Clinical characteristics and survival of patients with normal-sized ovarian carcinoma syndrome: Retrospective analysis of a single institution 10-year experiment

Our plain-English summary of Clinical characteristics and survival of patients with normal-sized ovarian carcinoma syndrome: Retrospective analysis of a single institution 10-year experiment, by N. Yu, X. Li, B. Yang, et al (World Journal of Clinical Cases, 2020).

The study

• Authors: N. Yu, X. Li, B. Yang, J. Chen, M.F. Wu, J.C. Wei, K.Z. Li
• Journal: World Journal of Clinical Cases
• Published: 2020;8(21):5116-5127
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Normal size ovarian cancer syndrome (NOCS) is a challenge for clinicians regarding timely diagnosis and management due to atypical clinical and imaging features. It is extremely rare with only a few cases reported in the literature. More data are needed to clarify its biological behavior and compare the differences with abnormal size ovarian cancer.

Aim: To assess the clinical and pathological features of NOCS patients treated in our institution in the last 10 years and to explore risk factors for relapse and survival.

Methods: Patients who were pathologically diagnosed with NOCS between 2008 and 2018 were included. Papillary serous ovarian carcinoma (PSOC) patients were initially randomly recruited as the control group. Demographics, tumor characteristics, treatment procedures, and clinical follow-up were retrospectively collected. Risk factors for progression-free survival and overall survival were assessed.

Results: A total of 110 NOCS patients were included; 80 (72.7%) had primary adnexal carcinoma, two (1.8%) had mesotheliomas, 18 (16.4%) had extraovarian peritoneal serous papillary carcinoma, and eight (7.3%) had metastatic tumors. Carbohydrate antigen (CA)125 and ascites quantity were lower in the NOCS cohort than in the PSOC group. The only statistically significant risk factors for worse overall survival (P < 0.05) were the levels of CA199 and having fewer than six chemotherapy cycles. The 1-year, 3-year, and 5-year survival rates were 75.5%, 27.7%, and 13.8%, respectively.

Conclusion: The clinical symptoms of the NOCS group are atypical, and the misdiagnosis rate is high. Ascites cytology and laparoscopic exploration are valuable in the early diagnosis to avoid a misdiagnosis. The level of CA199 is the most important predictor of overall survival, and more than six cycles of chemotherapy contributes to the increased survival rates of NOCS patients.

©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.

In plain English

This retrospective study from Tongji Hospital, Wuhan, China, reviewed 110 women diagnosed with normal-sized ovarian carcinoma syndrome (NOCS) in 2008 to 2018. In NOCS, cancer has spread through the abdomen while the ovaries stay normal in size. It compared them with 152 papillary serous ovarian carcinoma patients. The article does not discuss asbestos. The text gives the NOCS patients' diagnoses as 80 primary adnexal carcinoma, two malignant peritoneal mesothelioma, 18 extraovarian peritoneal serous papillary carcinoma and eight metastatic tumors, which total 108; a table lists 19 and nine for the last two groups. Before surgery, the tumor marker CA125 and the volume of abdominal fluid (ascites) were significantly lower in NOCS patients. The misdiagnosis rate in the NOCS group was 23.6%. Overall NOCS survival was 75.5% at 1 year, 27.7% at 3 years and 13.8% at 5 years. In multivariate analysis, preoperative CA199 of 35 U/mL or higher and fewer than six chemotherapy cycles were significant risk factors for worse overall survival. The authors concluded that CA199 level is the most important predictor of overall survival. They noted that small numbers limited some analyses.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective cohort study (review of all NOCS cases at one medical center), with a comparison group of papillary serous ovarian carcinoma patients
• Who was studied: 110 patients diagnosed with normal-sized ovarian carcinoma syndrome (NOCS) and 152 comparison patients with papillary serous ovarian carcinoma (PSOC), Tongji Hospital, Wuhan, China, 2008 to 2018
• Exposure: No asbestos or other environmental exposure was studied. The factors examined were clinical features, tumor markers (CA125, CA199), surgery and chemotherapy.
• Main results:
  • The text reports that among the 110 NOCS patients, 80 (72.7%) had primary adnexal carcinoma, two (1.8%) malignant peritoneal mesothelioma, 18 (16.4%) extraovarian peritoneal serous papillary carcinoma and eight (7.3%) metastasis. These total 108.
  • Table 2 instead lists 80 primary adnexal, 2 MPM, 19 EPSPC and 9 metastatic cases, which total 110.
  • Preoperative CA125 and ascites volume were significantly lower in the NOCS group than in the PSOC group (1318.04 vs 1863.38 U/mL; 1658.63 vs 2302.24 mL, P less than 0.05).
  • The misdiagnosis rate in the NOCS group was 23.6%.
  • Overall 1-, 3- and 5-year survival rates in the NOCS group were 75.5%, 27.7% and 13.8%.
  • At follow-up, 60 NOCS patients (54.5%) were alive, 34 (30.9%) had died of NOCS, and 16 were lost to follow-up.
  • Survival did not differ significantly among the primary ovarian, extraovarian peritoneal serous papillary carcinoma and metastatic subgroups.
  • In the multivariate analysis of NOCS patients (Table 5), a preoperative CA199 of 35 U/mL or higher was a significant risk factor for worse overall survival: hazard ratio 3.004, 95% CI 1.133 to 7.960, P 0.027.
  • In the univariate analysis (Table 4), the hazard ratio for overall survival with preoperative CA199 of 35 U/mL or higher was 2.546 (95% CI 1.156 to 5.608, P 0.020). The discussion cites this figure as the main prognostic indicator.
  • Six or more chemotherapy cycles was associated with lower risk of death in the multivariate analysis: hazard ratio 0.313, 95% CI 0.127 to 0.770, P 0.012. In the univariate analysis the hazard ratio was 0.307, 95% CI 0.138 to 0.684.
• The authors' conclusion: The authors concluded that CA199 level is the most important predictor of overall survival in NOCS, and that more than six chemotherapy cycles contributes to increased survival.
• Limitations the authors state:
  • Some statistical analyses were limited by low numbers.
  • Some subcategories had limited numbers of patients.
  • The study was retrospective. The authors suggest that prospective cohorts are needed to collect data and standardize management.

Topics

Medical terms in this study, explained in our Lexicon: Carcinoma, Ovarian Cancer, Progression-Free Survival, Overall Survival, Mesothelioma, Serous Papillary Carcinoma, Ascites, Chemotherapy.

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