Purpose
Here we assess whether molecular subtyping identifies biological
features of tumors that correlate with survival and surgical outcomes of
high-grade serous ovarian cancer (HGSOC).
Experimental Design
Consensus clustering of pooled mRNA expression data from over 2,000
HGSOC cases was used to define molecular subtypes of HGSOCs. This de
novo classification scheme was then applied to 381 Mayo Clinic
HGSOC patients with detailed survival and surgical outcome information.
Results
Five molecular subtypes of HGSOC were identified. In the pooled
dataset, three subtypes were largely concordant with prior studies
describing proliferative, mesenchymal, and immunoreactive tumors
(concordance > 70%), and the group of tumors previously described
as differentiated type was segregated into two new types, one of which
(anti-mesenchymal) had down-regulation of genes that were typically
upregulated in the mesenchymal subtype. Molecular subtypes were
significantly associated with overall survival (p<0.001) and with rate of
optimal surgical debulking (≤1 cm, p=1.9E-4) in the pooled
dataset. Among stage III-C or IV Mayo Clinic patients, molecular subtypes
were also significantly associated with overall survival (p=0.001),
as well as rate of complete surgical debulking (no residual disease;
16% in mesenchymal tumors comparing to >28% in other
subtypes; p=0.02).
Conclusions
HGSOC tumors may be categorized into five molecular subtypes that
associate with overall survival and the extent of residual disease following
debulking surgery. Because mesenchymal tumors may have features that were
associated with less favorable surgical outcome, molecular subtyping may
have future utility in guiding neoadjuvant treatment decisions for women
with HGSOC.