Advanced stage primary mucinous ovarian carcinoma. Where do we stand ?

A Commentary to this article is available

A Related Article is available

Abstract

Objective

To evaluate factors associated with survival of patients with advanced stage mucinous ovarian carcinoma (MOC) using a large multi-institutional database.

Methods

Patients diagnosed between 2004 and 2014 with advanced stage (III–IV) MOC were identified within the National Cancer Database. Those without a personal history of another primary tumor who received cancer-directed surgery with a curative intent were selected for further analysis. Overall survival (OS) was evaluated with Kaplan–Meier curves, and compared with the log-rank test. Multivariate Cox analysis was performed to identify independent predictors of survival.

Results

A total of 1509 patients with a median age of 59 years (IQR 20) met the inclusion criteria: stage III (n = 1045, 69.3%) and stage IV disease (n = 464, 30.7%). Patients who received chemotherapy (n = 1065, 70.6%) had better OS compared to those who did not (n = 385, 25.5%), (median OS 15.44 vs 5.06 months, p < 0.001). The type of reporting facility (p = 0.65) and the year of diagnosis (p = 0.27) were not associated with OS. Presence of residual disease was strongly associated with OS (p < 0.001). After controlling for confounders, the administration of chemotherapy (HR 0.63, 95% CI 0.55, 0.72) was associated with better survival.

Conclusion

Advanced stage MOC has an extremely poor prognosis. Patients who received chemotherapy had a small improvement in survival. Every effort to achieve complete gross resection should be performed. Given no improvement in survival outcomes over time, there is an eminent need for novel treatment options.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

References

  1. 1.

    Ledermann JA, Luvero D, Shafer A et al (2014) Gynecologic cancer intergroup (GCIG) consensus review for mucinous ovarian carcinoma. Int J Gynecol Cancer 24(9 Suppl 3):S14–S29

    Article  Google Scholar 

  2. 2.

    Brown J, Frumovitz M (2014) Mucinous tumors of the ovary: current thoughts on diagnosis and management. Curr Oncol Rep 16(6):389

    Article  Google Scholar 

  3. 3.

    Yemelyanova AV, Vang R, Judson K, Wu LS, Ronnett BM (2008) Distinction of primary and metastatic mucinous tumors involving the ovary: analysis of size and laterality data by primary site with reevaluation of an algorithm for tumor classification. Am J Surg Pathol 32(1):128–138

    Article  Google Scholar 

  4. 4.

    Perren TJ (2016) Mucinous epithelial ovarian carcinoma. Ann Oncol 27(Suppl 1):i53–i57

    Article  Google Scholar 

  5. 5.

    Soslow RA (2011) Mucinous ovarian carcinoma: slippery business. Cancer 117(3):451–453

    Article  Google Scholar 

  6. 6.

    Crane EK, Brown J (2018) Early stage mucinous ovarian cancer: a review. Gynecol Oncol 149(3):598–604

    Article  Google Scholar 

  7. 7.

    Schiavone MB, Herzog TJ, Lewin SN et al (2011) Natural history and outcome of mucinous carcinoma of the ovary. Am J Obstet Gynecol 205(5):480.e1–8

    Article  Google Scholar 

  8. 8.

    Simons M, Massuger L, Bruls J et al (2017) Relatively poor survival of mucinous ovarian carcinoma in advanced stage: a systematic review and meta-analysis. Int J Gynecol Cancer 27(4):651–658

    Article  Google Scholar 

  9. 9.

    Bilimoria KY, Stewart AK, Winchester DP et al (2008) The National Cancer Data Base: a powerful initiative to improve cancer care in the United States. Ann Surg Oncol 15(3):683–690

    Article  Google Scholar 

  10. 10.

    Mackay HJ, Brady MF, Oza AM et al (2010) Gynecologic Cancer InterGroup. Prognostic relevance of uncommon ovarian histology in women with stage III/IV epithelial ovarian cancer. Int J Gynecol Cancer 20(6):945–952.

  11. 11.

    Meagher NS, Schuster K, Voss A et al (2018) Does the primary site really matter? Profiling mucinous ovarian cancers of uncertain primary origin (MO-CUP) to personalise treatment and inform the design of clinical trials. Gynecol Oncol 150(3):527–533

    Article  Google Scholar 

  12. 12.

    Zaino RJ, Brady MF, Lele SM et al (2011) Advanced stage mucinous adenocarcinoma of the ovary is both rare and highly lethal: a Gynecologic Oncology Group study. Cancer 117:554–562

    Article  Google Scholar 

  13. 13.

    Simons M, Ezendam N, Bulten J, Nagtegaal I, Massuger L (2015) Survival of patients with mucinous ovarian carcinoma and ovarian metastases: a population-based cancer registry study. Int J Gynecol Cancer 25(7):1208–1215

    Article  Google Scholar 

  14. 14.

    Pectasides D, Fountzilas G, Aravantinos G et al (2005) Advanced stage mucinous epithelial ovarian cancer: the Hellenic Cooperative Oncology Group experience. Gynecol Oncol 97(2):436–441

    Article  Google Scholar 

  15. 15.

    Alexandre J, Ray-Coquard I, Selle F et al (2010) Mucinous advanced epithelial ovarian carcinoma: clinical presentation and sensitivity to platinum-paclitaxel-based chemotherapy, the GINECO experience. Ann Oncol 21(12):2377–2381

    CAS  Article  Google Scholar 

  16. 16.

    Hess V, A'Hern R, Nasiri N et al (2004) Mucinous epithelial ovarian cancer: a separate entity requiring specific treatment. J Clin Oncol 22(6):1040–1044

    CAS  Article  Google Scholar 

  17. 17.

