Elsevier

Gynecologic Oncology

Volume 121, Issue 3, 1 June 2011, Pages 482-486
Gynecologic Oncology

Low-grade serous primary peritoneal carcinoma,☆☆

https://doi.org/10.1016/j.ygyno.2011.02.017Get rights and content

Abstract

Objective

10% of women with serous ovarian cancer have low-grade carcinomas. These patients are diagnosed at a younger age, have a longer overall survival and a lower response rate to platinum-based chemotherapy compared to women with high-grade serous ovarian carcinoma. It remains unclear if these features are similar in women with low-grade primary peritoneal cancer (PPC). To further explore this issue, a retrospective analysis of the clinical and pathologic characteristics of women with low-grade serous PPC was performed.

Methods

A retrospective study of 53 patients with low-grade serous PPC evaluated at a single institution from 1986 to 2009 was performed. All cases were reviewed by a gynecologic pathologist to confirm low-grade serous PPC.

Results

Median age at diagnosis was 51.7 years (range 27.1–82.4). 46 patients (86.8%) underwent primary surgery, with optimal tumor reduction achieved in 30 patients (65.2%). 48 patients (90.6%) received chemotherapy as part of their initial treatment. At the completion of primary treatment, 66.7% of patients were noted to have persistent or progressive disease. With a median follow-up of 66.1 months, the 5-year PFS was 16%, yet the 5-year OS was 69%.

Conclusion

To our knowledge, this is the first report of women with low-grade serous PPC. Similar to low-grade serous ovarian carcinoma, patients with low-grade serous PPC have high rates of persistent disease at the completion of primary treatment yet a long overall survival. Further study focusing specifically on low-grade serous ovarian and primary peritoneal carcinomas is needed to determine the optimal treatment of these diseases.

Research Highlights

► This study is the first reported series of women with low-grade serous primary peritoneal cancer. ► The pathogenesis and clinical behavior of low-grade serous ovarian and primary peritoneal are distinct from high-grade serous tumors. ► Women with low-grade primary peritoneal cancer have high rates of persistent disease at the completion of primary treatment, yet have a prolonged survival.

Introduction

Primary peritoneal carcinoma (PPC) is a malignancy that diffusely involves the peritoneal surfaces while sparing or minimally involving the ovaries [1], [2], [3], [4]. It is histologically indistinguishable from epithelial ovarian cancer, and has similar clinical characteristics, patterns of spread, response to treatment, and survival rates [3], [5], [6], [7], [8], [9]. Previous reports have suggested that women with PPC have similar epidemiologic features to women with epithelial ovarian cancer, with the exception of an older age at diagnosis and increased rate of obesity [8], [10], [11], [12], [13], [14]. The recommended treatment for serous PPC is similar to that for serous ovarian carcinoma; however, optimal cytoreduction may be more difficult to achieve in women with PPC due to widespread peritoneal disease without the presence of a predominant pelvic or ovarian mass [15].

To date, most of the literature evaluating PPC has focused on patients with high-grade serous tumors, with little published about low-grade serous PPC. There is now an increasing body of literature on low-grade serous ovarian carcinomas. Low-grade serous ovarian carcinomas represent approximately 10% of ovarian carcinomas [16] and have distinct histologic, pathologic and clinical features [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27]. Previous studies have reported that women with low-grade serous ovarian carcinomas are diagnosed at a younger age, have a longer overall survival, and yet have a lower response rate to platinum-based chemotherapy compared with women with high-grade serous ovarian carcinoma [28], [29], [30]. However, it remains unclear if these features are similar in women with low-grade PPC. A systematic MEDLINE search (keywords primary peritoneal cancer, low-grade serous ovarian and peritoneal cancer, English language, 1950 to 2010) revealed no reports of low-grade serous PPC. To further explore this issue, we retrospectively evaluated the clinical and pathologic characteristics of women with low-grade serous PPC.

Section snippets

Materials and methods

Following the approval from The University of Texas MD Anderson Cancer Center Institutional Review Board, we searched the institutional databases of the Departments of Gynecologic Oncology and Pathology to identify patients with low-grade serous primary peritoneal carcinoma. Although a histopathologic review of all cases had been performed at the time of original diagnosis and/or presentation to MD Anderson Cancer Center, all cases were re-reviewed by a gynecologic pathologist for the purposes

Results

Our database search identified 53 eligible patients with low-grade serous PPC evaluated at The University of Texas MD Anderson Cancer Center between 1986 and 2009. Patient demographics are shown in Table 1. Eighteen patients (34%) had undergone previous bilateral salpingo-oophorectomy (BSO) a median of 12.8 years (range, 3.0 to 27.7) prior to the diagnosis of PPC. The findings at BSO included endometriosis (n = 5), ovarian serous cystadenoma (n = 1), and normal ovaries removed at the time of

Discussion

To our knowledge, this is the first series of women with low-grade serous PPC ever reported. The principal findings of our study are that patients with low-grade serous PPC have higher rates of persistent disease at the completion of primary treatment and a longer survival when compared with previously published reports of patients with high-grade serous ovarian and PPC. In addition, our data suggest that differences may exist between women diagnosed with low-grade serous PPC and published data

Conflict of interest statement

The authors report no conflict of interest.

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    Presented in part at the 46th annual meeting of the American Society of Clinical Oncologists, Chicago, Illinois, June 2010.

    ☆☆

    This study was supported in part by the MD Anderson Low-Grade Serous Ovarian Cancer Research Fund.

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