Does synchronous endometrioid endometrial cancer have any prognostic effect on Stage I endometrioid ovarian cancer?

Abstract

Objective

To determine the effect of synchronous endometrial endometrioid cancer (SEEC) on the prognosis of patients with Stage 1 endometrioid ovarian cancer (EOC).

Study design

Clinicopathological data of cases with Stage 1 EOC from January 2000 to November 2013 were retrieved from the computerized database of Etlik Zubeyde Hanim Women's Health and Research Hospital. Of the 31 patients included in the study, 15 patients had primary synchronous endometrial and ovarian cancer (SEOC) (Group 1) and 16 patients had EOC alone (Group 2).

Results

Ovarian cancer substage and grade were compared between the two groups, and no significant differences were found. Most of the patients with SEEC had Grade 1 tumours (n = 13, 86.7%). In Group 1, nine (60.0%) patients had endometrial tumours with superficial myometrial invasion, and six (40.0%) patients had deep myometrial invasion. Median follow-up was 94 months. Ten-year disease-free survival rates were 92.9% for Group 1 and 84.6% for Group 2 (p = 0.565).

Conclusion

Patients with Stage 1 EOC have excellent long-term survival. The presence of SEEC does not influence the prognosis of patients with Stage 1 EOC, even in the presence of deep myometrial invasion.

Introduction

Ovarian cancer is the most lethal of all the gynaecological cancers [1]. Recent data have shown that ovarian cancer has two distinct histological types, and each type has a completely different pathogenesis [2]. Type 1 tumours arise from ovarian surface epithelium and mullerian inclusions, either from endosalpingiosis or invagination of the ovarian surface epithelium during repair of ovulation or implantation of cells from the endometrium. This process typically involves a relatively slow and multistep pathway, and accounts for many early-stage cancers such as endometrioid, clear cell, mucinous, and low-grade serous cancers. In contrast, the more common high-grade serous cancers (Type 2) have a phenotype that resembles the fallopian tube mucosa, and they commonly have p53 mutations. These tumours appear to develop rapidly, and are almost always at an advanced stage at presentation.

Endometrioid ovarian cancer (EOC) is a Type 1 tumour that has specific clinical and pathological features. It usually presents as early-stage disease and well-differentiated histology. Another distinct property of EOC is its frequent co-occurrence with synchronous endometrial tumours [3]. Synchronous endometrial and ovarian cancer (SEOC) is seen in approximately 10% of all women with ovarian cancer and 5% of all women with endometrial cancer [4]. Women with SEOC differ from women with primary endometrial or ovarian cancer alone, particularly in terms of prognosis. The prognostic effect of synchronous endometrial endometrioid cancer (SEEC) in the management of EOC has been a subject of debate in the literature. Therefore, this study sought to determine the prognostic effect of SEEC on Stage 1 EOC.