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DOI: 10.1055/s-2004-832305
© Georg Thieme Verlag Stuttgart · New York
Etablierte und experimentelle Prognosefaktoren des Ovarialkarzinoms
Conventional and Experimental Prognostic Factors in Ovarian CancerPublication History
Publication Date:
12 October 2004 (online)
Zusammenfassung
Das Ovarialkarzinom ist das vierthäufigste Malignom der europäischen Frau, nimmt aber mit seiner schlechten Prognose den 1. Platz in der Mortalitätsstatistik der gynäkologischen Malignome ein.Eine Vielzahl von Prognosefaktoren sind beim Ovarialkarzinom bisher identifiziert worden, die jedoch aufgrund ungenügender Daten bezüglich ihres Stellenwertes als „echter” Prognosefaktor in der Literatur häufig kontrovers diskutiert werden. Mit dem kontinuierlich wachsenden Verständnis der Tumorbiologie des Ovarialkarzinoms und mit Hilfe neuer molekularbiologischer Techniken lassen sich zunehmend weitere potenzielle Prognosefaktoren identifizieren, die jedoch meist noch auf die Bestätigung durch größere Fallserien warten lassen.Der vorliegende Beitrag diskutiert den Stellenwert konventioneller Prognosefaktoren, wie Tumorstadium, Alter, postoperativer Tumorrest, Lymphknotenstatus, Aszites und neueren propagierten Faktoren, wie Her-2-Status, PAI-1, MMP, VEGF und CD24.
Abstract
Epithelial ovarian cancer is the leading cause of death from gynaecologic malignancies in western countries. In the clinical day treatment decision of the physician (e. g. surgery, chemotherapy) based on individual prognostic factors of the patient with ovarian cancer.The tumor stage at time of diagnosis and the postoperative residual tumor mass are prognostic factors and are unequivocally related to overall survival. Other prognostic factors are identified mostly in small series and are discussed in the literature controversially.This article discussing the value of conventional prognostic factors, as stage, postoperative tumor mass, age, lymph node status, ascites) and newer molecular biological factors, as Her-2-status, PAI-1, MMP, VEGF and CD24.
Schlüsselwörter
Ovarialkarzinom - Prognosefaktoren - Molekularbiologie - Übersicht
Key words
Ovarian cancer - prognostic factor - molecular biology - review
Literatur
- 1 Ali-Fehmi R, Che M, Khalifeh I, Malone J M, Morris R, Lawrence W D, Munkarah A R. The effect of cyclooxygenase-2 expression on tumor vascularity in advanced stage ovarian serous carcinoma. Cancer. 2003; 98 1423-1429
- 2 Avarez L D, To A, Boots L R. et al . CA 125 as a serum marker for poor prognosis in ovarian malignancies. Gynecol Oncol. 1987; 26 284-289
- 3 Baiocchi G, Grosso G, Di Re E. Systematic pelvic and peraortic lymphadenectomy at second look laparotomy for ovarian cancer. Gynecol Oncol. 1998; 69 151-156
- 4 Bridgewater J A, Nelstrop A E, Rustin G J, Gore M E, McGuire W P, Hoskins W J. Comparison of Standard and CA-125 Response Criteria in Patients With Epithelial Ovarian Cancer Treated With Platinum or Paclitaxel. J Clin Oncol. 1999; 17 501-508
- 5 Bristow R E, Tomacruz R S, Armstrong D K, Trimble E L, Montz F J. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol. 2002; 20 1248-1259
- 6 Burger R A, Grosen E A, Ioli G R, Van Eden M E, Brightbill H D, Gatanaga M, DiSaia P J, Granger G A, Gatanaga T. Host-tumor interaction in ovarian cancer. Spontaneous release of tumor necrosis factor and interleukin-1 inhibitors by purified cell populations from human ovarian carcinoma in vitro. Gynecol Oncol. 1994; 55 294-303
