Association of Types of Epithelial Ovarian Cancer with Stage, Cytoreduction and Progression Free Survival Rate
Authors: S Nanjundappan 
Published: September 2022

Introduction: To assess the clinical impact of the Types of Epithelial ovarian tumour designated as Type I and II according to Immunohistochemistry and Histopathology to study the association of Types of EOC with stage, cytoreductability and progression fr ee survival rate. Methods: This study was conducted in the Department of Gynaecological oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India in year 2017 – 2018 after obtaining the approval of the Institute Ethical Review Board committee. Pa tients were asked to sign an informed written consent after explaining the need for the procedure, their possible outcomes and the significance of the results. No new intervention was required in this study. All patients with Epithelial ovarian cancer that was surgically treated (Both Primary delbulking and interval debulking surgery) in the Dept. of Gynaecological Oncology were recruited in this study. Intraoperative mapping of pattern of distribution of disease was done and the patients were divided into 3 Groups. Group A (Pelvis, nodes), Group B (omentum, peritoneum, hemidiaphragm, surface liver), Group C ( Mesentry, Porta hepatic, Lesser sac). If disease was found to be extensive (Fagotti>8/PCI>17) these patients underwent Neoadjuvant cheomotherapy with P aclitaxil and Carboplatin and then assessed for interval surgery. Residual disease was defined as R0 - no residual macroscopic disease after surgery, R1 - 0.1 - 0.5cm residual disease, R2 - 0.5 - 1cm, R3>1cm Stages are defined according to the FIGO classification WH O 2014 criteria (I – IV), stage I/II is considered early FIGO stage, and stage III/IV, where the tumor has spread beyond the pelvic region, as late FIGO stage. The categories of grade are well - differentiated (Grade 1) moderately differentiated (Grade 2), and poorly differentiated (Grade 3). Grade 1 is considered as low - grade tumors and Grades 2 - 3 as high - grade tumors. Histologic types were defined as serous adenocarcinoma, mucinous adenocarcinoma, endometrioid adenocarcinoma, clear cell neoplasms, carcinosarc oma, transitional/Brenner tumors, mixed tumors, or undifferentiated carcinomas along with their HC markers (p53, WT 1, ER, Napsin) were obtained from their histopathology reports. All pathologic diagnoses were given by our dedicated Onco - pathologists . Kaplan - Meier and logistic/Cox - regression analyses were performed to assess the impact of histological type on surgical outcome and survival. Results : All EOC patients (n=101) reporting to our Dept. of Gynaecological oncology who underwent tumour debulki ng in our institution (09/2016 – 012/2018) were classified into one of two groups: type I tumours (n=36); composed of low - grade serous, low - grade endometrioid, clear cell, mucinous and transitional carcinomas; and Type II tumours (n=65) composed of high - grad e serous, high - grade endometrioid, undifferentiated and malignant mixed - mesodermal tumours. Primary debulking surgery rate (PDS) with complete cytoreduction (R0) was more in Type I EOC, with almost 91.2% vs 67.4% in Type II EOC showing clinically and stati stical significance (p value.0.016). Also R1/R2 (R1 - 0.1 - 0.5cm residual disease, R2 - 0.5 - 1cm residual disease), was more in Type II compared to Type I showing borderline statistical significance (p value.0.566). According to the pattern of distribution, PDS and IDS was assessed in all the 3 Groups in Type I & II EOC. Type I had 94.4% PDS compared with 66.2% Type II in Group A (pelvis, nodes) showing clinically and statistical significance (p value 0.001.). In group B (omentum, peritoneum, hemidiphram, liver) Type I had 88.2% PDS vs 60% in type II showing clinically and statistical significance (p value 0.038). In group C (Porta, mesentry, lesser sac) Type I had 75% PDS vs 63.2% in type II showing clinically and statistical significance(p value 0.0676). Accordi ng to the pattern of distribution, cytoreductability (R0/R1,2) was assessed in all the 3 Groups in type I & II EOC. Type I had 8.8% R1/2 compared with 32.6% Type II in Group A (pelvis, nodes) showing clinically and statistical significance (p value 0.016). In group B (omentum, peritoneum, hemidiphram, liver) Type I had 13.3% R1/2 vs 51.9% in type II showing clinically and statistical significance(p value 0.044). In group C (Porta, mesentry, lesser sac) Type I had 33.3%R1/2 vs 58.3% in type II, not showing s tatistical significance (p value 0.429). Conclusion : Type I EOC patients appear to present at earlier stages with younger age of presentation, their d istribution in group B (Omentum, P eritoneum, Surface Liver, Hemidiaphragm) has a significant p value in r elation to their cytoreductability (R0,R1/2). However, Progression free survival analysis an o verall survival was not significant due to the short follow up interval.