Retrospective Study of the Epidemiology, Pathology, and Therapeutic Management in Patients With Mucinous Ovarian Tumors

Abstract

Aim: We sought to determine the epidemiology of mucinous ovarian tumors, the correlation between serum biomarkers and tumor status, and the outcomes of the management in different subtypes of mucinous ovarian tumors in a Chinese surgical cohort. Methods: A total of 513 patients were enrolled from January 2009 to May 2017. The number of patients who had benign mucinous ovarian tumor, borderline mucinous ovarian tumor, or malignant mucinous ovarian tumor was pathologically quantified. All patients underwent surgery with or without postoperative adjuvant therapy. Prognosis was analyzed based on clinicopathological characteristics and the type of treatment received. Hyperthermic intraperitoneal chemotherapy efficacy and adverse effects in patients were also explored. Results: In all, 383 (75%) patients were diagnosed as having benign mucinous ovarian tumor, 76 (14%) patients with borderline mucinous ovarian tumor, and 54 (5%) patients with malignant mucinous ovarian tumor. Levels of serum biomarkers increased as the tumors became more malignant. Patients with stage IA and IC (unilateral) malignant mucinous ovarian tumor who underwent fertility conserving surgery did not experience poorer prognoses when compared to those who received non-fertility conserving surgery. Hyperthermic intraperitoneal chemotherapy followed by chemotherapy significantly influenced survival rates in patients with a ruptured malignant mucinous ovarian tumor. Conclusions: Levels of serum tumor markers, carbohydrate antigen 125, carbohydrate antigen 199, carbohydrate antigen 242, and carcinoembryonic antigen may be useful in monitoring for malignant transformation. Fertility conserving surgery might be a preferable surgical procedure for patients with malignant mucinous ovarian tumor at early stage (IA and IC [unilateral]). Hyperthermic intraperitoneal chemotherapy appears to be a well-tolerated and promising postoperative adjuvant.

Retrospective study of characteristics and hyperthermia intraperitoneal perfusion in mucinous borderline ovarian tumor and mucinous ovarian carcinoma

“…The findings of the current study revealed that the rates of under-diagnosis and over-diagnosis of MBOT by FS biopsy were 35.2% and 2.8%; the accuracy rate of FS examination diagnosis was 61.9%. In the present study, we included a relatively large number of patients with MBOT, and our results are similar to this of previous studies (7,18,27). This low accuracy may be due to the following reasons: first, because the tumor diameter for MBOT is larger than that of other histological types, it is difficult to accurately estimate the entire tumor pathology by FS for each centimeter of the neoplasm in a limited time; second, technical parameters such as sampling doctor and freezing process could influence the FS accuracy, third, MBOT are composed of so many complex components that benign, borderline, or invasive lesions can be presented in the same specimen; fourth, if extensive sampling is not possible, the pathologist may choose safety for diagnosis in the cases of doubt; finally, specialized gynecological pathologists are also important.…”

“…MOC usually presents as a huge pelvic mass which can be symptomatic or asymptomatic at diagnosis (2), There are concerns regarding the risk of intraoperative cyst rupture, whereby mucus enters the abdominal and pelvic cavity, which can induce peritoneal hyperplasia and metaplasia into mucusproducing epithelium, forming peritoneal myxoma, which accounts for 2-5% of ovarian mucinous tumors; the 5-year survival rate is about 45-54%, and the 10-year survival rate is about 18% (6). Previous study has shown that women with MOC have a worse prognosis in contrast to women with other subtypes of epithelial ovarian cancers after being matched for stage and other factors (7). At present, complete surgical resection is still the gold-standard therapy for all MOC (8), In addition to surgery, advanced-stage ovarian carcinomas are often treated with adjuvant carboplatin-based chemotherapy (8); however, these regimes were developed largely against the more common high-grade serous ovarian carcinoma and have lower efficacy in treating MOC (8).…”

“…There are concerns regarding the risk of intraoperative cyst rupture, whereby mucus enters the abdominal and pelvic cavity, which can induce peritoneal hyperplasia and metaplasia into mucus-producing epithelium, forming peritoneal myxoma, which accounts for 2–5% of ovarian mucinous tumors; the 5-year survival rate is about 45–54%, and the 10-year survival rate is about 18% ( 6 ). Previous study has shown that women with MOC have a worse prognosis in contrast to women with other subtypes of epithelial ovarian cancers after being matched for stage and other factors ( 7 ). At present, complete surgical resection is still the gold-standard therapy for all MOC ( 8 ).…”

Fertility-Sparing Surgery for Ovarian Cancer

“…Table 2 provides a summary of reported recurrence risk and survival rates after FSS for patients with EOC [ 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 ].…”

Conservative treatment of borderline ovarian tumors: a retrospective study

“…Unlike ovarian neoplasms, BOTs are often associated with infertility, have a lower incidence, a lower association with breast cancer (BRCA) genes, are diagnosed at early stages and have a good survival rate even when they involve a peritoneal lesion. They are more common in younger patients, so one of the goals in these patients is fertility preservation [ 2 , 3 ]. The treatment of these tumors is highly controversial and continues to be debated.…”