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1096
Ovarian Serous Borderline Tumors with Invasive
Peritoneal Implants
David M. Gershenson, M.D.1
Elvio G. Silva, M.D.2
Lawrence Levy, B.A.3
Thomas W. Burke, M.D.1
Judith K. Wolf, M.D.1
Carmen Tornos, M.D.2
BACKGROUND. The objective of the current study was to update the authors’ experience with patients with ovarian serous borderline tumors with invasive peritoneal
implants to gain additional insight into the biologic behavior of these tumors and
a better understanding of the effect of postoperative treatment.
METHODS. Thirty-nine patients with ovarian serous borderline tumors with invasive
1
Department of Gynecologic Oncology, The
University of Texas M. D. Anderson Cancer Center, Houston, Texas.
2
Department of Pathology, The University of
Texas M. D. Anderson Cancer Center, Houston,
Texas.
3
Department of Biomathematics, The University
of Texas M. D. Anderson Cancer Center, Houston, Texas.
peritoneal implants were identified through a retrospective review. Major endpoints selected for analysis were surgicopathologic response, time to recurrence,
type of recurrence, progression free survival, and overall survival. Univariate and
multivariate regression analyses also were performed.
RESULTS. Median follow-up time was 111 months. Four of 7 evaluable patients
who had second-look surgery (57%) had a response to chemotherapy. Twelve of
39 patients (31%) either developed progressive disease or had a recurrence. The
median time from date of diagnosis to recurrence was 24 months. In 10 of these
12 patients with a recurrence, tissue was available; 9 had invasive low grade serous
carcinoma and 1 had a recurrent borderline tumor. Macroscopic residual disease
was the only factor studied that had a significant effect on survival; patients with
no macroscopic residual tumor had a significantly better survival than those with
any macroscopic residual tumor (P õ 0.01). In univariate regression analysis, macroscopic residual disease and the presence of frankly invasive implants were significant predictors of progression free survival. Platinum-based chemotherapy was
associated with a significantly shorter progression-free survival. Only macroscopic
residual tumor was a significant predictor of survival.
CONCLUSIONS. Greater than 30% of patients with ovarian serous borderline tumors
with invasive peritoneal implants will develop progressive or recurrent tumor,
most commonly serous carcinoma. The presence of macroscopic residual disease
appears to be the major predictor of recurrence and survival. However, in this
study, the authors were unable to elucidate the role of postoperative therapy or
the criteria for selection of patients for such therapy. Cancer 1998;82:1096–103.
q 1998 American Cancer Society.
KEYWORDS: ovary, borderline tumors, chemotherapy, surgery.
S
Address for reprints: David M. Gershenson,
M.D., Department of Gynecologic Oncology,
Box 67, The University of Texas M. D. Anderson
Cancer Center, 1515 Holcombe Blvd., Houston,
TX 77030.
Received August 11, 1997; revision received
December 4, 1997; accepted December 4, 1997.
erous borderline tumor of the ovary initially was described in 1929
by Taylor.1 Current information suggests that women with Stage
I serous borderline tumors have an excellent prognosis, with a disease
free survival rate approaching 100%.2 Standard therapy for Stage I
serous borderline tumors is comprised of surgery alone. However,
for women with serous borderline tumors with peritoneal implants
information regarding rate of recurrence, the nature of recurrence,
and survival is sparse, and there is no consensus regarding standard
therapy. Specifically, the benefits of any type of postoperative therapy
remain unclear.3 – 14
Several investigators have attempted to correlate outcome with
q 1998 American Cancer Society
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Serous Borderline Tumors/Gershenson et al.
1097
FIGURE 1. (A) Peritoneal implant associated with an ovarian serous borderline tumor. A small area of early stromal invasion is noted (arrow) (1100).