- 7 Burghardt E, Girardi F, Lahousen M. Patterns of pelvic and paraaortic lymph node involvement in ovarian cancer. Gynecol Oncol. 1991; 40 103-106
- 8 Burghardt E, Pickel H, Lahousen M, Stettner H. Pelvic lymphadenectomy in operative treatment of ovarian cancer. Am J Obstet Gynecol. 1986; 155 315-319
- 9 Carnino F, Fuda G C, Ciccone G, Iskra L, Guercio E, Dadone D, Conte P F. Significance of Lymph Node Sampling in Epithelial Carcinoma of the Ovary. Gynecol Oncol. 1997; 65 467-472
- 10 Chambers S, Ivins M, Carcangiu M. Plasminogen activator inhibitor-1 is an independent poor prognostic factor for survival in advanced stage epithelial ovarian cancer patients. Int J Cancer (Pred Oncol). 1998; 79 449-454
- 11 Chi D S, Liao J B, Leon L F, Venkatraman E S, Hensley M L, Bhaskaran D, Hoskins W J. Identification of prognostic factors in advanced epithelial ovarian carcinoma. Gynecol Oncol. 2001; 82 532-537
- 12 Cobleigh M A, Vogel C L, Tripathy D, Robert N J, Scholl S, Fehrenbacher L, Wolter J M, Paton V, Shak S, Lieberman G, Slamon D J. Multinational study of the efficacy and safety of humanized anti-HER2 monoclonal antibody in women who have HER2-overexpressing metastatic breastcancer that has progressed after chemotherapy for metastatic disease. J Clin Oncol. 1999; 17 2639-2648
- 13 Cooper B C, Sood A K, Davis C S, Ritchie J M, Sorosky J I, Anderson B, Buller R E. Preoperative CA 125 levels: an independent prognostic factor for epithelial ovarian cancer. Obstet Gynecol. 2002; 100 59-64
- 14 Dembo A J, Davy M, Stenwig A E, Berle E J, Bush R S, Kjorstad K. Prognostic factors in patients with stage I epithelial ovarian cancer. Obstet Gynecol. 1990; 75 263-273
- 15 Denkert C, Kobel M, Pest S. et al . Expression of cyclooxygenase 2 is an independent prognostic factor in human ovarian carcinoma. Am J Pathol. 2002; 160 893-903
- 16 Di Re F, Baiocchi G, Fontanelli R, Gross G. et al . Systematic pelvic and paraaortic lymphadenectomy for advanced ovarian cancer: Prognostic significance of node metastasis. Gynecol Oncol. 1996; 62 360-365
-
17 Dt. Krebsgesellschaft .Kurzgefasste Interdisziplinäre Leitlinien. Maligne Ovarialtumoren. 3. Aufl. W. Zuckschwerdt-Verlag, München, Bern, Wien, New York 2002
- 18 du Bois A, Luck H J, Meier W, Adams H P, Mobus V, Costa S. et al . A randomized clinical trial of cisplatin/paclitaxel versus carboplatin/paclitaxel as first-line treatment of ovarian cancer. J Natl Cancer Inst. 2003; 95 1320-1329
- 19 Eisenkop S M, Friedman R L, Spirtos N M. The role of secondary cytoreductive surgery in the treatment of patients with recurrent epithelial ovarian carcinoma. Cancer. 2000; 88 144-153
- 20 Eisenkop S M, Friedman R L, Wang H J. Complete cytoreductive surgery is feasible and maximizes survival in patients with advanced epithelial ovarian cancer: A prospective study. Gynecol Oncol. 1998; 69 103-108
- 21 Eisenkop S M, Friedman R L, Wang H J. Complete cytoreductive surgery is feasible and maximizes survival in patients with advanced epithelial ovarian cancer: A prospective study. Gynecol Oncol. 1998; 69 103-108
-
22 Elbendare A A, Berchuk A, Bast R C. Biology of epithelial ovarian cancer. In: Lawton FG, Neijt JP, Swenerton KD. Epithelial cancer of the ovary. BMJ Publishing Group, London 1995; 20-25
-
23 Enomoto T, Kuragaki C, Yamasaki M, Sugita N. et al .Is Clear Cell Carcinoma and Mucinous Carcinoma of the Ovary Sensitive to Combination Chemotherapy with Paclitaxel and Carboplatin?. 39th ASCO Annual Meeting 2003; Abstract 1797
