| Objective:The purpose of this study is to analyze the differences of clinic opatholog ica l characteristics between patients with SEOC and patients with ECOM,to explore the risk factors affecting the prognosis of patients with SEOC,and to identify the molecular classification and gene mutation of lesions in different parts of SEOC patients.In order to better differentiate and diagnose this kind of disease,it can provide reference for standardized diagnosis and treatment and improving the prognosis of SEOC patients.Methods:1.Retrospective analysis was conducted in Qingdao University affiliated Hospital from January 2013 to December 2021.According to the diagnostic criteria put forward by Scully and Ulbright,67 patients with SEOC and 82 patients with ECOM were diagnosed.Data of the patients were collected,including age of onset,symptoms at first visit,menopause,body mass index(BMI),reproductive history,personal and family tumor history,preoperative imaging examination,serological tumor marker level,mode of operation,intraoperative ascites or pelvic peritoneal lavage fluid delivery,postoperative pathology,postoperative adjuvant treatment,etc.,and follow-up of the progression-free survival time and overall survival time of the patients.Statistical methods were used to compare the differences between the two methods,and survival analysis was conducted by Kaplan-Meier method and COX regression method to explore the independent risk factors affecting the prognosis of SEOC.2.Formalin fixed and paraffin embedded sections of endometrial and ovarian lesions were selected from 13 patients with SEOC(including 7 patients with recurrence and 6 patients without recurrence).DNA was extracted.Next generation sequencing(NGS)technology was used to detect genes of POLE,MSI,TP53,BRCA1 and BRCA2,analyze the sequencing results,clarify molecular characteristics,and find mutational differences.Results:1.The median age of onset in 67 patients with SEOC was 51 years old,and the average age of onset was 51.39 ±8.71 years old.Most of the patients were premenopausal.The initial symptoms mainly included irregular vaginal bleeding(52.24%)and abdominal discomfort(such as abdominal pain,abdominal distension,palpable mass).19.40% of the patients had no obvious clinical symptoms and only endometrial and / or ovarian abnormalities were found during routine physical examination.All patients received surgical treatment,and94.03% of the patients received adjuvant chemotherapy and / or radiotherapy after operation.Among the postoperative pathological types,endometrioid carcinoma was the most common histopathological type of endometrioid carcinoma(74.63%).Most of the endometrial lesions were confined to the mucosa or only superficial myometrium infiltration(< 1/2 myometrium)(89.55%).The tumor is well differentiated.The follow-up period of 67 SEOC patients was 4-117 months.As of the follow-up date,13 patients(19.40%)had postoperative recurrence,and 5 patients(7.46%)died.2.Among the 13 patients with recurrent SEOC,about 30.77% of the patients with endometrial and ovarian lesions had endometrioid carcinoma.The remaining 69.23% of the recurrent patients had different or the same histopathological types of endometrial and ovarian lesions and were non-endometrioid carcinoma(mostly serous carcinoma,clear cell carcinoma,etc.).3.The median age of onset of 82 patients with ECOM was 54 years old,and the average age of onset was 55.04 ±9.31 years old.Most of the patients were menopausal.85.37% of them had irregular vaginal bleeding,and a few had abdominal discomfort.In the imaging examination,the vast majority of patients can find varying degrees of endometrial thickening or uterine space occupying,pelvic masses.53.66% of the patients’ ovarian tumors involve both sides,and most of the maximum diameters are less than 5cm.The histopathological types of endometrial and ovarian lesions were the same,mainly poorly differentiated,often accompanied by pelvic lymph node metastasis(63.41%)and positive vascular thrombus(69.51%).The 82 patients were followed up for 3-117 months.As of the follow-up date,31 patients(37.80%)relapsed and 9 patients(10.98%)died.4.Compared with ECOM patients,there were significant differences in average age of onset,menopause,first visit symptom,involved ovary side,maximum diameter of ovarian tumor,degree of myometrial invasion,pathological type of endometrial lesion,pathological type of ovarian lesion,differentiation degree of endometrial and ovarian focus,pelvic lymph node metastasis and positive vascular cancer thrombus between SEOC and ECOM patients.(P<0.05).5.The PFS of patients in this study was analyzed by Kaplan Meier curve.The PFS of the SEOC group was significantly better than that of the ECOM group,and the prognosis was better(P =0.002).6.In the univariate analysis of the prognosis of SEOC,intraoperative exploration of ascites,pathological stage and type of endometrial lesions,pathological differentiation,stage and type of ovarian lesions and postoperative adjuvant therapy were the influencing factors of PFS.Menopause,pathological differentiation,stage and type of endometrial lesions,and adjuvant therapy after operation are the influencing factors of OS.7.The results of COX regression multivariate analysis showed that the SEOC patients with higher endometrial stage and histological type of non-endometrioid carcinoma had lower PFS and higher risk of disease progression.The OS of patients with non-endometrioid carcinoma and no adjuvant therapy after operation were relatively low and the risk of death was high.8.Next generation sequencing technology was used to detect the genes of 13 patients with SEOC.61.54% of patients had mutations of different molecular characteristics of endometrium and 69.23% of patients had mutations of different molecular characteristics of ovaries.The patients with the same molecular types of endometrial and ovarian lesions accounted for 61.54%,and the patients with different molecular types accounted for38.46%.71.43% of the SEOC patients with endometrioid carcinoma had the same molecular typing,but the molecular characteristics were not completely the same.Conclusions:1.The age of onset in SEOC group was younger than that in ECOM group,and most of the patients were not menopausal.The main symptoms were irregular vaginal bleeding,abdominal discomfort,superficial myometrium invasion,no vascular tumor thrombus invasion,better tumor differentiation,early tumor stage and better prognosis than ECOM group.Excessive treatment should be prevented.2.Pathological stages and histopathological types of endometrial lesions are independent risk factors for PFS in patients with SEOC.Histopathological types of endometrial lesions and postoperative adjuvant therapy are independent risk factors for OS in patients with SEOC.Postoperative adjuvant therapy and long-term follow-up observation should be paid to the patients with endometrial lesions whose stage is higher than stage I and the pathological type of endometrial lesions is non-endometrioid carcinoma.3.Gene sequencing showed that most of the SEOC patients with endometrioid carcinoma had the same molecular typing of endometrium and ovarian lesions,and tended to be clonerelated.However,in the same patient with the same molecular typing,the molecular characteristics of different parts may also be different.Patients with SEOC have a high frequency of MSI-H,so we should pay attention to the screening of Lynch syndrome. |
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