(B) Higher magnification of the area with early stromal invasion. Individual tumor cells are observed infiltrating the stroma (1250).
the type of peritoneal implants.5,6,9,15 – 21 In these studies, peritoneal implants have been classified as either
noninvasive or invasive based on their histopathologic
appearance. However, no clear picture emerges regarding the prognostic significance of the type of peritoneal implant. In a 1990 report of our experience with
patients seen at our institution between 1956 and 1985
who had serous borderline tumors with peritoneal implants, we identified 37 patients with noninvasive peritoneal implants and 13 with invasive peritoneal implants. Since 1985, we have seen and/or treated 62
more women with serous borderline tumors and peritoneal implants. The purpose of this study was to update our experience with this group of patients with
the objectives of gaining additional insight into the
biologic behavior of serous borderline tumors with invasive peritoneal implants and understanding better
the influence of postoperative treatment.
MATERIALS AND METHODS
The medical records of all patients with the diagnosis
of serous borderline tumors of the ovary seen at The
University of Texas M. D. Anderson Cancer Center
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from 1956 through mid-1996 were reviewed retrospectively. Those patients who met the following criteria
were included in this study: 1) primary ovarian serous
borderline tumor, and 2) evidence of invasive peritoneal implants on histologic review. Thirty-nine such
patients were identified and comprise the study population.
Although all cases were reviewed histologically at
the time of initial referral, histopathologic review of
the primary tumor and the peritoneal implants was
performed in all 39 cases for the purpose of this study
by one of the authors (E.G.S.). The median number of
slides of the primary ovarian tumor reviewed was 16
(range, 4 – 40 slides). All primary tumors exhibited the
typical histologic criteria for serous borderline tumors:
1) stratification of the epithelial lining of the papillae;
2) formation of microscopic papillary projections or
tufts, often detached, arising from the epithelial lining
of the papillae; 3) varying degrees of nuclear atypia;
and 4) absence of frank stromal invasion. In some
tumors, stromal microinvasion was noted; in such
cases, areas of microinvasion were õ3 mm in greatest
dimension. Tumors with foci ú 3 mm in greatest di-
W: Cancer
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CANCER March 15, 1998 / Volume 82 / Number 6
FIGURE 2. Invasive peritoneal implant (arrows) associated with an ovarian serous borderline tumor. A group of tumor cells is observed infiltrating
the stroma (1100).
mension were diagnosed as serous carcinomas and
were excluded from this study.
Peritoneal implants were classified as either noninvasive or invasive. Noninvasive peritoneal implants
were glandular or papillary proliferations with cell detachments. Cellular atypia, psammoma bodies, and
desmoplastic fibrosis were present in some cases. Invasive peritoneal implants were lesions similar to noninvasive implants but with epithelial cells infiltrating
the stroma. Invasive implants were subdivided into
two types: 1) early invasive implants, in which only a
few individual cells were observed in the stroma (Fig.
1); and 2) frankly invasive implants, in which numerous single cells or groups of cells were observed in the
stroma (Fig. 2). For the purpose of this analysis, cases
in which both noninvasive and invasive implants were
observed were classified according to the most infiltrative type present. An additional 73 cases in which
only noninvasive peritoneal implants were present
were excluded from this study and are the subject of
a separate article.
All patients underwent initial surgery. Surgical
staging of these tumors was determined retrospec-
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tively according to criteria of the 1985 classification
system of the International Federation of Gynecology
and Obstetrics based on careful review of surgical
notes and pathology review.22 For purposes of staging,
only documented sites of resection or biopsy were
used. As in every study of this type, surgical staging
was not comprehensive in every case. Extent of residual disease was determined based on descriptions in
written and dictated surgical reports and on clinical
evaluation of patients in the early postoperative period. Detailed information concerning postoperative
therapy and second-look surgery also was abstracted.
During the study period, recommendations regarding
postoperative treatment, including type of chemotherapy, were made at the discretion of the attending physician.
For those patients who were clinically disease free
at completion of chemotherapy, second-look surgery
was discussed and recommended at the discretion of
the attending physician. For patients who underwent
second-look surgery, surgicopathologic response was
assessed. A surgicopathologic complete response was
defined as no macroscopic or microscopic evidence
of disease as documented by second-look surgery. A
surgicopathologic partial response was defined as
¢50% decrease in all measurable lesions found at second-look surgery compared with residual disease at
initial surgery. Nonresponsiveness was defined as either stable disease or progressive disease at secondlook surgery compared with residual disease at initial
surgery.