- 24 Fajac A, Benard J, Lhomme K. C-erB2gene amplification and protein expression in ovarian epithelial tumors: evaluation of their respective prognostic significance by multivariate analysis. Int J Cancer (Pred Oncol). 1995; 65 146-151
- 25 Ferrandina G, Lauriola L, Zannoni G F, Fagotti A, Fanfani F, Legge F, Maggiano N, Gessi M, Mancuso S, Ranelletti F O, Scambia G. Increased cyclooxygenase-2 (COX-2) expression is associated with chemotherapy resistance and outcome in ovarian cancer patients. Ann Oncol. 2002; 13 1205-1211
- 26 Geisler J P, Miller G A, Lee T H, Harwood R M, Wiemann M C, Geisler H E. Relationship of preoperative serum CA-125 to survival in epithelial ovarian carcinoma. J Reprod Med. 1996; 41 140-142
- 27 Geisler J P, Wiemann M C, Miller G A. et al . Estrogen and progesterone receptor status as prognostic indicator in patients with optimally cytoreduced stage IIIc serous cystadenocarcinomaof the ovary. Gynecol Oncol. 1996; 60 424-427
- 28 Gotlieb W H, Abrams J S, Watson J M, Velu T J, Berek J S, Martinez-Maza O. Presence of interleukin 10 (IL-10) in the ascites of patients with ovarian and other intra-abdominal cancers. Cytokine. 1992; 4 385-390
-
29 Hess V, A'Hern R P, Gore M E. Relative Platinum-Resistance of Mucinous Carcinoma of the Ovary. 39th ASCO Annual Meeting 2003; Abstract 1796
- 30 Hoskins W. Surgical staging and cytoreductive surgery of epithelial ovarian cancer. Cancer. 1993; 71 1534-1540
- 31 Hoskins W J, McGuire W P, Brady M F, Homesley H D, Creasman W T, Berman M, Ball H, Berek J S. The effect of diameter of largest residual disease on survival after primary cytoreductive surgery in patients with suboptimal residual epithelial ovarian carcinoma. Am J Obstet Gynecol. 1994; 170 974-980
- 32 Hsieh C Y, Chen C A, Chou C H, Lai K P, Jeng Y M, Kuo M L, Wei L H. Overexpression of Her-2/NEU in Epithelial Ovarian Carcinoma Induces Vascular Endothelial Growth Factor C by Activating NF-kappaB: Implications for Malignant Ascites Formation and Tumor Lymphangiogenesis. J Biomed Sci. 2004; 11 249-259
- 33 Jacobs I J, Menon U. Progress challenges in screening for early detection of ovarian cancer. Mol Cell Proteomics. 2004; 3 355-366
- 34 Jacobs J, Oram J, Fairbanks, Turner J, Frost C, Grudzinskas J G. A risk of malignancy index incorporating CA125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer. Br J Obstet Gynecol. 1990; 97 922-992
- 35 Kikkawa F, Kawai M, Mizuno, Ishikawa H, Kojima M, Maeda O, Tamakoshi K, Suganuma N, Tomoda Y, Hattori S. Recurrence of epithelial ovarian carcinoma after clinical remission. Gynecol Obstet Invest. 1994; 38 65-69
- 36 Kindermann G, Maassen V, Kuhn W. Laparoscopic management of ovarian tumors subsequently diagnosed as malignant: a survey from 127 German departments of obstetrics and gynecology. J Pelvic Surgery. 1996; 2 245-251
- 37 Kishi T, Grass L, Soosaipillai A, Scorilas A, Harbeck N, Schmalfeldt B, Dorn J, Mysliwiec M, Schmitt M, Diamandis E P. Human kallikrein 8, a novel biomarker for ovarian carcinoma. Cancer Res. 2003; 63 2771-2774
- 38 Klemi P J, Joensuu H, Salmi T. Prognostic value of flow cytometric DNA content analysis in granulosa cell tumor of the ovary. Cancer. 1990; 65 1189-1193
- 39 Kommoss F, Pfisterer J, Thome M, Schafer W, Sauerbrei W, Pfleiderer A. Steroid receptors in ovarian carcinoma: Immunohistochemical determination may lead to new aspects. Gynecol Oncol. 1992; 47 317-322
