Discussion: ‘Ovarian epithelial carcinoma with pelvic endometriosis,’ by Wang et al




In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed:


Wang S, Qui L, Lang JH, et al. Clinical analysis of ovarian epithelial carcinoma with coexisting pelvic endometriosis. Am J Obstet Gynecol 2013;208:413.e1-5.


Discussion Questions




  • ■

    Why is this study question important?


  • ■

    What was the study design?


  • ■

    What were the results?


  • ■

    What were the study’s strengths and limitations?


  • ■

    What is the clinical impact of this study?





Introduction





See related article, page 413




For a summary and analysis of this discussion, see page 415

Clear cell carcinoma of the ovary is a less common type of epithelial ovarian cancer. Histologic diagnosis can be tricky, as specific morphologic and immunohistologic traits distinguish it from other epithelial ovarian variants. Historically, clear cell and serous cancers have been combined in clinical studies, and it has been presumed that treatment is similar. But given the poor prognosis of clear cell carcinoma and its possible lack of sensitivity to platinum-based chemotherapy, different treatment regimen and alternative surgical staging strategies are under consideration. In a new study, Wang et al describe their experience at Peking University.


Linda Van Le, MD and George A. Macones, MD, MSCE, Associate Editor




Introduction





See related article, page 413




For a summary and analysis of this discussion, see page 415

Clear cell carcinoma of the ovary is a less common type of epithelial ovarian cancer. Histologic diagnosis can be tricky, as specific morphologic and immunohistologic traits distinguish it from other epithelial ovarian variants. Historically, clear cell and serous cancers have been combined in clinical studies, and it has been presumed that treatment is similar. But given the poor prognosis of clear cell carcinoma and its possible lack of sensitivity to platinum-based chemotherapy, different treatment regimen and alternative surgical staging strategies are under consideration. In a new study, Wang et al describe their experience at Peking University.


Linda Van Le, MD and George A. Macones, MD, MSCE, Associate Editor




Background


Van Le: Why is this study question important?


Doll: Dr Wang and colleagues explored the differences between endometriosis-associated epithelial ovarian cancer (EAOC) and “typical” epithelial ovarian cancer. This study question is important, as epithelial ovarian cancer is the most lethal of gynecologic malignancies. The benign but locally destructive process of endometriosis has been associated with ovarian cancer for decades, with conflicting data as to its importance as a prognostic indicator. Specifically, endometriosis has been associated with the less frequent subtypes of clear cell, endometrioid, and low-grade serous ovarian cancer.


Studies that can elucidate the role of endometriosis as a possible progenitor to subtypes of epithelial ovarian cancer or as a modulator of disease significantly contribute to our ongoing efforts to understand ovarian cancer. This study aims to describe the clinical and pathologic differences in EAOC, and the results may serve as an initial step in understanding the relationship between these 2 diseases in a way that is meaningful to patient outcomes.

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May 13, 2017 | Posted by in GYNECOLOGY | Comments Off on Discussion: ‘Ovarian epithelial carcinoma with pelvic endometriosis,’ by Wang et al

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