No patient in this study was lost to follow-up. Descriptive statistics were calculated with the SAS program.23 The endpoints selected for analysis were surgicopathologic response, time to recurrence, type of recurrence, progression free survival time, and overall
survival time. Progression free survival times and overall survival times were analyzed by means of the life
table methods of Kaplan and Meier. The statistical significance of the various factors was tested by the log
rank test.
A subset of variables was selected for further investigation. The Cox proportional hazards model was used
to identify prognostic factors. Cox’s proportional hazards
model was fit with each of the variables of interest for
two outcomes: progression free survival and overall survival. The variables of interest were age at diagnosis, type
of surgery (bilateral salpingo-oophorectomy vs. unilateral salpingo-oophorectomy), stage (II vs. III and IV),
macroscopic residual tumor (no macroscopic tumor vs.
macroscopic tumor), postoperative therapy (none vs.
any), postoperative therapy (platinum-based chemotherapy vs. other), presence of any frankly invasive implants (no vs. yes), and number of sites of invasive im-
W: Cancer
Serous Borderline Tumors/Gershenson et al.
TABLE 1
Patient Characteristics
Characteristic
Type of initial surgery
BSO { TAH
USO
Ovarian cystectomy
FIGO stage
IIB
IIC
IIIA
IIIB
IIIC
IV
Macroscopic residual disease
(cm)
0
°2
ú2
Initial postoperative therapy
None
Chemotherapy
Radiotherapy
Radiotherapy / chemotherapy
No. of patients
%
34
4
1
87
10
3
2
3
14
14
5
1
5
8
36
36
13
3
30
8
1
77
21
3
7
30
1
1
18
77
3
3
BSO: bilateral salpingo-oophorectomy; TAH: total abdominal hysterectomy; USO: unilateral salpingooophorectomy; FIGO: International Federation of Gynecology and Obstetrics.
plants (1 vs. ú1). After completion of a univariate analysis, a multivariate analysis was performed.
RESULTS
The median age of the 39 patients at diagnosis was 37
years (range, 17 – 60 years). Table 1 summarizes other
patient characteristics at diagnosis. Twenty-eight patients underwent primary surgery at other hospitals
prior to referral to M. D. Anderson Cancer Center, 10
patients underwent primary surgery at M. D. Anderson, and 1 patient underwent primary surgery at another hospital and underwent reexploration on referral.
The sites of peritoneal implants, including the frequency with which each site was sampled and the
frequency with which each site was involved with tumor, are noted in Table 2. As noted, the most common
sites of tumor involvement were the omentum, pelvic
peritoneum, sigmoid colon, and small intestine. Only
23% of patients had sampling of pelvic lymph nodes,
and only 15% had sampling of paraaortic lymph
nodes.
Thirty of the 39 patients (77%) had noninvasive
peritoneal implants coexisting with invasive implants.
Thirty-five patients (90%) had early invasive implants,
and 9 patients (23%) had frankly invasive implants (5
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1099
patients had both early invasive and frankly invasive
implants).
Of the 31 patients who received postoperative chemotherapy, 22 received platinum-based chemotherapy, and 9 received single agent melphalan chemotherapy (1 in conjunction with radiotherapy). Platinum-based chemotherapy included cisplatin plus
cyclophosphamide in 13 patients; carboplatin plus cyclophosphamide in 3 patients; a combination of cisplatin and doxorubicin plus cyclophosphamide in 2
patients; single agent cisplatin in 1 patient; single
agent carboplatin in 1 patient; cisplatin plus thiotepa
in 1 patient; and cisplatin plus paclitaxel in 1 patient.
