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Wens FSPL, Hulsker CCC, Fiocco M, Zsiros J, Smetsers SE, de Krijger RR, van der Steeg AFW, Zweemer RP, Baas IO, Roes EM, Looijenga LHJ, Gerestein CG, Mavinkurve-Groothuis AMC. Small Cell Carcinoma of the Ovary, Hypercalcemic Type (SCCOHT): Patient Characteristics, Treatment, and Outcome-A Systematic Review. Cancers (Basel) 2023; 15:3794. [PMID: 37568608 PMCID: PMC10417391 DOI: 10.3390/cancers15153794] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Small-cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is a rare aggressive ovarian malignancy mainly affecting children, adolescents, and young adults. Since the discovery of mutations in the SMARCA4 gene in 2014, SCCOHT has become the subject of extensive investigation. However, international uniform treatment guidelines for SCCOHT are lacking and the outcome remains poor. The aim of this systematic review is to generate an overview of all reported patients with SCCOHT from 1990 onwards, describing the clinical presentation, genetic characteristics, treatment, and outcome. METHODS A systematic search was performed in the databases Embase, Medline, Web of Science, and Cochrane for studies that focus on SCCOHT. Patient characteristics and treatment data were extracted from the included studies. Survival was estimated using Kaplan-Meier's methodology. To assess the difference between survival, the log-rank test was used. To quantify the effect of the FIGO stage, the Cox proportional hazard regression model was estimated. The chi-squared test was used to study the association between the FIGO stage and the surgical procedures. RESULTS Sixty-seven studies describing a total of 306 patients were included. The median patient age was 25 years (range 1-60 years). The patients mostly presented with non-specific symptoms such as abdominal pain and sometimes showed hypercalcemia and elevated CA-125. A great diversity in the diagnostic work-up and therapeutic approaches was reported. The chemotherapy regimens were very diverse, all containing a platinum-based (cisplatin or carboplatin) backbone. Survival was strongly associated with the FIGO stage at diagnosis. CONCLUSIONS SCCOHT is a rare and aggressive ovarian cancer, with a poor prognosis, and information on adequate treatment for this cancer is lacking. The testing of mutations in SMARCA4 is crucial for an accurate diagnosis and may lead to new treatment options. Harmonization and international collaboration to obtain high-quality data on diagnostic investigations, treatment, and outcome are warranted to be able to develop international treatment guidelines to improve the survival chances of young women with SCCOHT.
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Affiliation(s)
- Francis S. P. L. Wens
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (F.S.P.L.W.); (C.C.C.H.); (M.F.); (J.Z.); (S.E.S.); (R.R.d.K.); (A.F.W.v.d.S.); (L.H.J.L.)
| | - Caroline C. C. Hulsker
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (F.S.P.L.W.); (C.C.C.H.); (M.F.); (J.Z.); (S.E.S.); (R.R.d.K.); (A.F.W.v.d.S.); (L.H.J.L.)
| | - Marta Fiocco
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (F.S.P.L.W.); (C.C.C.H.); (M.F.); (J.Z.); (S.E.S.); (R.R.d.K.); (A.F.W.v.d.S.); (L.H.J.L.)
- Mathematical Institute, Leiden University, 2311 EZ Leiden, The Netherlands
- Biomedical Data Science Department, Section Medical Statistics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - József Zsiros
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (F.S.P.L.W.); (C.C.C.H.); (M.F.); (J.Z.); (S.E.S.); (R.R.d.K.); (A.F.W.v.d.S.); (L.H.J.L.)
| | - Stephanie E. Smetsers
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (F.S.P.L.W.); (C.C.C.H.); (M.F.); (J.Z.); (S.E.S.); (R.R.d.K.); (A.F.W.v.d.S.); (L.H.J.L.)
| | - Ronald R. de Krijger
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (F.S.P.L.W.); (C.C.C.H.); (M.F.); (J.Z.); (S.E.S.); (R.R.d.K.); (A.F.W.v.d.S.); (L.H.J.L.)
- Department of Pathology, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
| | - Alida F. W. van der Steeg
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (F.S.P.L.W.); (C.C.C.H.); (M.F.); (J.Z.); (S.E.S.); (R.R.d.K.); (A.F.W.v.d.S.); (L.H.J.L.)
| | - Ronald P. Zweemer
- Department of Gynecologic Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands; (R.P.Z.); (C.G.G.)
| | - Inge O. Baas
- Department of Medical Oncology, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands;
| | - Eva Maria Roes
- Department of Gynecologic Oncology, Erasmus Medical Center Cancer Institute, 3015 GD Rotterdam, The Netherlands;
| | - Leendert H. J. Looijenga
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (F.S.P.L.W.); (C.C.C.H.); (M.F.); (J.Z.); (S.E.S.); (R.R.d.K.); (A.F.W.v.d.S.); (L.H.J.L.)
| | - Cornelis G. Gerestein
- Department of Gynecologic Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands; (R.P.Z.); (C.G.G.)
| | - Annelies M. C. Mavinkurve-Groothuis
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (F.S.P.L.W.); (C.C.C.H.); (M.F.); (J.Z.); (S.E.S.); (R.R.d.K.); (A.F.W.v.d.S.); (L.H.J.L.)
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Münstedt K, Estel R, Dreyer T, Kurata A, Benz A. Small Cell Ovarian Carcinomas - Characterisation of Two Rare Tumor Entities. Geburtshilfe Frauenheilkd 2013; 73:698-704. [PMID: 24771926 DOI: 10.1055/s-0032-1328658] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 04/28/2013] [Accepted: 04/29/2013] [Indexed: 10/26/2022] Open
Abstract
Objective: Small cell ovarian carcinomas (SCOC) are differentiated into two types: hypercalcaemic (SCOCHT) and pulmonary (SCOCPT). Unfortunately, little is known about pulmonary-type small cell ovarian carcinoma. Study Design: We carried out a systematic analysis of all available reports in the literature on individual cases of SCOCHT and SCOCPT. Results: We found that patients with SCOCPT were significantly older than those with SCOCHT. Vimentin and chromogranin detection by immunohistochemistry allow good differentiation between the two types. Interestingly, SCOCPT but not SCOCHT was found to be associated with other benign and malignant ovarian tumours in about 44 % of cases. Although the percentage of R0/R1 resections was high (~ 74 %), survival was poor; even in patients with disease limited to the ovaries (stage Ia and Ib) the recurrence rate was 40 %. Chemotherapy with etoposide or anthracyclines could be useful. Conclusion: Taking the limitations of our study such as its retrospective nature into account and based on the results from studies of small cell carcinomas originating from other tumour sites, we conclude that treatment of SCOCPT should be based on the therapies used to treat other small cell carcinomas. Surgery is appropriate, especially in very early stages of disease, but chemotherapy should not be omitted. Newer concepts such as treatment with somatostatin analogues could help to control symptoms and stabilise some slow-growing tumours.
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Affiliation(s)
- K Münstedt
- Frauenklinik, Universitätsklinikum Gießen, Gießen
| | - R Estel
- Frauenklinik, Universitätsklinikum Gießen, Gießen
| | - T Dreyer
- Frauenklinik, Universitätsklinikum Gießen, Gießen
| | - A Kurata
- Frauenklinik, Universitätsklinikum Gießen, Gießen
| | - A Benz
- Frauenklinik, Universitätsklinikum Gießen, Gießen
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