    Morgan RJ Jr, Armstrong DK, Alvarez RD et al (2016) Ovarian cancer, version 1: 2016, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 14(9):1134–1163

    Article  Google Scholar 

  18. 18.

    Mueller JJ, Lajer H, Mosgaard BJ et al (2018) International study of primary mucinous ovarian carcinomas managed at tertiary medical centers. Int J Gynecol Cancer 28(5):915–924

    Article  Google Scholar 

  19. 19.

    Schlappe B, Zhou Q, O'Cearbhaill R et al (2018) Comparison of outcomes of primary mucinous ovarian cancer patients receiving either an adjuvant gynecologic or gastrointestinal chemotherapy regimen. Gynecol Oncol 149(Supplement 1):236

    Article  Google Scholar 

  20. 20.

    Gore ME, Hackshaw A, Brady WE et al (2015) Multicentre trial of carboplatin/paclitaxel versus oxaliplatin/capecitabine, each with/without bevacizumab, as first line chemotherapy for patients with mucinous epithelial ovarian cancer (mEOC). As presented at the 2015 ASCO Annual Meeting. https://meetinglibrary.asco.org/content/145864-156 (abstract 5528).

  21. 21.

    Warren JL, Butler EN, Stevens J et al (2015) Receipt of chemotherapy among medicare patients with cancer by type of supplemental insurance. J Clin Oncol 33(4):312–318

    Article  Google Scholar 

  22. 22.

    Reghunathan M, Kelly KJ, Valasek MA, Lowy AM, Baumgartner JM (2018) Histologic predictors of recurrence in mucinous appendiceal tumors with peritoneal dissemination after HIPEC. Ann Surg Oncol 25(3):702–708

    Article  Google Scholar 

  23. 23.

    Mercier F, Bakrin N, Bartlett DL et al (2018) Peritoneal carcinomatosis of rare ovarian origin treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a multi-institutional cohort from PSOGI and BIG-RENAPE. Ann Surg Oncol 25(6):1668–1675

    Article  Google Scholar 

  24. 24.

    Mueller JJ, Schlappe BA, Kumar R et al (2018) Massively parallel sequencing analysis of mucinous ovarian carcinomas: genomic profiling and differential diagnoses. Gynecol Oncol 150(1):127–135

    CAS  Article  Google Scholar 

  25. 25.

    Mohammed RAA, Makboul R, Elsers DAH et al (2017) Pattern of HER-2 gene amplification and protein expression in benign, borderline, and malignant ovarian serous and mucinous neoplasms. Int J Gynecol Pathol 36(1):50–57

    CAS  Article  Google Scholar 

  26. 26.

    McAlpine JN, Wiegand KC, Vang R et al (2009) HER2 overexpression and amplification is present in a subset of ovarian mucinous carcinomas and can be targeted with trastuzumab therapy. BMC Cancer 9:433

    Article  Google Scholar 

  27. 27.

    Sato N, Saga Y, Mizukami H et al (2012) Cetuximab inhibits the growth of mucinous ovarian carcinoma tumor cells lacking KRAS gene mutations. Oncol Rep 27(5):1336–1340

    CAS  PubMed  Google Scholar 

  28. 28.

    Matsuo K, Nishimura M, Bottsford-Miller JN et al (2011) Targeting SRC in mucinous ovarian carcinoma. Clin Cancer Res 17(16):5367–5378

    CAS  Article  Google Scholar 

  29. 29.

    Liu T, Hu W, Dalton HJ et al (2013) Targeting SRC and tubulin in mucinous ovarian carcinoma. Clin Cancer Res 19(23):6532–6543

    CAS  Article  Google Scholar 

  30. 30.

    Inaba K, Oda K, Aoki K et al (2016) Synergistic antitumor effects of combination PI3K/mTOR and MEK inhibition (SAR245409 and pimasertib) in mucinous ovarian carcinoma cells by fluorescence resonance energy transfer imaging. Oncotarget 7(20):29577–29591

    Article  Google Scholar 

  31. 31.

    Muyldermans K, Moerman P, Amant F et al (2013) Primary invasive mucinous ovarian carcinoma of the intestinal type: importance of the expansile versus infiltrative type in predicting recurrence and lymph node metastases. Eur J Cancer 49(7):1600–1608

    CAS  Article  Google Scholar 

Download references

Funding

The authors declare no source of funding for the research conducted.

Author information

Affiliations

Authors

Contributions

DN: Conception, Protocol/project development, Data collection and management, Data analysis and interpretation, Manuscript writing/editing. BAA: Protocol/project development, Data interpretation, Manuscript writing/editing. AFH: Data interpretation, Manuscript writing/editing. RGII: Data interpretation, Manuscript writing/editing. RAB: Data interpretation, Manuscript writing/editing. MAM: Data interpretation, Manuscript writing/editing. EK: Data interpretation, Manuscript writing/editing. NAL: Supervision, Protocol/project development, Data interpretation, Manuscript writing/editing.

Corresponding author

Correspondence to Dimitrios Nasioudis.

Ethics declarations

Conflict of interest

All authors declare no potential conflict of interest, including and financial or personal relationship which could be viewed as one.

Ethical approval

The National Cancer Database is available to the public for research purpose. All patient data are de-identified. The present study was deemed exempt by the institutional review board.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 1.43 MB)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Nasioudis, D., Albright, B.B., Ko, E.M. et al. Advanced stage primary mucinous ovarian carcinoma. Where do we stand ?. Arch Gynecol Obstet 301, 1047–1054 (2020). https://doi.org/10.1007/s00404-020-05489-3

Download citation

Keywords

  • Ovary
  • Cancer
  • Mucinous
  • Advanced stage