Eighteen of the 39 patients (46%) underwent second-look surgery after completion of initial postoperative chemotherapy. For 11 of these 18 patients, residual disease at the completion of initial surgery was
microscopic (no macroscopic residual disease), and
second-look findings were either macroscopically and
histologically negative (nine patients) or showed
involvement of the residual ovary only (two patients).
Of the remaining 7 patients, 1 (14%) had a complete
surgicopathologic response, 3 (43%) had a partial surgicopathologic response, and 3 (43%) had no response
to chemotherapy. The findings of these seven patients
are noted in Table 3.
Median follow-up time was 111 months. Twelve
of 39 patients (31%) either developed progressive disease on therapy (1 patient) or recurred after completion of primary treatment (11 patients). Diagnosis of
progression or recurrence was confirmed by imaging
studies (chest X-ray, computed tomography, etc.) in
eight patients, by a combination of imaging studies
and abnormal serum CA 125 in three patients, and by
abnormal CA 125 alone in one patient. The median
time from date of diagnosis to disease progression or
recurrence was 24 months (range, 3 – 219 months).
The site(s) of tumor progression or recurrence in
these 12 patients included the pelvis in 8 patients, the
upper abdomen in 5 patients, the chest in 3 patients,
the retroperitoneal lymph nodes in 1 patient, and the
peripheral lymph nodes in 1 patient. In 10 of the 12
patients, tissue was obtained by either biopsy or surgical exploration at diagnosis of progression or recurrence. In nine cases, invasive low grade serous carcinoma was observed (Fig. 3); in one case, recurrent
borderline tumor was noted. Once disease progression
or recurrence was diagnosed, the median survival time
was 52.5 months.
The time to progression of disease was significantly longer for patients with no macroscopic residual disease at initial surgery than for those with any
macroscopic residual disease (P õ 0.01). Patients with
any frankly invasive peritoneal implants had a signifi-
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TABLE 2
Sites of Peritoneal Implants in Patients with Serous Borderline Tumors of the Ovary (n Å 39)
Site
No. of patients
sampled
Frequency of
sampling
(%)
No. of patients
involved with
tumor
Frequency of
tumor sites
involved (%)
Omentum
Pelvic peritoneum
Uterus
Sigmoid colon
Fallopian tube
Small intestine
Appendix
Colon
Abdominal peritoneum
Pelvic lymph nodes
Paraaortic lymph nodes
Peripheral lymph nodes
35
22
35
14
31
9
6
6
14
9
6
1
90
56
90
36
79
23
15
15
36
23
15
3
30
16
10
10
7
5
2
1
1
1
0
1
86
73
29
71
23
56
33
17
7
11
0
100
TABLE 3
Surgicopathologic Findings in Patients (n Å 7) Assessable for Response
Patient
Age
(yrs)
FIGO stage
Macroscopic residual
disease (cm)
Postoperative treatment
Response
1
2
3
4a
5
6a
7
24
54
28
30
34
44
38
IIIC
IIIB
IIIB
IIIA
IIC
IIIB
IIIC
ú2
õ2
õ2
0
õ2
0
õ2
Carboplatin / cyclophosphamide
Cisplatin
Cisplatin / doxorubicin / cyclophosphamide
Cisplatin / doxorubicin / cyclophosphamide
Melphalan
Cisplatin / cyclophosphamide
Melphalan
PR
PR
NR
NR
PR
NR
CR
FIGO: International Federation of Gynecology and Obstetrics; PR: partial response; NR: no response; CR: complete response.
a
Although Patients 4 and 6 had no gross residual disease at completion of primary surgery, both had macroscopic tumor at second-look surgery.
cantly shorter time to progression of disease than
those with only early invasive implants (P Å 0.03).
Those patients who received postoperative platinumbased chemotherapy had a significantly worse progression free survival than all other patients (those
who received no postoperative therapy and those who
received other types of postoperative therapy; P Å
0.01). Age at diagnosis, stage, type of surgery, postoperative treatment, coexistence of noninvasive implants, and the number of sites of invasive implants
had no effect on progression free survival. Macroscopic residual disease (no macroscopic residual vs.
macroscopic residual) was the only factor that had a
significant influence on survival (P õ 0.01).
