Advanced stage mucinous epithelial ovarian cancer: The Hellenic Cooperative Oncology Group experience
Introduction
Ovarian cancer is a major cause of morbidity and mortality among gynecological malignancies [1]. The current standard treatment of epithelial ovarian cancer (EOC) of all histological subtypes involves primary optimal debulking surgery followed by cisplatin-based chemotherapy. Despite, however, the significant advances in surgery and chemotherapy achieved over the past decades, the resulting overall 5-year survival rate remains quite low, approximately 30–40% [2], [3], [4]. This is mainly attributed to the fact that patients usually present with advanced stage disease as well as to the lack of effective therapies [5].
Mucinous epithelial ovarian cancer (mEOC) of all stages accounts for 11.2–19.9% of primary EOC [6]. In randomized clinical trials using platinum-based chemotherapy, the incidence of patients with advanced mEOC ranged from 2.4% to 5.2% [7], [8], [9], [10], [11]. Little is known about the variation of response and survival rates in women with mEOC, as only few studies have assessed the mucinous subtype of ovarian cancer [12], [13], [14]. Two or three studies have reported a poorer outcome of platinum-based chemotherapy in patients with mEOC compared to those with other histological subtypes [12], [13], [14], [15]. However, McGuire et al. [7] and ICON3 collaborators [11] concluded that they did not modify the management of mEOC when the histological subgroups were analyzed separately.
Since mEOC seems to have a different biological behavior than sEOC, which represents the most common histopathological subtype, we retrospectively investigated the outcome of platinum-based chemotherapy in stages III and IV mEOC patients.
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Patients and methods
Between July 1983 and February 2003, a total of 1446 patients with EOC underwent primary treatment at different centers of the Hellenic Cooperative Oncology Group (HeCOG). Of this group of patients, 47 were originally diagnosed with stages III and IV mEOC through the medical records and the electronic tumor registry of HeCOG. All pathologic specimens from primary surgery were examined by expertise pathologists of the referral centers with a great experience in gynecological malignancies.
Results
Patients' characteristics are demonstrated in Table 1. The median age was 62 years (range 30–79 years) for the study group and 61 years (range 25–77 years) for the control group; this difference was not statistically significant. The median duration of follow-up was 77.8 months (range 0.3–225.8 months). The rates of stage III (64% vs. 64%) and stage IV (36% vs. 36%) were similar in both groups. At the completion of primary surgery, 27% of patients had residual disease <2 cm in the study group
Discussion
Our study was undertaken to compare response and survival to platinum-based chemotherapy between patients with advanced stages III and IV mEOC and sEOC. Recently, a body of evidence has been accumulated to support the contention that mEOC possibly demonstrates a distinctly different clinical behavior from the other EOC. Few clinical studies have evaluated the response to platinum-based regimens in mEOC. The Gynecological Oncology Group (GOG) evaluating cisplatin, cyclophosphamide ± doxorubicin
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