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Survival Rates for International Federation of Gynecology and Obstetrics Stage III Ovarian Carcinoma by Cell Type: A Study of 262 Unselected Patients With Uniform Pathologic Review
  1. Jeffrey D. Seidman, MD*,
  2. Anna Yemelyanova, MD,
  3. Jonathan A. Cosin, MD,
  4. Anthony Smith, MD* and
  5. Robert J. Kurman, MD,§
  1. * From the Department of Pathology and Laboratory Medicine, Washington Hospital Center, Washington, DC;
  2. Departments of Pathology, Obstetrics and Gynecology, The Johns Hopkins University School of Medicine, Baltimore, MD;
  3. Department of Obstetrics and Gynecology, Washington Hospital Center, Washington, DC; and
  4. § Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD.
  1. Address correspondence and reprint requests to Jeffrey D. Seidman, MD, Department of Pathology, Washington Hospital Center, 110 Irving St, NW, Washington, DC 20010. E-mail: Jeffrey.d.seidman{at}medstar.net.

Abstract

Objective Published data are conflicting on the influence of cell type on prognosis in ovarian cancer. The recent separation of low-grade serous carcinoma as a distinctive cell type of ovarian cancer with an indolent behavior, in retrospect, suggests that survival in studies that have not separated this group may be inaccurate.

Methods An unselected series of 262 International Federation of Gynecology and Obstetrics stage III ovarian carcinomas was studied. Diagnostic classification of each tumor was made with particular attention to recent refinements in cell-type classification. Survival curves were constructed according to Kaplan-Meier and compared with the log-rank test.

Results The 5-year survival for 207 high-grade serous carcinomas was 40%, as compared with 71% for 18 patients with low-grade serous carcinoma (P = 0.0113). Low-grade serous carcinoma was significantly more likely to be optimally debulked (P = 0.0039) and significantly less likely to be substage IIIC (P < 0.0001). The survival for carcinosarcoma was significantly inferior to all serous carcinomas (P = 0.0322). The significance of this latter comparison was lost when carcinosarcomas were compared with only high-grade serous carcinoma (P > 0.05).

Conclusions Low-grade serous carcinoma has a significantly better prognosis than high-grade serous carcinoma and also differs with regard to substage distribution and proportion of patients optimally debulked. Because of its excellent prognosis, failure to separate low-grade serous carcinomas, notwithstanding its infrequent occurrence, can change the results of survival analyses that do not make this separation.

  • Ovarian carcinoma
  • Survival
  • Serous carcinoma
  • Grade
  • Clear cell carcinoma
  • Carcinosarcoma

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Footnotes

  • The authors declare no conflicts of interest.

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