Different Patterns of Disease Spread between Advanced-Stage Type I and II Epithelial Ovarian Cancer

Abstract

Background and Aims: Two types of epithelial ovarian carcinoma (EOC) have been recently distinguished. Type I comprises low-grade serous, endometrioid and clear-cell tumors. High-grade endometrioid and serous tumors belong to type II. The aim of this study was to compare patterns of disease spread in advanced-stage type I and II EOCs at primary surgery. Methods: Surgical and pathological data of 233 patients with advanced-stage EOCs were collected, 42 with type I and 191 with type II. The two groups were compared for tumor localization at primary surgery. Intraoperative mapping of ovarian cancer (IMO) was used to assess tumor dissemination. Results: Tumor involvement was significantly higher in the type II group for the following: peritoneum (68.1 vs. 40.5%, p < 0.001), pouch of Douglas (60.2 vs. 40.5%, p = 0.06), vesicouterine ligament (40.8 vs. 19%, p = 0.027), diaphragm (45.0 vs. 11.9%, p < 0.001), serosa of liver (17.2 vs. 4.8%, p = 0.05), omentum (81.1 vs. 59.5%, p = 0.007), mesentery (42.9 vs. 16.7%, p = 0.005), pleural effusions (19.4 vs. 4.6%, p = 0.01) and ascites (60.7 vs. 21.4%, p < 0.001). IMO levels were different between the two groups (p = 0.001). Conclusions: This study provides clinical evidence in favor of the dualistic model of carcinogenesis, since types I and II are characterized by different findings at primary surgery.

Comparison between types I and II epithelial ovarian cancer using histogram analysis of monoexponential, biexponential, and stretched‐exponential diffusion models

“…In our study, conventional MR images were primarily analyzed. A peritoneal implant was a significant predictor of type II cancer, as previously reported, which was in accordance with the aggressive nature of type II cancer. Among other morphological features, only size and texture of lesion could differentiate the two types of EOC.…”

Patterns and Prognostic Importance of Hepatic Involvement in Patients with Serous Ovarian Cancer: A Single-Institution Experience with 244 Patients

“…Both LPI and hematogenous metastases were associated with increasing age at multivariate analysis, consistent with prior studies where more advanced disease was seen in older patients (3,29). Suboptimal cytoreduction was also associated with LPI, which is intuitive because an incomplete surgical resection would make the patient more prone to peritoneal recurrence, a precursor for LPI (4,30). This is further substantiated by the fact that there was no relationship between suboptimal cytoreduction and hematogenous metastatic disease, which was associated with higher tumor grades and advance stage disease.…”

Salvage radiation therapy for localized recurrent ovarian cancer

“…High-grade serous ovarian cancer has a propensity for intra-abdominal relapse, while the non-endometrioid subtypes have distinct patterns of spread and are more likely to be pelvic-confined at diagnosis and recurrence 14. These biological differences may account for the lower rate of relapse that was observed for patients with recurrent non-serous tumors treated with involved field radiotherapy compared with serous cancers (median disease-free survival 22.8 months vs 11.5 months).…”