Clinicopathological prognostic parameters in patients with tubo-ovarian carcinoma effusions.

ABSTRACT

OBJECTIVE: To analyse the predictive and prognostic role of clinicopathological parameters in patients with tubo-ovarian carcinoma and malignant effusion. METHODS: A retrospective series of 700 malignant peritoneal (n = 610) and pleural (n = 90) effusions from 558 patients was revised for histotype based on the 2014 World Health Organization criteria. The role of clinicopathological parameters in determining outcome was assessed. RESULTS: The majority of specimens (597 effusions from 473 patients) were high-grade serous carcinomas (HGSC), followed by low-grade serous carcinoma (LGSC; 48 effusions, 37 patients), clear cell carcinoma (CCC; 23 effusions, 19 patients) and carcinosarcoma (CS; 16 effusions, 16 patients). Patients with CCC and CS had the shortest, those with HGSC intermediate, and those with LGSC longest overall and progression-free survival (both P < 0.001). For patients with HGSC, older age (P = 0.002), more advanced FIGO stage (IV vs III; P < 0.001), delayed/no surgery (P < 0.001), larger residual disease volume (RD; P < 0.001), non-complete response to chemotherapy at diagnosis (P < 0.001), and primary platinum resistance (P < 0.001) were associated with shorter overall survival. In Cox multivariate analysis, FIGO stage (P = 0.002) and primary platinum resistance (P < 0.001) were independent prognosticators. Significant association was additionally found for parameters analysed for progression-free survival in HGSC (previous chemotherapy P = 0.029; age P = 0.046; FIGO stage, upfront therapy, RD P < 0.001), of which previous chemotherapy, upfront therapy, and RD were independent prognosticators (all P < 0.001). CONCLUSIONS: The vast majority of malignant effusions in patients with tubo-ovarian carcinoma are derived from serous carcinoma or related tumours, such as CS. Histology is a powerful prognostic factor in this patient group, as are established clinical parameters.