Advertisement

Journal of Zhejiang University SCIENCE B

, Volume 9, Issue 6, pp 435–440 | Cite as

Advanced primary peritoneal carcinoma: clinicopathological and prognostic factor analyses

  • Chao Zhang
  • Xiao-ping Li
  • Heng Cui
  • Dan-hua Shen
  • Li-hui Wei
Article

Abstract

Objective

To investigate the factors favoring a positive prognosis for advanced primary peritoneal carcinoma (PPC).

Methods

Twenty-four cases meeting the criteria for PPC were analyzed retrospectively for the clinicopathologic profiles. Immunohistochemistry was used to determine the expressions of p53, Top2α, Ki-67 and Her-2/neu. Then all these clinicopathological factors and molecular markers were correlated with the prognosis.

Results

There were 15 cases of primary peritoneal serous papillary carcinoma (PPSPC), 6 cases of mixed epithelial carcinoma (MEC) and 3 cases of malignant mixed Mullerian tumor (MMMT). All patients underwent cytoreductive surgery with optimal debulking achieved in 3 cases. Among those receiving first-line chemotherapy, 13 patients received the TP regimen (paclitaxel-cisplatin or carboplatin) and 7 patients received the PAC regimen (cisplatin-doxorubicin-cyclophosphamide). The median overall survival of all patients was 42 months, while the breakdown for survival time for patients with PPSPC, MMT and MEC was 44, 13 and 19 months, respectively. The expressions of p53, Top2α and Ki-67 were all demonstrated in 11 cases respectively. None showed the expression of Her-2/neu. There were significant differences in the median survival between patients with PPSPC and those with MMMT (44 months vs 13 months, P<0.05), also between patients receiving TP combination and those receiving the PAC regimen (75 months vs 28 months, P<0.05). Another significant difference in the median progression-free survival (PFS) was identified between patients with positive p53 immunostaining and those with negative p53 immunostaining (15 months vs 47 months, P<0.05), whereas age, menopausal status, residual tumor size and the other molecular factors did not significantly impact survival.

Conclusion

Patients with PPC should be treated with a comprehensive management plan including appropriate cytoreductive surgery and responsive chemotherapy. Overestimating an optimal debulking surgery may not benefit survival. The pathologic subtype, chemotherapy regimen and p53 overexpression were significant prognostic factors.

Key words

Primary peritoneal carcinoma (PPC) Cytoreductive surgery Chemotherapy Immunohistochemistry Prognosis 

