与其他组织学类型的卵巢癌相比，卵巢癌肉瘤具有高度侵袭性。

Ovarian carcinosarcoma is highly aggressive compared to other ovarian cancer histotypes.

作者信息

McFarlane Iona, Porter Joanna M, Brownsell Elizabeth, Ghaoui Nidal, Connolly Kathryn C, Herrington C Simon, Hollis Robert L

机构信息

The Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, United Kingdom.

The Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.

出版信息

Front Oncol. 2024 May 24;14:1399979. doi: 10.3389/fonc.2024.1399979. eCollection 2024.

DOI:10.3389/fonc.2024.1399979

PMID:38854725

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11157229/

Abstract

BACKGROUND

Ovarian carcinosarcoma (OCS) is an unusual ovarian cancer type characterized by distinct carcinomatous and sarcomatous components. OCS has been excluded from many of the pan-histotype studies of ovarian carcinoma, limiting our understanding of its behavior.

METHODS

We performed a multi-cohort cross-sectional study of characteristics and outcomes in ovarian cancer patients from Scotland (n=2082) and the Surveillance, Epidemiology and End Results Program (SEER, n=44946) diagnosed with OCS or one of the other major histotypes: high grade serous (HGSOC), endometrioid (EnOC), clear cell (CCOC), mucinous (MOC) or low grade serous ovarian carcinoma (LGSOC). Differences in overall survival were quantified using Cox regression models to calculate hazard ratios (HR).

RESULTS

Across both cohorts, OCS patients were significantly older at diagnosis compared to all other histotypes (median age at diagnosis 69 and 67 in Scottish and SEER cohorts) and demonstrated the shortest survival time upon univariable analysis. Within the Scottish cohort, 59.3% and 16.9% of OCS patients presented with FIGO stage III and IV disease, respectively; this was significantly higher than in EnOC, CCOC or MOC (P<0.0001 for all), but lower than in HGSOC (P=0.004). Multivariable analysis accounting for other prognostic factors identified OCS as independently associated with significantly shorter survival time compared to HGSOC, EnOC, LGSOC and MOC in both the Scottish (multivariable HR vs OCS: HGSOC 0.45, EnOC 0.39, LGSOC 0.26, MOC 0.43) and SEER cohorts (multivariable HR vs OCS: HGSOC 0.59, EnOC 0.34, LGSOC 0.30, MOC 0.81). Within the SEER cohort, OCS also demonstrated shorter survival compared to CCOC (multivariable HR 0.63, 95% CI 0.58-0.68), but this was not replicated within the Scottish cohort (multivariable HR for CCOC: 1.05, 95% CI 0.74-1.51). Within early-stage disease specifically (FIGO I-II or SEER localized stage), OCS was associated with the poorest survival of all histotypes across both cohorts. In the context of late-stage disease (FIGO III-IV or SEER distant stage), OCS, MOC and CCOC represented the histotypes with poorest survival.

CONCLUSION

OCS is a unique ovarian cancer type that affects older women and is associated with exceptionally poor outcome, even when diagnosed at earlier stage. New therapeutic options are urgently required to improve outcomes.

摘要

背景

卵巢癌肉瘤（OCS）是一种罕见的卵巢癌类型，其特征为具有明显的癌性和肉瘤性成分。OCS被排除在许多卵巢癌的全组织学类型研究之外，这限制了我们对其行为的了解。

方法

我们对来自苏格兰（n = 2082）以及监测、流行病学和最终结果计划（SEER，n = 44946）中被诊断为OCS或其他主要组织学类型之一的卵巢癌患者进行了多队列横断面研究，这些组织学类型包括高级别浆液性癌（HGSOC）、子宫内膜样癌（EnOC）、透明细胞癌（CCOC）、黏液性癌（MOC）或低级别浆液性卵巢癌（LGSOC）。使用Cox回归模型计算风险比（HR）来量化总生存期的差异。

结果

在两个队列中，与所有其他组织学类型相比，OCS患者诊断时年龄显著更大（苏格兰队列和SEER队列中诊断时的中位年龄分别为69岁和67岁），单因素分析显示其生存期最短。在苏格兰队列中，分别有59.3%和16.9%的OCS患者表现为国际妇产科联盟（FIGO）III期和IV期疾病；这显著高于EnOC、CCOC或MOC（所有比较P < 0.0001），但低于HGSOC（P = 0.004）。在考虑其他预后因素的多因素分析中，在苏格兰队列（多因素HR对比OCS：HGSOC为0.45，EnOC为0.39，LGSOC为0.26，MOC为0.43）和SEER队列（多因素HR对比OCS：HGSOC为0.59，EnOC为0.34，LGSOC为0.30，MOC为0.81）中，均确定OCS与生存期显著缩短独立相关，与HGSOC、EnOC、LGSOC和MOC相比。在SEER队列中，与CCOC相比，OCS生存期也较短（多因素HR为0.63，95%置信区间为0.58 - 0.68），但在苏格兰队列中未观察到这一结果（CCOC的多因素HR：1.05，95%置信区间为0.74 - 1.51）。特别是在早期疾病（FIGO I - II期或SEER局限期）中，在两个队列的所有组织学类型中，OCS的生存期最差。在晚期疾病（FIGO III - IV期或SEER远处转移期）中，OCS、MOC和CCOC是生存期最差的组织学类型。