Pathological Characterization of Ovarian Cancer Patients Who Underwent Debulking Surgery in Combination With Diaphragmatic Surgery

Abstract

Despite exhaustive efforts to detect early-stage ovarian cancers, greater than two-thirds of patients are diagnosed at an advanced stage. Although diaphragmatic metastasis is not rare in advanced ovarian cancer patients and often precludes optimal cytoreductive surgery, little is known about the mechanisms and predictive factors of metastasis to the diaphragm. Thus, as an initial step toward investigating such factors, the present study was conducted to characterize the pathological status of ovarian cancer patients who underwent debulking surgery in combination with diaphragmatic surgery.This is a retrospective and cross-sectional study of patients who underwent debulking surgery in combination with diaphragmatic surgery at our institution between January 2005 and July 2015. Clinicopathological data were reviewed by board-certified gynecologists, pathologists, and cytopathologists. The rates of various pathological findings were investigated and compared by Fisher exact test between 2 groups: 1 group that was pathologically positive for diaphragmatic metastasis (group A) and another group that was pathologically negative for diaphragmatic metastasis (group B).Forty-six patients were included: 41 patients pathologically positive and 5 pathologically negative for diaphragmatic metastasis. The rates of metastasis to the lymph node (95.8% vs 20%, P = 0.001) and metastasis to the peritoneum except for the diaphragm (97.6% vs 60.0%, P = 0.028) were significantly increased in group A compared with group B. However, no significant differences between the 2 groups were found for rates of histological subtypes (high-grade serous or non-high-grade serous), the presence of ascites, the presence of malignant ascites, exposure of cancer cells on the ovarian surface, blood vascular invasion in the primary lesion, and lymphovascular invasion in the primary lesion.Our study demonstrated that metastasis to the lymph node and nondiaphragmatic metastasis to the peritoneum are significantly associated with metastasis to the diaphragmatic peritoneum, indicating that these factors may be pathological predictors of diaphragmatic metastasis in patients with ovarian cancer. However, as the data available are not sufficient to demonstrate the predictive power of these factors, a further comprehensive, large-scale study should be performed.

Lentiviral CRISPR/Cas9 nickase vector mediated BIRC5 editing inhibits epithelial to mesenchymal transition in ovarian cancer cells

“…This metastatic process is often accompanied by ascitic fluid accumulation, which is associated with tumor metastasis and chemoresistance, further contributing to a poor survival rate in patients [ 2 , 3 ]. The current clinical therapy is to perform debulking surgery followed by chemotherapy [ 4 ]. However, ovarian cancers are frequently recurrent, and become chemoresistant once recurrence occurs.…”

Cytological detection of metastatic chordoma cells in pleural effusions: A case report

“…It is speculated that exfoliation of cancer cells from serosal membrane alone is not sufficient to achieve anchorage-independent cancer growth in the serosal cavity. 20 It presumably requires a particular microenvironment such as coelomic fluid accumulation under various pathological conditions that efficiently supports cancer cell growth. 20,21 Further studies are indispensable for elucidating the mechanisms of malignant pleural effusion.…”

“…20 It presumably requires a particular microenvironment such as coelomic fluid accumulation under various pathological conditions that efficiently supports cancer cell growth. 20,21 Further studies are indispensable for elucidating the mechanisms of malignant pleural effusion.…”

Prognostic significance of the degree of lymphatic vessel invasion in locally advanced, surgically resectable pancreatic head cancer

“…Given that the lymphatic system is a continuum including lymphatic capillaries, collecting lymphatic vessels, intervening LNs and the thoracic duct, LN metastasis itself represents only a part of the lymphogenous spread of cancer. [19,20] The intralymphatic cancer cells observed in the primary lesion can be interpreted as not only a predictor of LN metastasis but also as a result of downstream lymphostasis by lymphogenous spread of cancer outside the primary lesion. [19,20] Therefore, it is reasonable that a high degree of lymphatic vessel invasion is associated with a poor prognosis of pancreatic cancer.…”