In the univariate Cox proportional hazards model
analysis (Table 4), residual tumor at initial surgery, the
presence of frankly invasive implants, and postoperative platinum-based chemotherapy were significant
predictors of progression free survival. Platinumbased chemotherapy had a negative effect. Only mac-
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roscopic residual tumor was a significant predictor of
survival.
In the multivariate analysis involving a forward
stepwise regression analysis, no other factors provided
additional prognostic information with regard to time
to progression once macroscopic residual disease and
platinum-based chemotherapy were included. Once
macroscopic residual disease was included, no other
variable provided additional prognostic information
with regard to survival.
At the time of analysis, 28 of the 39 patients (72%)
were alive and well, 5 patients (13%) were alive with
disease, and 6 patients (15%) had died of progressive
ovarian tumor.
DISCUSSION
Nearly 70 years after the initial description of borderline tumors of the ovary,1 the biologic behavior of advanced stage serous borderline tumor remains obscure, and there is no general agreement regarding
W: Cancer
Serous Borderline Tumors/Gershenson et al.
FIGURE 3. Recurrent serous carcinoma from a patient who was diagnosed originally with an ovarian serous borderline tumor with invasive
peritoneal implants (1100).
standard treatment. Our initial effort at elucidating
these issues was reported in 1990 and included 82
patients who had primary serous borderline tumor of
the ovary in association with ‘‘peritoneal implants.’’ 6
In fact, most of these patients originally were treated
as if they had invasive epithelial ovarian carcinoma
because for most of the study period the entity of serous borderline tumor was not recognized officially by
the pathology staff at our institution. Only 13 of the
patients in that report had invasive peritoneal implants. To our knowledge, our current data base of 39
patients with serous borderline tumors and invasive
peritoneal implants represents the largest collection
of such patients reported to date.
The literature on this topic is confounded because
relatively few authors classify the type of peritoneal
implant and because many series combine serous borderline tumors with mucinous borderline tumors so
that it often is difficult or impossible to distinguish the
characteristics and biologic behavior of the two. Table
5 presents the number of recurrences and deaths
among 208 patients with Stage II – IV serous borderline
tumors from 8 relatively large series in which the types
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1101
of peritoneal implants were not reported.3,4,7,8,10,11,14,24
As noted, the total recurrence rate is 21%, and the total
percentage of patients dead of disease is 10%. These
proportions are only slightly lower than those observed in the current series. In three additional large
series, serous borderline tumors could not be distinguished reliably from mucinous borderline tumors in
the analyses reported.12,25,26
Relatively few investigators have reported the outcome of patients with Stage II – IV serous borderline
tumors in which the types of peritoneal implants were
classified. Table 6 presents a summary of the studies
in which invasive peritoneal implants were noted.5,9,15 –
18,20,21
Of the 60 patients in these studies, 45% had a
recurrence, and 37% died of tumor, proportions that
are somewhat higher than those reported in our series.
Of course, another factor that may be responsible
for the lack of uniformity throughout the literature
may be the different histologic definitions of peritoneal implants. Based on our experience, we subdivided
our study population into those with early invasive
implants and those with frankly invasive implants. Although there was a significant difference between
these two groups with regard to time to progression
or recurrence, there was no difference in survival
times. Our inability to detect a difference in the effect
of the type of invasive implant on survival may be
related to the relatively small number of patients studied. We plan to continue to study possible differences
in outcome associated with early versus frankly invasive implants, but we are not recommending any
change in the current classification system of peritoneal implants at the current time.
We observed that ú75% of our study group had
no macroscopic residual tumor at initial surgery; only
1 patient had bulky residual disease. The only factor
studied in this group of patients that influenced time
to recurrence or progression and survival consistently
was macroscopic residual disease at initial surgery.
