Response and Survival in Patients with Serous Ovarian Tumors of Low Malignant Potential
Abstract & Commentary
Synopsis: Patients with progressive or recurrent serous ovarian tumors of low malignant potential have a long interval from diagnosis to progression and from progression to death, resulting in extended overall survival.
Source: Crispens MA, et al. Obstet Gynecol. 2002;99: 3-10.
Crispens and colleagues from m.d. anderson Cancer Center report 53 patients who developed progressive or recurrent disease after an original diagnosis of serous borderline tumor of the ovary. The original stage of these tumors was either II or III in all but 2 of the 40 patients for whom adequate surgical staging was performed. In 49 patients with known histology of progression or recurrence, 36 (73%) had low-grade serous carcinomas, and 13 (27%) had serous ovarian tumors of low malignant potential. Forty-five patients received nonsurgical therapy and had an evaluable response. There were 6 (13%) patients with a complete response and 6 (13%) patients with a partial response to nonsurgical treatment. The median time to first progression or recurrence was 5.6 years. Median survival from diagnosis of first recurrence was 7.7 years. Median survival from initial diagnosis was 21 years. Nineteen (36%) patients are dead of tumor. Patients who recurred with low-grade serous carcinoma were more likely to die of tumor than those with serous ovarian tumors of low malignant potential (47% vs 0%; P = .045). Optimal secondary cytoreduction at time of recurrence was associated with improved survival (P = .007). Crispens et al concluded that patients with progressive or recurrent serous ovarian tumors of low malignant potential have a long interval from diagnosis to progression and from progression to death, resulting in extended overall survival. Recurrence as low-grade serous carcinoma and failure to achieve optimal secondary cytoreduction were adverse prognostic factors, and there were relatively few responses to nonsurgical therapy.
Comment by David M. Gershenson, MD
Originally described by Taylor in 1929, serous borderline tumors of the ovary generally have an excellent prognosis. Although the recurrence rate is exceedingly low in stage I disease— < 1% —patients with stage II-IV serous borderline tumors associated with peritoneal implants have at least a 10-20% risk of recurrence. As noted, most of the patients in this study originally had stage II or III disease. The study spans a period of approximately 41 years, but, based on the long intervals noted, such a long observation period is necessary to understand the biologic behavior of these uncommon tumors. Unfortunately, the issue of postoperative treatment for patients with stage II-IV serous borderline tumors remains controversial. No studies, including our own, have demonstrated a clear benefit associated with postoperative platinum-based chemotherapy in these patients. However, the numbers from all the series are small, and the follow-up is short in many of the studies. As noted, the 2 factors that had the most effect on survival after diagnosis of recurrence were the type of histology—low-grade serous carcinoma vs. borderline tumor—and the success of secondary cytoreductive surgery in those patients who underwent such a procedure. One of the major findings of this study was that treatment for recurrence had little objective effect. Future studies in this area will focus on prevention and early detection, the search for more effective therapies, identification of a biomarker for high risk of relapse to better select patients for improved treatments, and the further elucidation of the clonality of these fascinating tumors.
Dr. Gershenson is Professor and Deputy Chairman, Department of Gynecology, M.D. Anderson, Cancer Center, Houston.
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