1. Ji Young Lee, MD, PhD, David Marchetti, MD, M Steven Piver, MD Department of Obstetrics and Gynecology Sisters of Charity Hospital, Buffalo, NY The Clinical significance of DNA ploidy as a prognostic factor in patients with Borderline Ovarian Tumor Retrospective study

2. INTRODUCTION

3. Howard Taylor Described Borderline Ovarian Tumor as “ semi-malignant ” ….propensity to metastasize but maintained a rather indolent course… Surg Gynecol Obstet 1929; 48: 204-230

5. 10-20% of epithelial ovarian tumor Mean age 45.7 yr 75% of tumors are Stage I 5 YSR for early stage tumors ≥ 95% Recurrence rate 8~32% Risk factors for recurrence FIGO stage, Age, Residual disease, Histology, DNA ploidy etc.

6. DNA Ploidy DNA Ploidy The most important prognostic factor in 370 patients with the borderline ovarian tumor Int J Gynecol Oncol 1993 3: 349

7. A Review of the Literature

8. 1.Report the results regarding DNA ploidy and other Clinicopathologic variables 2. Evaluate the clinical significance of DNA Ploidy in 30 consecutive patients with Borderline Ovarian Tumor OBJECTIVES

9. MATERIALS & METHODS

10. Retrospective Study Review of Cancer Registry of Sisters Hospital A total of 30 consecutive patients with Borderline Ovarian Tumor Histologic evaluation of Paraffin Tissue Blocks DNA Flow Cytometry for DNA ploidy Analysis -Primary Tumor

11. Histology Definition Malignant characteristics of epithelial hyperplasia or stratification, mitotic activity, and cellular/nuclear atypia No Stromal Invasion MUCINOUS TYPE

12. DNA Flow Cytometry by USLABS (Irvine, CA) Diploid ( DI=1.0, single peak)Aneuploid (DI;1.1-1.9), Multi-peak

13. RESULTS ….and DISCUSSION

14. Age Distribution of Borderline Ovarian Tumor Age MEAN AGE 54.5 yo Patients (No.)

15. Age distribution of Borderline Ovarian Tumor Sep 1993 – Sep 2004 in Sweden Int J Gynecol Cancer 2008;18:453–459.

16. Patients (No.) Age Histology and Age Distribution of Borderline Ovarian Tumor Serous Mixed Mucinous

17. Diploid Aneuploid Age Patients (No.) DNA Ploidy and Age at Diagnosis

18. The relationship of Histopathology and FIGO stage of disease

19. The relationship of DNA ploidy and Histology of disease

20. DNA ploidy and Histologic type Histology-DNA Ploidy Patients (No.)

21. The relationship of DNA ploidy and FIGO stage of disease

22. DNA Ploidy and Disease Stage Diploid Aneuploid Patients (No.) Stage-DNA Ploidy

23. Characteristics of 30 patients

24. Histology Borderline Ovarian Tumor Tropé CG. Seminars in surgical oncology 2000 9(1)69 –75

25. The relation of histopathology to ploidy status Histopathology Number Diploid Aneuploid No FCM of cases (%) Serous 219 (54.9) 167 27 25 Mucinous 171 (42.9) 127 32 12 Endometrioid 5 (1.2) 3 2 — Clear cell 1 (0.2) — 1 — Mixed 3 (0.8) 2 1 — Total 399 299 63 37 Int J Gynecol Cancer 2008;18:453–459.

26. N Recurred Died Stage I 686 29 9 Stage II & III 219 40 22 Total 905 69(7.6%) 31(3.4%) Rubin SC, Sutton GP (2001,Ovarian cancer 2 nd edition) Overall Recurrence and survival in Borderline ovarian tumor

27. DNA Ploidy and Prognosis in Borderline Ovarian Tumor (I) Cancer 1992 69(10): 2510

28. Seidman JD et al. Cancer 1993;71:12 …DNA ploidy may be of little prognostic importance Harlow BL et al. Gynecol Oncol 1993;50:305 … No correlation between DNA ploidy and Survival or Recurrence DNA Ploidy and Prognosis in Borderline Ovarian Tumor (II)

29. Mean Follow-up 36 months ( range 6-72 months ) No recurrence in 30 patients No death from disease Chemotherapy was given to 4 of 30 patients (1 stage IIC-Aneuploidy and 3 IIIC stage-Diploidy)

30. CONCLUSION

31. DNA was not recognized as an important prognostic factor in this study More prolonged follow-up will be needed to evaluate the clinical correlation between DNA ploidy and recurrence / survival Reassess the quality and quantity of tissue blocks for DNA Ploidy analysis

32. REFERENCES

35. ACKNOWLEDGEMENT

36. M Steven Piver, MD David Marchetti, MD Judine Davis, MD Anthony Pivarunas, DO Pathology Department USLABS, CA