Those patients who had no macroscopic residual tumor had a significantly better progression free survival
and overall survival than patients with any macroscopic residual tumor. Leake et al.8 made a similar
observation in their study that included 65 patients
with Stage II and III serous borderline tumors. Patients
with no macroscopic residual disease had a significantly lower recurrence rate (19% vs. 66%) and a significantly better survival rate (92% vs. 69%). However,
they did not classify the type of peritoneal implant in
their series. Bostwick et al. also noted that the inability
to excise all macroscopically visible tumor at initial
surgery or at recurrence was associated with a greater
risk of persistent or recurrent tumor than was present
in those patients who underwent excision of all grossly
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CANCER March 15, 1998 / Volume 82 / Number 6
TABLE 4
Cox Proportional Hazards Analyses of Patients (n Å 39) with Ovarian Serous Borderline Tumors with Invasive Peritoneal Implants
Survival outcome
Age at diagnosis (yrs)
Type of surgery (BSO { TAH vs. USO)
Stage (II vs. III / IV)
Residual macroscopic tumor (0 vs. any)
Postoperative therapy (none vs. any)
Postoperative therapy (platinum-based
chemotherapy vs. other)
Frankly invasive implants (no vs. yes)
No. of sites of invasive implants (1 vs. ú1)
Progression free survival outcome
Relative hazard
Significance
Relative hazard
Significance
1.06 (0.99–1.13)
1.61 (0.19–13.80)
—
10.65 (1.92–59.00)
0.81 (0.09–7.07)
P Å 0.10
P Å 0.68
P Å 0.17
P Å 0.01
P Å 0.85
1.04 (0.99–1.09)
0.73 (0.09–5.75)
—
4.94 (1.51–16.17)
1.70 (0.21–13.43)
P Å 0.18
P Å 0.76
P Å 0.06
P Å 0.01
P Å 0.59
4.88 (0.57–42.08)
1.68 (0.31–9.16)
0.48 (0.06–4.11)
P Å 0.10
P Å 0.56
P Å 0.47
9.19 (1.16–73.07)
3.27 (1.03–10.33)
0.86 (0.23–3.26)
P Å 0.01
P Å 0.05
P Å 0.83
BSO: bilateral salpingo-oophorectomy; TAH: total abdominal hysterectomy; USO: unilateral salpingo-oophorectomy.
TABLE 5
Disease Recurrence and Death from Tumor in Patients with Stage II–
IV Serous Borderline Tumors (Type of Peritoneal Implants
Undefined)
Study
No. with recurrence
No. dead of tumor
Barnhill et al.3
Bostwick et al.4
Rice et al.7
Leake et al.8
Kennedy and Hart10
Kaern et al.11
Chambers et al.14
Massad et al.24
Total
4/40
3/22
1/13
26/65
1/26
7/13
2/18
0/11
44/208 (21%)
0/40
2/22
0/13
12/65
1/26
6/13
0/18
0/11
21/208 (10%)
TABLE 6
Disease Recurrence and Death from Tumor in Patients with Stage II–
IV Serous Borderline Tumors with Invasive Peritoneal Implants
Study
No. with recurrence
No. dead of tumor
Kliman et al.5
Manchul et al.9
Russell15
Michael and Roth16
McCaughey et al.17
Bell et al.18
De Nictolis et al.20
Seidman and Kurman21
Total
0/2
1/5
3/6
1/8a
5/11b
5/6
4/9
8/13c
27/60 (45%)
0/2
0/5
3/6
1/8a
4/11b
4/6
4/9
6/13c
22/60 (37%)
a
Four patients had been followed for °2 years.
