Clinical Analysis Of Cases Of Low-grade And High-grade Serous Ovarian Cancer

Objective:To compare the clinical characteristics of low-grade serous ovarian cancer and high-grade serous ovarian cancer,in order to provide reference basis for the differentiation of the two.Methods:The clinical data of 21 patients with low-grade serous ovarian cancer and95 patients with high-grade serous ovarian cancer confirmed by pathology in our hospital from January 2010 to December 2020 were analyzed retrospectively.The general data(including age,BMI,smoking and menopause)and clinical features(including clinical manifestation,auxiliary examination,histopathological immunohistochemistry and surgery-pathological stage)were compared.Results:1.The average age of diagnosis in low-grade serous ovarian cancer group was 46.86±14.81 years,which was lower than that in high-grade serous ovarian cancer group(53.32±7.79 years),but the difference was not statistically significant.There were fewer menopausal patients in low-grade serous ovarian cancer group than in high-grade serous ovarian cancer group,and the difference was statistically significant.There was no significant difference in BMI and smoking status between the two groups.2.The most common clinical manifestations in the low-grade serous ovarian cancer group were lower abdominal mass and abdominal pain,accounting for 71.4% and23.8%,respectively,while other clinical manifestations accounted for a small proportion(9.5% of urine frequency and 4.8% of anal distension).The most common clinical manifestations in the high-grade serous ovarian cancer group were lower abdominal mass,abdominal pain,vaginal bleeding or bloody secretions and abdominal distension,accounting for 56.8%,31.6%,22.1% and 15.8%,respectively.The proportion of other clinical manifestations is small(6.3% of vaginal discharge,3.2% of frequent urination or dysuria,2.1% of changes in defecation habits).There was significant difference in the performance of lower abdominal mass between the two groups.3.Among the tumor markers detected in the low-grade serous ovarian cancer group,the positive rate of CA125 was 71.4%,the positive rate of HE4 was 40%,the positive rate of ROMA was 70%,the positive rate of CA199 was 10%,the positive rate of CEA was 0%,and the positive rate of AFP was 5.6%.Among the tumor markers detected in the high-grade serous ovarian cancer group,the positive rate of CA125 was 83%,the positive rate of HE4 was 43.2%,the positive rate of ROMA was 73%,the positive rate of CA199 was 7.4%,the positive rate of CEA was 12.5%,the positive rate of AFP was2.6%.There was no significant difference in preoperative tumor markers and ROMA between the two groups.4.There was no significant difference in tumor location,blood flow and pelvic and peritoneal effusion between low-grade serous ovarian cancer group and high-grade serous ovarian cancer group.In the low-grade serous ovarian cancer group,ultrasound revealed mixed mass in 12 cases(60%),cystic mass in 6 cases(30%),and solid mass in2 cases(10%).In the high-grade serous ovarian cancer group,ultrasound revealed mixed mass in 44 cases(48.9%),solid mass in 35 cases(38.9%),and cystic mass in 11cases(12.2%).The difference between the mass properties of the two groups was statistically significant.5.In the low grade serous ovarian cancer group,there were 6 patients with stage I(33.3%),1 patient with stage II(5.6%),and 11 patients with stage III(61.1%).In the high-grade serous ovarian cancer group,there were 18 patients with stage I(18.9%),18 patients with stage II(18.9%),56 patients with stage III(58.9%),and 3 patients with stage IV(3.2%).Stage I and II were collectively referred to as early stage,and stage III and IV were referred to as late stage.There was no significant difference in staging between the two groups.6.About immunohistochemical indexes in the low-grade serous ovarian cancer group,the positive rates of P16,WT-1 and PAX-8 were 90.9%,80%,and 100%,respectively.P53 mutant type accounted for 57.1%,wild type accounted for 42.9%,and Ki-67 high expression accounted for 38.5%,low expression accounted for 61.5%,ER high expression accounted for 46.2%,low expression accounted for 53.8%,PR high expression accounted for 33.3%,and low expression accounted for 66.7%.In the high-grade serous ovarian cancer group,the positive rates of P16,WT-1 and PAX-8were 94.7%,88.9%,and 94.5%,respectively.P53 mutant type accounted for 94.7%,wild type accounted for 5.3%,Ki-67 high expression accounted for 95.7%,low expression accounted for 4.3%,ER high expression accounted for 37.0%,low expression accounted for 63.0%,PR high expression accounted for 5.7%,and low expression accounted for 94.3%.Comparing the expression of P53,Ki-67 and PR between the two groups,the difference was statistically significant.Conclusion:1.The incidence of low-grade serous ovarian cancer is lower and the age of diagnosis is younger.Patients with lower abdominal mass were more likely to be diagnosed as low-grade serous ovarian cancer,but the remaining clinical manifestations of the two groups were not specific.The results of five preoperative tumor markers in the two groups of patients did not help the differential diagnosis between them.2.The mass properties of the tumor indicated by ultrasound helps to distinguish the two.If the tumor is solid,it is more likely to be high-grade serous ovarian cancer,while if the tumor is cystic,it is more likely to be low-grade serous ovarian cancer.However,the final diagnosis still requires pathological examination.3.Histopathological immunohistochemistry indicated that the wild-type P53,low expression of Ki-67 and high expression of PR were more inclined to low-grade serous ovarian cancer,while the mutant P53,high expression of Ki-67 and low expression of PR were more inclined to high-grade serous ovarian cancer.