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Improved Classification of Epithelial Ovarian Cancer: Results of 3 Danish Cohorts
  1. Karina Dahl Steffensen, MD, PhD*,,
  2. Marianne Waldstrøm, MD,
  3. Anni Grove, MD§,
  4. Bente Lund, MD,
  5. Niels Pallisgård, MSc and
  6. Anders Jakobsen, MD, DMSc*,
  1. * Department of Oncology, Vejle Hospital, Vejle;
  2. Institute of Regional Health Services Research, University of Southern Denmark, Odense;
  3. Department of Pathology, Vejle Hospital;
  4. § Institutes of Pathology and
  5. Oncology, Aalborg Hospital, Aalborg; and
  6. Department of Clinical Biochemistry, Vejle Hospital, Vejle, Denmark.
  1. Address correspondence and reprint requests to Karina Dahl Steffensen, MD, PhD, Department of Oncology, Vejle Hospital, Kabbeltoft 25, DK-7100 Vejle, Denmark. E-mail: Karina.Dahl.Steffensen{at}


Objective An increasing body of evidence has suggested that epithelial ovarian cancer (EOC) patients can broadly be divided into 2 groups on the basis of histopathologic parameters and molecular profiles. Type 1 tumors are slow-growing tumors with inherent mutations such as KRAS or BRAF mutations, whereas type 2 tumors are more rapidly growing tumors of which many contain TP53 mutations. In the present study, we performed a comprehensive study in a large Danish material to evaluate the clinical importance.

Materials and Methods A total of 512 tissue samples were included (430 EOCs, 34 borderline, 28 benign tumors, and 20 normal ovaries). KRAS mutations (codon 12/13) and BRAF codon 600 mutations were analyzed from formalin-fixed paraffin-embedded tissue by ARMS qPCR. p53 expression was examined by immunohistochemistry.

Results Of the EOC patients, 25% had histopathologically classified type 1 tumors, and of these, 44% were either KRAS or BRAF mutated. Of patients with histopathologic type 2 tumors, 66% showed p53 protein overexpression, whereas 4 (1.5%) patients contained a KRAS mutation. In a univariate survival analysis, a large difference in survival was seen between patients with type 1 and type 2 tumors. Patients with type histologic 2 tumors had significantly worse survival compared with patients with type 1 tumors (P < 10−5). International Federation of Gynecology and Obstetrics (FIGO) stage, tumor grade, residual tumor, and KRAS/BRAF mutation were independent predictors of overall survival in the multivariate analysis. Patients with KRAS/BRAF mutated carcinomas showed independent decreased overall survival with a hazard ratio of 2.01 (95% confidence interval, 1.13–3.57; P = 0.018).

Conclusions KRAS/BRAF mutations are with very few exceptions constrained to patients with histopathologic type 1 tumors, whereas p53 overexpression is very frequent in type 2 tumors. KRAS/BRAF mutations had independent prognostic importance. The classification presented here should have a major therapeutic implication and serve as a hallmark of future clinical trials.

  • KRAS
  • BRAF
  • p53
  • Ovarian cancer
  • Molecular genetics

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  • The authors have no conflicts of interest to declare.