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| Backgroud Recent studies demonstrated that epithelial ovarian cancer (EOC) has been several different diseases and the two-tier system divided it to type I and type II EOC. HE4 has been a complementary biomarker for diagnosis of epithelial ovarian cancer (EOC). This study aimed to evaluate the difference of clinicopathologic characteristics and HE 4 expression in these two type EOC.
Methods This retrospective study included 127 EOC patients. Data on patient demographics, cancer stages, grades, histology, operation procedures performed, residual disease, adjuvant chemotherapy, recurrence, and survival were collected. 134 ovarian carcinoma tissue specimens and 40 matching borderline ovarian tumor specimens were picked from the archive of pathologic department. Immunohistochemistry was applied to assess HE4 expression in EOC and borderline ovarian tumor tissue specimens.
Results Of the 127 patients, there were 42 type I EOC(7 low grade serous carcinomas, 8 mucinous carcinomas, 12 endometriod carcinomas and 15 clear cell carcinomas) and 85 type II EOC( 83 high grade serous carcinomas and 2 malignant mixed mesodermal tumors). The median followed-up time was 18.3 months. There were statistic difference between the two type EOC in terms of menopausal state, FIGO stage and pathologic differentiation, but not in residual tumor and chemotherapy relieveation. In type I EOC, the median follow-up time was 31 months (4-72m) and the median progression-free survival was 72 months (95%CI:40.34-103.66).There were 15(35.7%) relapsed or progressive patients. In type II EOC, the median follow-up time was 17 months(0-60m) and the median progression-free survival was 27 months (95%CI:17.83-36.17). There were 47(55.3%) relapsed or progressive patients. There had significant statistic difference between the two type EOC in terms of progression-free survival (p<0.001). Among the 44 type I specimens, 25 were positive expression of HE4 (56.8%), in contract, the positive expression specimens in type II was 78 (86.7%). There was significant difference between type I and type II EOC in expression of HE4. Also, there had significant difference between high-grade serous carcinoma and borderline serous tumor, but no difference between low-grade serous carcinoma and borderline serous tumor or other EOC and its corresponding borderline tumor.
Conclusion The different clinic-pathologic characteristics between type I and type II EOC make the two-tier system of EOC reasonable and reliable. HE4 would be a powerful biomarker to distinguish type II EOC from borderline tumor but it is less useful in type I EOC. Type I EOC would be generated from its corresponding borderline tumor. |
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| Keywords:epithelial ovarian cancer; borderline tumor; human epididymis protein 4(HE4); immunohistochemistry; the two-tier system of EOC |
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