Predicting clinical outcome in patients diagnosed with synchronous ovarian and endometrial cancer.
OBJECTIVE
Patients with synchronous ovarian and endometrial cancers may represent cases of a single primary tumor with metastasis (SPM) or dual primary tumors (DP). The diagnosis given will influence the patient's treatment and prognosis. Currently, a diagnosis of SPM or DP is made using histologic criteria, which are frequently unable to make a definitive diagnosis.


METHODS
In this study, we used genetic profiling to make a genetic diagnosis of SPM or DP in 90 patients with synchronous ovarian/endometrial cancers. We compared genetic diagnoses in these patients with the original histologic diagnoses and evaluated the clinical outcome in this series of patients based on their diagnoses.


RESULTS
Combining genetic and histologic approaches, we were able make a diagnosis in 88 of 90 cases, whereas histology alone was able to make a diagnosis in only 64 cases. Patients diagnosed with SPM had a significantly worse survival than patients with DP (P = 0.002). Patients in which both tumors were of endometrioid histology survived longer than patients of other histologic subtypes (P = 0.025), and patients diagnosed with SPM had a worse survival if the mode of spread was from ovary to endometrium rather than from endometrium to ovary (P = 0.019).


CONCLUSIONS
Genetic analysis may represent a powerful tool for use in clinical practice for distinguishing between SPM and DP in patients with synchronous ovarian/endometrial cancer and predicting disease outcome. The data also suggest a hitherto uncharacterized level of heterogeneity in these cases, which, if accurately defined, could lead to improved treatment and survival.
Ramus
Susan J
SJ
Gynaecological Cancer Research Laboratory, University College London Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.
Elmasry
Karim
K
Luo
Zhiyuan
Z
Gammerman
Alex
A
Lu
Karen
K
Ayhan
Ayse
A
Singh
Naveena
N
McCluggage
W Glenn
WG
Jacobs
Ian J
IJ
Whittaker
John C
JC
Gayther
Simon A
SA
D016172:DNA Fingerprinting; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality / Q000473:pathology; D005260:Female; D018740:Genetic Heterogeneity; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis* / Q000401:mortality; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000401:mortality; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality / Q000473:pathology; D016019:Survival Analysis