- 40 Kristiansen G, Denkert C, Schluns K. et al . CD24 is expressed in ovarian cancer and is a new independent prognostic marker of patient survival. Am J Pathol. 2002; 161 1215-1221
- 41 Kuhn W, Schmalfeldt B, Reuning U. et al . Prognostic significance of urokinase (uPA) und ts inhibitor PAI-1 for survival in advanced ovarian carcinoma stage FIGO III c. Br J Cancer. 1999; 79 1746-1751
- 42 Kupryjanczyk J, Thor A D, Beauchamp R, Poremba C, Scully R E, Yandell D W. Ovarian, peritoneal, and endometrial serous carcinoma: clonal origin of multifocal disease. Mod Pathol. 1996; 9 166-173
- 43 Landis S H, Murray T, Bolden S. Cancer Statistic. CA Cancer J Clin. 1999; 8 49-54
- 44 Lavin P T, Knapp R C, Malkasian G. et al . CA-125 for the monitoring of ovarian carcinoma during primary therapy. Obstet Gynecol Gynecol. 1987; 69 223-227
- 45 Lengyel E, Schmalfeldt B, Konik E. et al . Expression of latent matrix metalloproteinase-9 predicts survival in advanced ovarian cancer. Gynecol Oncol. 2001; 82 291-298
- 46 Lichtenegger W, Sehouli J, Buchmann E, Karajanev C, Weidemann H. Operative results after primary and secondary debulking-operations in advanced ovarian cancer. J Obstet Gyn Res. 1998; 24 447-451
- 47 Lück H .J, Kommoss F, Riener E. et al . HER2-expression in advanced ovarian cancer: A prognostic and predictive marker?. Eur J Cancer. 2003; 39 (Suppl 1) 16
- 48 Maggioni A, Maneshi F, Maggioni C. et al . Randomized trial of lymphadenektomie (LY) vs, sampling (SA) or resection of bulky nodes (RBN) as primary surgical procedure in early epithelial ovarian cancer. Int J Gynecol Cancer. 1999; 9 43
- 49 Makar A, Baekelandt M, Tropè C O, Kristensen G B. The prognostic Significance of Residual Disease, FIGO Substage, Tumor Histology, and Grade in Patients with FIGO Stage III Ovarian Cancer. Gynecol Oncol. 1995; 56 175-180
- 50 Manenti L, Paganoni P, Floriani I, Landoni F, Torri V, Buda A, Taraboletti G, Labianca R, Belotti D, Giavazzi R. Expression levels of vascular endothelial growth factor, matrix metalloproteinases 2 and 9 and tissue inhibitor of metalloproteinases 1 and 2 in the plasma of patients with ovarian carcinoma. Eur J Cancer. 2003; 39 1948-1956
- 51 Mayr D, Diebold J. Grading of ovarian carcinomas. Int J Gynecol Pathol. 2000; 19 348-353
- 52 Meerpohl H G. Prognostic factors of ovarian cancer. Onkologie. 1985; 8 296-304
-
53 Meigs J V. Tumors of the female pelvic organs. Mc Millan, New York 1934
- 54 Munnel E W. The changing prognosis and treatment in cancer of the ovary. Am J Obstet Gynecol. 1968; 100 790
- 55 Menon U, Talaat A, Rosenthal A N, Macdonald N D, Jeyerajah A R, Skates S J, Sibley K, Oram D H, Jacobs I J. Performance of ultrasound as a second line test to serum CA 125 in ovarian cancer screening. Br J Obstet Gynecol. 2000; 107 165-169
- 56 Mujoo K, Watanabe M, Nakamura J, Khokhar A R, Siddik Z H. Status of p53 phosphorylation and function in sensitive and resistant human cancer models exposed to platinum-based DNA damaging agents. J Cancer Res Clin Oncol. 2003; 129 709-718
- 57 NIH . National Institutes of Health Consensus Development Conference Statement. Ovarian Cancer: Screening, Treatment, and Follow-up. Gynecol Oncol. 1994; 55 4-12
- 58 Omura G A, Brady M F, Homesley H D, Yordan E, Major F J, Buchsbaum H J, Park R C. Long-term follow-up and prognostic factor analysis in advanced ovarian carcinoma: the Gynecologic Oncology Group experience. J Clin Oncol. 1991; 9 1138-1150
