Why do Women With Double Primary Carcinoma of the Endometrium and Ovary Have a Favorable Prognosis?

Abstract

Patients with double primary cancer (DPC) of the ovary and endometrium are considered to have a better prognosis than patients with only epithelial ovarian cancer (EOC). The aim of this study was to clarify the difference in prognosis by comparing clinicopathologic characteristics and survival. From the population-based database of the nationwide Netherlands Cancer Registry, women diagnosed between 1996 and 2006 with EOC were identified. Within this database of all EOC patients in 11 hospitals, the DPC patients were identified. Differences in characteristics between EOC-only and DPC patients were tested using Pearson χ tests and t-tests. Differences in overall survival were analyzed by Kaplan-Meier survival analyses and log-rank tests. Multivariable Cox regression analyses were performed to study the factors that influence survival. Among 1105 EOC patients, 29 (2.6%) DPC patients were identified. DPC patients were more often premenopausal (P<0.01), in the early stage of disease (P<0.01), and more often had low-grade endometrioid tumors. Overall survival was better for DPC patients (P=0.004), but after stratification for stage the overall survival was similar. In multivariable analysis, DPC patients did not show a favorable prognosis after adjustment for age, disease stage, histology, tumor grade, and residual tumor after surgery. DPC patients seem to constitute a prognostically favorable group among EOC patients; however, after correction for age, stage, histology, tumor grade, and residue, survival is similar. This study shows how important it is for clinicians to distinguish DPC from metastatic diseases.

Synchronous Ovarian and Endometrial Cancer—an International Multicenter Case-Control Study

“…This is a comparable observation with that reported from a population-based analysis in which survival was not different after adjusting for age, disease stage, histology, tumor grade, and residual tumor after surgery between the 2 groups. 22 An ostensive better survival rate of patients with SEOC due to better prognostic factors has been explained by several authors before. 12,13,17,23 To overcome some shortages in earlier studies, the setup of a case-control study was chosen to minimize bias in this study.…”

High Prevalence of Atypical Hyperplasia in the Endometrium of Patients With Epithelial Ovarian Cancer

“…1,2 Another justification to perform routine hysterectomy in patients with EOC includes the presence of a double primary carcinoma in the endometrium in 10% of endometrioid ovarian carcinomas and in 2% to 5% of serous, clear cell, and mucinous carcinomas. [3][4][5] Knowledge of the prevalence of synchronous endometrial premalignancies in these women is nevertheless poor.…”

Müllerian precursor lesions in serous ovarian cancer patients: using the SEE-Fim and SEE-End protocol

“…Further, identification of invasive endometrial carcinoma seems slightly increased in the current study (8%), compared with the prevalence reported after routine sampling (2-5%). 15,34 This might be because of the introduction of the SEE-End protocol. In half of the cases, additional serous tubal carcinoma was found and in one case was found even in the endocervix.…”

“…12 Moreover, double primary endometrial carcinomas are identified in 10% of endometrioid ovarian carcinomas and in 2-5% of other ovarian carcinoma types. [13][14][15] The current study was performed to analyze the cervix, endometrium and tubal epithelium thoroughly in serous ovarian cancer patients. Therefore, structural embedding of the entire endometrium and fallopian tubal epithelium was performed and extensive histological assessment of tissue for all cases.…”