Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2020; 8(21): 5116-5127
Published online Nov 6, 2020. doi: 10.12998/wjcc.v8.i21.5116
Clinical characteristics and survival of patients with normal-sized ovarian carcinoma syndrome: Retrospective analysis of a single institution 10-year experiment
Nan Yu, Xi Li, Bin Yang, Jing Chen, Ming-Fu Wu, Jun-Cheng Wei, Ke-Zhen Li
Nan Yu, Xi Li, Bin Yang, Jing Chen, Ming-Fu Wu, Jun-Cheng Wei, Ke-Zhen Li, Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Author contributions: Yu N and Li KZ contributed to protocol/project development, data collection and management, data analysis, and manuscript writing/editing; Li X, Chen J, and Wei JC contributed to protocol/project development and manuscript writing/editing; Yang B contributed to data collection and management and manuscript writing/editing; Wu MF contributed the manuscript writing/editing.
Supported by National Key Technology R&D Program of China, No. 2019YFC1005200, and No. 2019YFC1005202; National Natural Science Foundation of China, No. 81501530, No. 81802896, and No. 81701530; Natural Science Foundation of Hubei Province, No. 2017CFB800; and Hubei Province Health and Family Planning Scientific Research Project, No. WJ2017Z013, and No. WJ2019M127.
Institutional review board statement: The Institutional Review Board of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology approved this study protocol.
Informed consent statement: In accordance with the rules of the ethics committee, this study applied for exemption from informed consent.
Conflict-of-interest statement: None declared.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at tjkeke@126.com.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ke-Zhen Li, PhD, Professor, Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan 430030, Hubei Province, China. tjkeke@126.com
Received: June 28, 2020
Peer-review started: June 28, 2020
First decision: August 8, 2020
Revised: August 16, 2020
Accepted: October 1, 2020
Article in press: October 1, 2020
Published online: November 6, 2020
Processing time: 130 Days and 23.6 Hours
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.

Keywords: Normal-sized ovarian carcinoma syndrome; Ovarian cancer; Survival; Prognostic factors; Epithelial ovarian carcinomas; Carbohydrate antigen 125

Core Tip: Normal size ovarian cancer syndrome is a rare and aggressive disease with poor prognosis. Carbohydrate antigen 199 may be an effective marker to monitor disease progression, and adequate adjuvant chemotherapy should be recommended for all patients following surgery, as patients with more than six cycles of chemotherapy have increased survival rates.