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Predicting Clinical Outcome in Patients Diagnosed with Synchronous Ovarian and Endometrial Cancer

Authors' Affiliations: ¹ Gynaecological Cancer Research Laboratory, University College London Elizabeth Garrett Anderson Institute for Women's Health, University College London; ² Department Computer Science, Royal Holloway, University of London; ³ Department Pathology, St. Bartholomew's and The Royal London; ⁴ London School of Hygiene and Tropical Medicine, London, United Kingdom; ⁵ M. D. Anderson Cancer Center, Houston, Texas; ⁶ Department Pathology, Seirei Mikatahara Hospital, Hamamatsu, Japan; and ⁷ Department Pathology, Royal Victoria Hospital, Belfast, United Kingdom

Requests for reprints: Simon A. Gayther, Gynaecological Cancer Research Laboratory, University College London Elizabeth Garrett Anderson Institute for Women's Health, University College London, The Paul O'Gorman Building, 72 Huntley Street, London WC1E 6BT, United Kingdom. Phone: 44-20-3108-2008; Fax: 44-20-3108-2010; E-mail s.gayther{at}ucl.ac.uk.

Purpose: Patients with synchronous ovarian and endometrial cancers may represent cases of a single primary tumor with metastasis (SPM) or dual primary tumors (DP). The diagnosis given will influence the patient's treatment and prognosis. Currently, a diagnosis of SPM or DP is made using histologic criteria, which are frequently unable to make a definitive diagnosis.

Experimental Design: In this study, we used genetic profiling to make a genetic diagnosis of SPM or DP in 90 patients with synchronous ovarian/endometrial cancers. We compared genetic diagnoses in these patients with the original histologic diagnoses and evaluated the clinical outcome in this series of patients based on their diagnoses.

Results: Combining genetic and histologic approaches, we were able make a diagnosis in 88 of 90 cases, whereas histology alone was able to make a diagnosis in only 64 cases. Patients diagnosed with SPM had a significantly worse survival than patients with DP (P = 0.002). Patients in which both tumors were of endometrioid histology survived longer than patients of other histologic subtypes (P = 0.025), and patients diagnosed with SPM had a worse survival if the mode of spread was from ovary to endometrium rather than from endometrium to ovary (P = 0.019).

Conclusions: Genetic analysis may represent a powerful tool for use in clinical practice for distinguishing between SPM and DP in patients with synchronous ovarian/endometrial cancer and predicting disease outcome. The data also suggest a hitherto uncharacterized level of heterogeneity in these cases, which, if accurately defined, could lead to improved treatment and survival.