year worldwide [1], Fallopian tube cancers seem to mimic advanced ovarian cancer. Both tumors may exhibit mlillerian duct-like differentiations and are considered to be closely related [1,2].…”

“…The annual rate is reported to be 2.9/million women/year worldwide [1], Fallopian tube cancers seem to mimic advanced ovarian cancer. Both tumors may exhibit mlillerian duct-like differentiations and are considered to be closely related [1,2]. The current clinical treatment is also similar to that for ovarian epithe lial tumors [3], But with an approximate response rate of 80%, but only a 20% 5-year survival [3], some progress in the understanding of the tumor biology is necessary to improve treatment.…”

Comparison Of Early-Stage High-Grade Serous Primary Fallopian Tube Cancers and Epithelial Ovarian Cancers: A Multicenter Study

“…Studies on the clinical outcomes of early-stage PFTC patients have yielded conflicting results; the survival times have been better than [4], similar to [5][6][7][8], or worse than, those of patients with EOC [9]. However, most cited studies enrolled patients with heterogeneous cancers (serous, mucinous, and endometrial), and patients differing in terms of cancer type.…”