CLC number

R711 R737 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Altaras, M.M., Aviram, R., Cohen, I., Cordoba, M., Weiss, E., Beyth, Y., 1990. Primary peritoneal papillary serous adenocarcinoma: clinical and management aspects. Gynecol. Oncol., 40(3):230–236. [doi:10.1016/0090-8258(90)90283-Q]CrossRefGoogle Scholar
  2. Ben-Baruch, G., Sivan, E., Moran, O., Rizel, S., Menczer, J., Seidman, D.S., 1996. Primary peritoneal serous papillary carcinoma: a study of 25 cases and comparison with stage III–IV ovarian papillary serous carcinoma. Gynecol. Oncol., 60(3):393–396. [doi:10.1006/gyno.1996.0060]PubMedCrossRefGoogle Scholar
  3. Bloss, J.D., Liao, S.Y., Buller, R.E., Manetta, A., Berman, M.L., McMeekin, S., Bloss, L.P., DiSaia, P.J., 1993. Extraovarian peritoneal serous papillary carcinoma: a case-control retrospective comparison to papillary adenocarcinoma of the ovary. Gynecol. Oncol., 50(3):347–351. [doi:10.1006/gyno.1993.1223]PubMedCrossRefGoogle Scholar
  4. Bloss, J.D., Brady, M.F., Liao, S.Y., Rocereto, T., Partridge, E.E., Clarke-Pearson, D.L., Gynecologic Oncology Group Study, 2003. Extraovarian peritoneal serous papillary carcinoma: a phase II trial of cisplatin and cyclophosphamide with comparison to a cohort with paillary serous ovarian carcinoma. Gynecol. Oncol., 89(1):148–154. [doi:10.1016/S0090-8258(03)00068-4]PubMedCrossRefGoogle Scholar
  5. Chu, C.S., Menzin, A.W., Leonard, D.G., Rubin, S.C., Wheeler, J.E., 1999. Primary peritoneal carcinoma: a review of the literature. Obstet. Gynecol. Surv., 54(5):323–335. [doi:10.1097/00006254-199905000-00023]PubMedCrossRefGoogle Scholar
  6. Dubernard, G., Morice, P., Rev, A., Camatte, S., Fourchotte, V., Thoury, A., Pomel, C., Pautier, P., Lhommé, C., Duvillard, P., 2004. Prognosis of stage III or IV primary peritoneal serous papillary carcinoma. Eur. J. Surg. Oncol., 30(9):976–981. [doi:10.1016/j.ejso.2004.08.005]PubMedGoogle Scholar
  7. Eltabbakh, G.H., Werness, B.A., Piver, S., Blumenson, L.E., 1998a. Prognostic factors in extraovarian primary peritoneal carcinoma. Gynecol. Oncol., 71(2):230–239. [doi:10.1006/gyno.1998.5090]PubMedCrossRefGoogle Scholar
  8. Eltabbakh, G.H., Piver, M.S., Natarajan, N., Mettlin, C.J., 1998b. Epidemiologic differences between women with extraovarian primary peritoneal carcinoma and women with epithelial ovarian cancer. Obstet. Gynecol., 91(2):254–259. [doi:10.1016/S0029-7844(97)00650-9]PubMedCrossRefGoogle Scholar
  9. Fromm, G.L., Gershenson, D.M., Silva, E.G., 1990. Papillary serous carcinoma of the peritoneum. Obstet. Gynecol., 75(1):89–95.PubMedGoogle Scholar
  10. Garamvoelgyi, E., Guillou, L., Gebhard, S., Salmeron, M., Seematter, R.J., Hadji, M.H., 1994. Primary malignant mixed mullerian tumor (metaplastic carcinoma) of the female peritoneum: a clinical, pathologic and immunohistochemical study of three cases and a review of the literature. Cancer, 74(3):854–863. [doi:10.1002/1097-0142(19940801)74:3〈854::AID-CNCR2820740311〉3.0.CO;2-R]PubMedCrossRefGoogle Scholar
  11. Gotlieb, W.H., Goldberg, I., Weisz, B., Davidson, B., Novikov, I., Kopolovic, J., Ben-Baruch, G., 2001. Topoisomerase II immunostaining as a prognostic marker for survival in ovarian cancer. Gynecol. Oncol., 82(1):99–104. [doi:10.1006/gyno.2001.6208]PubMedCrossRefGoogle Scholar
  12. Halperin, R., Zehavi, S., Hadas, E., Habler, L., Bukovsky, I., Schneider, D., 2001. Immunohistochemical comparison of primary peritoneal and primary ovarian serous papillary carcinoma. Int. J. Gynecol. Pathol., 209(4):341–345. [doi:10.1097/00004347-200110000-00005]CrossRefGoogle Scholar
  13. Killackey, M.A., Davis, A.R., 1993. Papillary serous carcinoma of the peritoneal surface: matched-case comparison with papillary serous ovarian carcinoma. Gynecol. Oncol., 51(2):171–174. [doi:10.1006/gyno.1993.1267]PubMedCrossRefGoogle Scholar
  14. Kowalski, L.D., Kanbour, A.I., Price, F.V., Finkelstein, S.D., Christopherson, W.A., Seski, J.C., Naus, G.J., Burnham, J.A., Kanbour-Shakir, A., Edwards, R.P., 1997. A casematched molecular comparison of extraovarian versus primary ovarian adenocarcinoma. Cancer, 79(8):1587–1594. [doi:10.1002/(SICI)1097-0142(19970415)79:8〈1587::AID-CNCR22〉3.0.CO;2-T]PubMedCrossRefGoogle Scholar
  15. Look, M., Chang, D., Sugarbaker, P.H., 2004. Long-term results of cytoreductive surgery for advanced and recurrent epithelial ovarian cancers and papillary serous carcinoma of the peritoneum. Int. J. Gynecol. Cancer, 14(1):35–41. [doi:10.1111/j.1048-891x.2004.14008.x]PubMedCrossRefGoogle Scholar
  16. Menzin, A.W., Aikins, J.K., Wheeler, J.E., Rubin, S.C., 1996. Surgically documented responses to paclitaxel and cisplatin patients with primary peritoneal carcinoma. Gynecol. Oncol., 62(1):55–58. [doi:10.1006/gyno.1996.0189]PubMedCrossRefGoogle Scholar
  17. Mills, S.E., Andersen, W.A., Fechner, R.E., Austin, M.B., 1988. Serous surface papillary carcinoma: a clinicopathologic study of 10 cases and comparison with stage III–IV ovarian serous carcinoma. Am. J. Surg. Pathol., 12(11):827–834.PubMedCrossRefGoogle Scholar
  18. Muto, M.G., Welch, W.R., Mok, S.C., Bandera, C.A., Fishbauqh, P.M., Tsao, S.W., Lau, C.C., Goodman, H.M., Knapp, R.C., Berkowitz, R.S., 1995. Evidence for a multifocal origin of papillary serous carcinoma of the peritoneum. Cancer Res., 55(3):490–492.PubMedGoogle Scholar
  19. Piver, M.S., Eltabbakh, G.H., Hempling, R.E., Recio, F.O., Blumenson, L.E., 1997. Two sequential studies for primary peritoneal carcinoma: induction with weekly cisplatin followed by either cisplatin-doxorubicin-cyclophosphamide or paclitaxel-cisplatin. Gynecol. Oncol., 67(2):141–146. [doi:10.1006/gyno.1997.4843]PubMedCrossRefGoogle Scholar
  20. Shen, D.H., Khoo, U.S., Xue, W.C., Ngan, H.Y., Wang, J.L., Liu, V.W., Chan, Y.K., Cheung, A.N., 2001. Primary peritoneal malignant mixed Mullerian tumors. A clinicopathologic, immunohistochemical and genetic study. Cancer, 91(5):1052–1060. [doi:10.1002/1097-0142(20010301)91:5〈1052::AID-CNCR1097〉3.3.CO;2-1]PubMedCrossRefGoogle Scholar
  21. Swerdlow, M., 1959. Mesothelioma of the pelvic peritoneum resembling papillary cystadeno-carcinoma of the ovary. Case Report. Am. J. Obstet. Gynecol., 77(1):197–200.PubMedGoogle Scholar

Copyright information

© Zhejiang University and Springer-Verlag GmbH 2008

Authors and Affiliations

  • Chao Zhang
    • 1
  • Xiao-ping Li
    • 1
  • Heng Cui
    • 1
  • Dan-hua Shen
    • 2
  • Li-hui Wei
    • 1
  1. 1.Gynecological Oncology CenterPeking University People’s HospitalBeijingChina
  2. 2.Department of PathologyPeking University People’s HospitalBeijingChina

Personalised recommendations