- 59 Paley P J, Staskus K A, Gebhard K. et al . Vascular endothelial growth factor expression in early stage ovarian carcinoma. Cancer. 1997; 80 98-106
- 60 Panici P B, Angioli R. Role of lymphadenectomy in ovarian cancer. Best Practice & Res Clin Obstet Gynecol. 2002; 16 529-551
- 61 Parazzini F, Valsecchi G, Bolis G. et al . Pelvic and paraaortic Lymph nodal status in advanced ovarian cancer and survival. Gynecol Oncol. 1999; 74 7-11
- 62 Parker D, Bradley C, Bogle S M, Lay J, Masood M, Hancock A K, Naylor B, Price J J. Serum albumin and CA 125 are powerful predictors of survival in epithelial ovarian cancer. Br J Obstet Gynecol. 1994; 101 888-893
-
63 Pecorelli S, Benedet J, Beller U, Creasman W, Heintz A, Pettersson F. FIGO Annual Report on the Results of Treatment in Gynaecological Cancer. Isis Medical Media Ltd., Oxford, England 2001; 6: 1-184
- 64 Pecorelli S, Boyle P, Odicino F, Sideri M Maisonneuve P, Severi G, Zigliani L. FIGO Annual Report on the Results on the Treatment in Gynaecological Cancer. J Epidemiol Biostat. 1998; 3 1-168
- 65 Pfisterer J, Kommoss F, Sauerbrei W. et al . Cellular DNA content and survival in advanced ovarian carcinoma. Cancer. 1994; 74 2509-2515
- 66 Pisa P, Halapi E, Pisa E K, Gerdin E, Hising C, Bucht A, Gerdin B, Kiessling R. Selective expression of interleukin 10, interferon gamma, and granulocyte-macrophage colony-stimulating factor in ovarian cancer biopsies. Proc Natl Acad Sci USA. 1992; 89 7708-7712
- 67 Puls L E, Duniho T, Hunter J E, Kryscio R, Blackhurst D, Gallion H. The Prognostic Implication of Ascites in Advanced-Stage Ovarian Cancer. Gynecol Oncol. 1996; 61 109-112
- 68 Radke J, Schmidt D, Bohme M, Schmidt U, Weise W, Morenz J. Zytokinspiegel im malignen Aszites und peripheren Blut von Patientinnen mit fortgeschrittenem Ovarialkarzinom. Geburtsh Frauenheilkd. 1996; 56 83-87
-
69 Rahaman J, Jennings T S, Dottino P, Cohen C J. Impact of Age on Survival in Advanced Ovarian Cancer: a Re-Examination. Proceedings of ASCO unter www.asco.org. 2001; Abstract 866
- 70 Reles A, Press M F, Schönborn I, Lichtenegger W, Strohmeyer T. p53 Proteinuberexpression in Ovarialkarzinomen: Korrelation mit histopathologischen Daten und klinischem Verlauf. Gynäkol Geburtsh Rundsch. 1995; 35 (Suppl 1) 93-97
- 71 Reles A, Wen W H, Schmider A, Gee C, Runnebaum I B, Kilian U, Jones L A, El-Naggar A, Minguillon C, Schonborn I, Reich O, Kreienberg R, Lichtenegger W, Press M F. p53 mutations and expression in ovarian cancers: correlation with overall survival. Int J Gynecol Pathol. 1999; 18 29-41
- 72 Roszkowski P, Wronkowski Z, Szamborski J. et al . Evaluation of selected prognostic factors in ovarian cancer. Eur J Gynecol Oncol. 1993; 14 (Suppl) 140-145
-
73 Sakurai S, Shimizu Y, Utsugi K, Umezawa S, Kato T, Fukasawa I, Inaba N, Hasumi K. Validity of complete paraaortic and pelvic lymphadenectomy in apparent stage I (pT1) ovarian carcinoma. 38th ASCO Annual Meeting 2002; Abstract 801
- 74 Scambia G, Testa U, Benedetti-Panici P, Foti E, Martucci R, Gadducci A, Perillo A, Facchini V, Peschle C, Mancuso S. Prognostic significance of interleukin-6 serum levels in patients with ovarian cancer. Br J Cancer. 1995; 71 354-356
- 75 Scambia G, Testa U, Panici P B, Martucci R, Foti E, Petrini M, Amoroso M, Masciullo V, Peschle C, Mancuso S. Interleukin-6 serum levels in patients with gynecological tumors. Int J Cancer. 1994; 57 318-323
