Biological Characteristics Affect Outcome in Early Stage Ovarian Cancer
According to a recent article published in the International Journal of Gynecologic Oncology, biological characteristics of a cancer, such as p53 status and EGFR status affect the outcomes of early stage ovarian cancer.
Ovarian cancer is associated with a high death rate, primarily because it is typically diagnosed after the cancer has spread. Early-stage ovarian cancer refers to cancer that has either not spread from its site or origin, or has only spread to nearby tissue. Staging of ovarian cancer refers to the determination of how far the cancer has spread, and dictates treatment options for a patient. Therefore, it is imperative that staging of ovarian cancer is accurate, so that patients may receive optimal treatment for their disease. However, researchers have realized that staging of early ovarian cancer may be improved upon by utilizing different variables either alone or in combination in addition to the current staging methods.
Researchers are becoming increasingly aware that specific biological factors of cancer cells affect a patient’s response to certain treatments and ultimately affect a patient’s long-term outcome. Understanding the role these factors play in regards to patient outcome is crucial to optimizing and individualizing treatment regimens for every cancer patient. Some biological factors, such as p53 status, epidermal growth factors receptor (EGFR) status or the aggressiveness of a cancer are being studied in various cancers. P53 is a gene that is involved in cellular replication, and when altered, or mutated, has been implicated in the development or spread of cancer. EGFR is part of a biological pathway that is also involved in cellular replication, and when overexpressed, has been demonstrated to be associated with the continued growth of cancer.
Researchers from Sweden recently conducted a clinical study to evaluate the association of certain biological characteristics and outcome of patients with early ovarian cancer. This study included data from 226 patients diagnosed with early ovarian cancer who were treated with surgery followed by chemotherapy or radiation therapy. The data included p53 status, EGFR expression and the aggressiveness of the cancer. Overall, the data revealed that each of these factors were independently associated with cancer-free survival. Expression of p53, EGFR and a higher tumor grade all predicted for a poorer cancer-free survival. According to these characteristics, high-, intermediate- and low-risk groups in terms of risk of cancer-free survival were established. The high-risk group was comprised of patients positive for p53 and EGFR, as well as a high-grade (aggressive) cancer, resulting in a 39% rate of cancer-free survival. The intermediate-risk group was comprised of patients negative for p53 or EGFR with a high-grade cancer, or patients positive for p53 and EGFR with a low-grade (non-aggressive) cancer, resulting in a 66% rate of cancer-free survival. The low-risk group was comprised of patients negative for p53 and EGFR with a low-grade cancer, resulting in an 89% rate of cancer-free survival.
The researchers concluded that p53, EGFR and tumor grade should be considered as part of the staging formula for early stage ovarian cancer. Each factor individually, as well as in combination, predicted for a high-, intermediate- or low-risk of cancer-free survival in these patients. Larger studies evaluating these factors and other biologic factors are warranted to further improve upon staging for this disease. Patients diagnosed with early ovarian cancer may wish to speak with their physician about testing for p53, EGFR and/or tumor grade, or the risks and benefits of participating in a clinical trial further evaluating staging methods.
Reference: Skirnisdottir I, Seidal T, Sorbe B, et al. A new prognostic model comprising p53, EGFR, and tumor grade in early stage epithelial ovarian carcinoma and avoiding the problem of inaccurate surgical staging. International Journal of Gynecologic Oncology. 2004; 14:259-270.
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