Distinct preoperative clinical features predict four histopathological subtypes of high-grade serous carcinoma of the ovary, fallopian tube, and peritoneum

Abstract

BackgroundThe Cancer Genome Atlas Research Network reported that high-grade serous carcinoma (HGSC) can be classified based on gene expression profiles into four subtypes, termed “immunoreactive,” “differentiated,” “proliferative,” and “mesenchymal.” We previously established a novel histopathological classification of HGSC, corresponding to the gene expression subtypes: immune reactive (IR), papillo-glandular (PG), solid and proliferative (SP), and mesenchymal transition (MT). The purpose of this study is to identify distinct clinical findings among the four pathological subtypes of HGSC, as well as to predict pathological subtype based on preoperative images.MethodsWe retrospectively assessed 65 HGSC cases (IR: 17, PG: 7, SP: 14, MT: 27) and analyzed preoperative images.ResultsAll IR cases originated from either the ovary or fallopian tube (P = 0.0269). Significantly more IR cases were diagnosed at earlier stages (P = 0.0013), and IR cases displayed lower levels of ascites (P = 0.0014), fewer peritoneal lesions (P = 0.0080), a sporadic pattern of peritoneal lesions (P = 0.0016), a lower incidence of omental cake (P = 0.0416), and fewer distant metastases (P = 0.0146) compared with the other subtypes. MT cases were more likely to be of peritoneal origin (P = 0.0202), presented at advanced stages with higher levels of ascites (P = 0.0008, 0.0052, respectively), and more frequently had a diffuse pattern of peritoneal lesions (P = 0.0059), omental cake (P = 0.0179), and distant metastasis (P = 0.0053). A decision tree analysis estimated the histopathological subtypes based on preoperative images, with a sensitivity of 67.3%.ConclusionsPathological subtypes of HGSC have distinct clinical behaviors, and preoperative images enable better prediction of pathological subtype. These findings may lead to individualized treatment plans if the effect of treatment based on the HGSC subtype is elucidated.Electronic supplementary materialThe online version of this article (10.1186/s12885-017-3573-1) contains supplementary material, which is available to authorized users.

TIMP-2 regulates proliferation, invasion and STAT3-mediated cancer stem cell-dependent chemoresistance in ovarian cancer cells

“…These indefinite findings regarding the expression of TIMP-2 in ovarian tumours may be due to different affinities of the antibodies used and differences in the experimental methods used for analysis of the studied protein. Alternatively, it could be [49,50].…”

“…These indefinite findings regarding the expression of TIMP-2 in ovarian tumours may be due to different affinities of the antibodies used and differences in the experimental methods used for analysis of the studied protein. Alternatively, it could be due to differences in the pathology of high-grade serous tumours as distinct histopathological and genetically different sub-types of high-grade serous tumours have been described [ 49 , 50 ].…”

Upfront debulking surgery versus interval debulking surgery for advanced tubo‐ovarian high‐grade serous carcinoma and diffuse peritoneal metastases treated with peritonectomy procedures plus HIPEC

“…Even though the biological factors driving platinum‐sensitivity remain open to characterization by current clinicopathologic data, a future treatment strategy should be accurate triage of those patients likely or unlikely to benefit from immediate aggressive surgical attempts or NACT. Gene expression profiling to classify HGSC molecular subtypes and RNA sequencing have already begun to create predictive models for tailoring cancer care in women with advanced disease and dismal tumor biology …”

Narrative review on serous primary peritoneal carcinoma of unknown primary site: four questions to be answered

“…The histopathological classification of high-grade serous carcinoma corresponding to the gene expression subtypes identified categorized primary ovarian tumors into mesenchymal transition in 34%, immune reactive in 32%, solid and proliferative in 25%, and papillaglandular in 9%. On the other hand, SPPC is commonly assigned to the mesenchymal transition type in 75% and lack immune reactive patterns (13).…”