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

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.