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Original research
Patterns of spread and genetic alterations of primary endometrioid carcinomas of the ovary
  1. Varvara Mazina1,
  2. Kyle Devins2,
  3. Lauren Philp3,
  4. Alexandra S Bercow1,
  5. Kaitlyn James4,
  6. Amy Bregar1,
  7. Rachel Clark Sisodia1,
  8. Esther Oliva2 and
  9. Marcela Del Carmen2
  1. 1 Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  3. 3 Gynecologic Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
  4. 4 Deborah Kelly Center for Clinical Research, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Varvara Mazina, Gynecologic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA; vmazina{at}mgh.harvard.edu

Abstract

Objective The primary objective was to characterize the rate of lymph node involvement in a cohort of patients with primary ovarian endometrioid adenocarcinoma. Additionally, we sought to quantify the recurrence rate, genetic alterations, and impact of lymphadenectomy on survival in this group of patients.

Methods Patients diagnosed with primary endometrioid adenocarcinoma of the ovary without synchronous carcinomas of the female genital tract between 2012 and 2021 were identified. Demographic and disease-related data were collected from pathology reports and clinical records. Kaplan–Meier survival analysis using log rank test and Cox regression was performed.

Results Sixty-three patients met inclusion criteria. Median age was 60 (range 22–90) years. Histologic grade was 1 in 20 (32%), 2 in 27 (43%), and 3 in 16 (25%) tumors. International Federation of Gynecology and Obstetrics (FIGO) stage after surgery included IA/B (n=20, 32%), IC (n=23, 37%), II (n=16, 25%), and III (n=4, 6%). Forty-one (65%) patients had pelvic and 33 (52%) had both pelvic and para-aortic lymphadenectomy. All assessed lymph nodes were negative for metastatic carcinoma. No patients with clinically pelvis-confined disease had tumors upstaged by either lymphadenectomy or omentectomy. Twenty-eight patients (44%) had germline mutational status documented; two had a germline BRCA mutation, confirmed to be pathogenic by molecular studies. Complete staging did not significantly impact progression free or overall survival, after adjusting for age and histologic grade in a Cox proportional hazards model. The recurrence rate was 15% for patients with grade 1 endometrioid carcinoma, 7% for grade 2, and 31% for grade 3, respectively.

Conclusion There were no lymph node metastases in patients with comprehensively staged primary endometrioid ovarian carcinoma. Staging did not impact survival and may be omitted, regardless of grade. Germline BRCA mutations are rare in ovarian endometrioid carcinoma compared with reported rates in high-grade serous carcinomas.

  • Ovarian Cancer
  • Surgical Oncology

Data availability statement

Data are available upon reasonable request. Data are available upon request from the corresponding author.

http://dx.doi.org/10.1136/ijgc-2023-004627

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    Data availability statement

    Data are available upon reasonable request. Data are available upon request from the corresponding author.

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    Footnotes

    • Twitter @AlexBercowMD

    • Contributors Varvara Mazina, MD: Overall study content and guarantor, study design, data generation, data interpretation, manuscript editing, and approval of final manuscript. Kyle Devins, MD: Study design, data generation, data interpretation, manuscript editing, and approval of final manuscript. Lauren Philp, MD: Manuscript editing, and approval of final manuscript. Alexandra S Bercow, MD: Manuscript editing, and approval of final manuscript. Kaitlyn James, PhD: Data interpretation, manuscript editing, and approval of final manuscript. Amy Bregar, MD: Manuscript editing, and approval of final manuscript. Rachel Sisodia, MD: Manuscript editing, and approval of final manuscript. Esther Oliva, MD: Study design, data interpretation, manuscript editing, and approval of final manuscript. Marcela G del Carmen, MD, MPH: Study design, data interpretation, manuscript editing, and approval of final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.