Six patients who did not have a recurrence had been followed for °1 year.
c
Eleven patients’ primary tumors were classified as ‘‘micropapillary serous carcinoma.’’
b
macroscopically tumor.4 Bell et al. observed that the
presence of macroscopic residual disease was associated with an increased risk of progressive tumor in
patients with invasive implants.18
One of the major unresolved issues regarding the
clinical management of advanced stage serous borderline tumors is the effect of postoperative therapy. In our
study, there was no difference in time to recurrence or
in survival time when patients who received any type of
postoperative therapy were compared with those who
received no postoperative therapy. Surprisingly, patients
who received postoperative platinum-based chemotherapy had a significantly worse progression free survival
than all other patients (those who received no postoperative therapy plus those who received other types of
therapy). In the survival analysis, no such negative effect
was observed for those who received platinum-based
chemotherapy. However, we believe that it is quite likely
that the observed effect on time to progression or recurrence of platinum-based chemotherapy was related to
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selection bias. Several other investigators have been unable to demonstrate any benefit from postoperative therapy.2,6,8,12,14,25,27,28 Nevertheless, it still is possible that
there is a beneficial influence of postoperative treatment
that remains undetected because of the relatively small
numbers of patients and variable follow-up times in reported series.
Nearly 33% of our patients with invasive peritoneal
implants developed progressive disease (1 patient) or
recurrent disease (11 patients). The time from diagnosis
to detection of recurrent tumor was quite variable, ranging from 3–219 months. At last follow-up, only approximately 50% of patients had died of tumor. Although we
may not yet understand fully the effect of contemporary
postoperative therapies on recurrence and survival, such
information on risk of recurrence and time to recurrence
is of extreme importance to patients and their families.
One of the most interesting findings of our study is
W: Cancer
Serous Borderline Tumors/Gershenson et al.
the histology of the recurrences. In nine of ten patients
for whom we had tissue from the recurrence, histologic
examination revealed invasive low grade serous carcinoma. We were able to identify only 17 patients from 7
previous reports in which the histology of the recurrence
was described.5,6,10,16,18,21,27 Whether such disease represents a true recurrence or a new primary tumor remains unclear. Future clonality studies hopefully
will elucidate the biology of this phenomenon. However, for the patient, such a distinction may be
merely academic.
This study, which to our knowledge is the largest
to date of patients with invasive peritoneal implants,
provides important information regarding the risk
of recurrence, the time to recurrence, and the type
of recurrence. However, it does not elucidate the
role, if any, of postoperative therapy or the selection
of patients for such therapy. Until such time as more
definitive information is available, we are continuing
to recommend six cycles of platinum-based chemotherapy for patients with serous borderline tumors
and invasive peritoneal implants. Hopefully, information from a prospective trial of the Gynecologic
Oncology Group and from larger data bases of combined series will allow us to resolve this critical issue.
In addition, studies of molecular and genetic biomarkers may identify cellular defects that predict
poor outcome and that may serve as targets for postoperative treatment.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
REFERENCES
1.
2.
3.
4.
5.
6.
7.
8.
Taylor HC. Malignant and semimalignant tumors of the
ovary. Surg Gynecol Obstet 1929;48:204–30.
Barnhill DR, Kurman RJ, Brady MF, Omura GA, Yordan E,
Given FT, et al. Preliminary analysis of the behavior of stage
I ovarian serous tumors of low malignant potential: a Gynecologic Oncology Group study. J Clin Oncol 1995;13:2752–6.
Barnhill D, Heller P, Brzozowski P, Advani H, Gallup D, Park
R. Epithelial ovarian carcinoma of low malignant potential.
Obstet Gynecol 1985;65:53–9.
Bostwick DG, Tazelaar HD, Ballon SC, Hendrickson MR,
Kempson RL. Ovarian epithelial tumors of borderline malignancy: a clinical and pathologic study of 109 cases. Cancer
1986;58:2052–65.
Kliman L, Rome RM, Fortune DW. Low malignant potential
tumors of the ovary: a study of 76 cases. Obstet Gynecol
1986;68:338–44.
Gershenson DM, Silva EG. Serous ovarian tumors of low
malignant potential with peritoneal implants. Cancer
1990;65:578–85.
Rice LW, Berkowitz RS, Mark SD, Yavner DL, Lage JM. Epithelial ovarian tumors of borderline malignancy. Gynecol
Oncol 1990;39:195–8.
Leake JF, Currie JL, Rosenshein NB, Woodruff JD. Long-term
follow-up of serous ovarian tumors of low malignant potential. Gynecol Oncol 1992;47:150–8.
