Approximately 5-30% of the ovarian cancers are metastatic malignancies. The prevalence of metastatic ovarian tumors varies with the incidence rates and spread patterns of primary malignancies. We evaluated the prevalence, pre- and postoperative characteristics of metastatic ovarian cancer in Korean women. We reviewed the records for 821 ovarian malignancies with pathological consultation from 1996-2006 and recorded patient demographical, radiological, histopathological, and survival data. The study included 112 cases of histologically confirmed metastatic ovarian cancer. Metastatic ovarian cancer accounted for 13.6% of all ovarian malignancy, primarily arising from the gastrointestinal tract. The preoperative detection rate with imaging was 75%, and none of the radiological or serological features were useful for differential diagnosis. In multivariate analysis for prognostic variables, the only significant factor was the primary tumor site (p=0.004). Furthermore, extensive resection increased survival for some patients. The differential diagnosis of metastatic ovarian cancer can be problematic, so multiple diagnostic approaches are necessary. The extent of cytoreductive surgery for this type of tumor must be decided on a case-by-case basis.

BackgroundTriple-negative breast cancer (TNBC) is a heterogeneous tumor lacking speci c therapeutic targets. Several TNBC classi cations have been identi ed using gene expression pro les, but they are di cult to use in clinical practice. In this study, we have developed a TNBC surrogate subtype classi cation that represents TNBC subtypes based on the Vanderbilt subtype classi cation. MethodsThis study included patients who underwent primary curative breast cancer surgery for TNBC between January 2009 and October 2017 at Seoul St. Mary's Hospital. Representative formalin-xed para n embedded blocks were used for gene expression analysis and tissue microarray construction for immunohistochemical (IHC) staining. The Vanderbilt subtypes were re-classi ed into 4 groups: basal-like (BL), mesenchymal-like (M), immunomodulatory (IM) and luminal androgen receptor (LAR) subtype. After IHC staining, classi cation and regression tree (CART) modeling was applied to develop a surrogate subtype classi cation. ResultsA total of 145 patients were included in this study. The study cohort was allocated to the Vanderbilt 4 subtypes as LAR (n = 22, 15.2%), IM (n = 32, 22.1%), M (n = 38, 26.2%), BL (n = 25, 17.2%) and unclassi ed (n = 28, 19.3%). After excluding nine (6.2%) patients due to poor IHC staining quality, CART modeling was performed. TNBC surrogate subtypes were de ned as follows: LAR subtype, androgen receptor Allred score 8; IM subtype, LAR-negative with a tumor-in ltrating lymphocyte (TIL) score > 70%; M subtype, LARnegative with a TIL score < 20%; BL subtype, LAR-negative with a TIL score 20-70% and diffuse, strong p16 staining. The study cohort was classi ed by the surrogate subtypes as LAR (n = 26, 17.9%), IM (n = 21, 14.5%), M (n = 44, 30.3%), BL1 (n = 27, 18.6%) and unclassi ed (n = 18, 12.4%). The performance of the surrogate subtypes to predict TNBC Vanderbilt 4 subtypes was good with an accuracy of 0.708. Each subtype exhibited distinct clinicopathologic features, and the M subtype showed a signi cantly worse survival rate than the other subtypes. ConclusionsIn this study, we have developed a TNBC surrogate subtype classi cation that correlates with the Vanderbilt subtype adopting AR, TIL and p16. The surrogate subtype classi cation is a practical and accessible diagnostic test, that can be easily applied in clinical practice. Background * Cancer staging was performed in accordance with the AJCC 7th staging system. † Ki67 median value at Seoul St. Mary's Hospital is 25% * Cancer staging was performed in accordance with the AJCC 7th staging system. † Ki67 median value at Seoul St. Mary's Hospital is 25% ‡ p-value when excluding LAR subtype * Cancer staging was performed in accordance with the AJCC 7th staging system. † Ki67 median value at Seoul St. Mary's Hospital is 25% ‡ p-value when excluding LAR subtype * Cancer staging was performed in accordance with the AJCC 7th staging system. † Ki67 median value at Seoul St. Mary's Hospital is 25% ‡ p-value when excluding LAR subtype

Background Triple-negative breast cancer (TNBC) is a heterogeneous tumor lacking specific therapeutic targets. Several TNBC classifications have been identified using gene expression profiles, but they are difficult to use in clinical practice. In this study, we have developed a TNBC surrogate subtype classification that represents TNBC subtypes based on the Vanderbilt subtype classification. Methods This study included patients who underwent primary curative breast cancer surgery for TNBC between January 2009 and October 2017 at Seoul St. Mary’s Hospital. Representative formalin-fixed paraffin embedded blocks were used for gene expression analysis and tissue microarray construction for immunohistochemical (IHC) staining. The Vanderbilt subtypes were re-classified into 4 groups: basal-like (BL), mesenchymal-like (M), immunomodulatory (IM) and luminal androgen receptor (LAR) subtype. After IHC staining, classification and regression tree (CART) modeling was applied to develop a surrogate subtype classification. Results A total of 145 patients were included in this study. The study cohort was allocated to the Vanderbilt 4 subtypes as LAR (n = 22, 15.2%), IM (n = 32, 22.1%), M (n = 38, 26.2%), BL (n = 25, 17.2%) and unclassified (n = 28, 19.3%). After excluding nine (6.2%) patients due to poor IHC staining quality, CART modeling was performed. TNBC surrogate subtypes were defined as follows: LAR subtype, androgen receptor Allred score 8; IM subtype, LAR-negative with a tumor-infiltrating lymphocyte (TIL) score > 70%; M subtype, LAR-negative with a TIL score < 20%; BL subtype, LAR-negative with a TIL score 20–70% and diffuse, strong p16 staining. The study cohort was classified by the surrogate subtypes as LAR (n = 26, 17.9%), IM (n = 21, 14.5%), M (n = 44, 30.3%), BL1 (n = 27, 18.6%) and unclassified (n = 18, 12.4%). The performance of the surrogate subtypes to predict TNBC Vanderbilt 4 subtypes was good with an accuracy of 0.708. Each subtype exhibited distinct clinicopathologic features, and the M subtype showed a significantly worse survival rate than the other subtypes. Conclusions In this study, we have developed a TNBC surrogate subtype classification that correlates with the Vanderbilt subtype adopting AR, TIL and p16. The surrogate subtype classification is a practical and accessible diagnostic test, that can be easily applied in clinical practice.

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