/ 7bba$$1304
02-23-98 10:47:39
cana
20.
21.
22.
23.
24.
25.
26.
27.
28.
1103
Manchul LA, Simm J, Levin W, Fyles AW, Dembo AJ, Pringle
JF, et al. Borderline epithelial ovarian tumors: a review of
81 cases with an assessment of the impact of treatment. Int
J Radiat Oncol Biol Phys 1992;22:867–74.
Kennedy AW, Hart WR. Ovarian papillary serous tumors of
low malignant potential (serous borderline tumors): a longterm follow-up study, including patients with microinvasion, lymph node metastasis, and transformation to invasive
serous carcinoma. Cancer 1996;78:278–86.
Kaern J, Tropé CG, Abeler VM. A retrospective study of 370
borderline tumors of the ovary treated at the Norwegian
Radium Hospital from 1970 to 1982. A review of clinicopathologic features and treatment modalities. Cancer 1993;
71:1810–20.
Fort MG, Pierce VK, Saigo PE, Hoskins WJ, Lewis JL. Evidence
for the efficacy of adjuvant therapy in epithelial ovarian tumors of low malignant potential. Gynecol Oncol 1989;32:
269–72.
Barakat RR, Benjamin I, Lewis JL, Saigo PE, Curtin JP, Hoskins WJ. Platinum-based chemotherapy for advanced stage
serous ovarian carcinoma of low malignant potential. Gynecol Oncol 1995;59:390–3.
Chambers JT, Merino MJ, Kohorn EI, Schwartz PE. Borderline ovarian tumors. Am J Obstet Gynecol 1988;159:1088–94.
Russell P. Borderline epithelial tumours of the ovary: a conceptual dilemma. Clin Obstet Gynecol 1984;11:259–77.
Michael H, Roth LM. Invasive and noninvasive implants in
ovarian serous tumors of low malignant potential. Cancer
1986;57:1240–7.
McCaughey WTE, Kirk ME, Lester W, Dardick I. Peritoneal
epithelial lesions associated with proliferative serous tumours of ovary. Histopathology 1984;8:195–208.
Bell DA, Weinstock MA, Scully RE. Peritoneal implants of
ovarian serous borderline tumors: histologic features and
prognosis. Cancer 1988;62:2212–22.
Russell P, Merkur H. Proliferating ovarian ‘‘epithelial’’ tumours: a clinico-pathological analysis of 144 cases. Aust N
Z J Obstet Gynecol 1979;19:45–55.
De Nictolis M, Montironi R, Tommasoni S, Carinelli S, Ojeda
B, Matias-Guiu X, et al. Serous borderline tumors of the
ovary. Cancer 1992;70:152–60.
Seidman JD, Kurman RJ. Subclassification of serous borderline tumors of the ovary into benign and malignant types:
a clinicopathologic study of 65 advanced stage cases. Am J
Surg Pathol 1996;20(11):1331–45.
Staging Announcement: FIGO Cancer Committee. Gynecol
Oncol 1986;25:383–5.
SAS/STAT user guide, 1990. Cary, NC: SAS Institute, 1990.
Massad LS, Hunter VJ, Szpak CA, Clarke-Pearson DL, Creasman WT. Epithelial ovarian tumors of low malignant potential. Obstet Gynecol 1991;78:1027–32.
Nation JG, Krepart GV. Ovarian carcinoma of low malignant
potential: staging and treatment. Am J Obstet Gynecol 1986;
154:290–3.
Hopkins MP, Kumar NB, Morley GW. An assessment of
pathologic features and treatment modalities in ovarian tumors of low malignant potential. Obstet Gynecol 1987;70:
923–9.
Nikrui N. Survey of clinical behavior of patients with borderline epithelial tumors of the ovary. Gynecol Oncol 1981;12:
107–19.
O’Quinn AG, Hannigan EV. Epithelial ovarian neoplasms of
low malignant potential. Gynecol Oncol 1985;21:177–85.
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