- 76 Schmalfeldt B, Prechtel D, Harting K, Spathe K, Rutke S, Konik E, Fridman R, Berger U, Schmitt M, Kuhn W, Lengyel E. Increased expression of matrix metalloproteinases (MMP)-2, MMP-9, and the urokinase- type plasminogen activator is associated with progression from benign to advanced ovarian cancer. Clin Cancer Res. 2001; 8 2396-2404
- 77 Schmider A, Gee C, Friedmann W, Lukas J J, Press M F, Lichtenegger W, Reles A. P21 (WAF1/CIP1) protein expression is associated with prolonged survival but not with p53 expression in epithelial ovarian carcinoma. Gynecol Oncol. 2000; 77 237-242
- 78 Schneider D, Halperin R, Halperin D, Bukovsky I, Hadas E. Prediction of the survival of patients with advanced ovarian cancer according to a risk model based on a scoring system. Eur J Gynecol Oncol. 1998; 19 547-552
-
79 Scully R E, Silva E. Pathology of ovarian cancer. In: Gersheson GM, McGuire WP (eds). Ovarian Cancer. Controversies in management. Churchill Livingstone, New York, Edinburgh, London, Madrid, Melbourne, San Francisco, Tokio 1988; 425-444
- 80 Sehouli J, Akdogan Z, Heinze T, Könsgen D, Stengel D, Mustea A, Lichtengger W. Preoperative Determination of CASA (Cancer Associated Serum Antigen) and CA-125 for the Discrimination between Benign and Malignant Pelvic Tumor Mass: A Prospective Study. Anticancer Res. 2003; 23 1115-1118
- 81 Sehouli J, Konsgen D, Mustea A, Oskay-Ozcelik G, Katsares I, Weidemann H, Lichtenegger W. “IMO” - Intraoperative Mapping of Ovarian Cancer. Zentralbl Gynakol. 2003; 125 129-135
- 82 Sevelda P, Vavra N, Schemper M. et al . Prognostic factors for survival in stage I epithelial ovarian carcinoma. Cancer. 1990; 65 2349-2352
- 83 Silverberg S G. Prognostic significance of pathologic features of ovarian carcinoma (Review). Current Topics Pathol. 1989; 78 85-109
- 84 Sliutz G. Prognosefaktoren beim Ovarialkarzinom. Wien, Med Wochenschr. 1996; 146 14-17
- 85 Sonmezer M, Gungor M, Ensari A, Ortac F. Prognostic significance of tumor angiogenesis in epithelial ovarian cancer: In association with transforming growth factor beta and vascular endothelial growth factor. Int J Gynecol Cancer. 2004; 14 82-88
- 86 Sowter H M, Corps A N, Evans A L, Clark D E, Charnock-Jones D S, Smith S K. Expression and localization of the vascular endothelial growth factor family in ovarian epithelial tumors. Lab Invest. 1997; 77 607-614
- 87 Tempfer C, Zeisler H, Sliutz G, Haeusler G, Hanzal E, Kainz C. Serum evaluation of interleukin 6 in ovarian cancer patients. Gynecol Oncol. 1997; 66 27-30
- 88 Thigpen T, Brady M F, Omura G A, Creasman W T, McGuire W P, Hoskins W J, Williams S. Age as prognostic factor in ovarian carcinoma. Cancer. 1993; 71 606-614
- 89 Tsuruchi N, Kamura T, Tsukamoto N, Akazawa K. et al . Relationship between Paraaortic Lymph Node Involvement and Intraperitoneal Spread in Patients with Ovarian Cancer-a multivariate Analysis. Gynecol Oncol. 1993; 49 51-55
- 90 van der Burg M EL, Lammes F B, Verweij J. et al . The role of CA125 in the early diagnosis of progresive disease in ovarian cancer. Ann Oncol. 1990; 1 301-302
- 91 Vergote I B, Bormer O P, Abeler V M. Evaluation of serum CA125 levels in the monitoring of ovarian cancer. Am J Obstet Gynecol. 1987; 157 88-92
- 92 Vergote I B, De Brabanter J, Fyles A. Prognostic importance of degree of differentiation and cyst rupture in stage I invasive epithelial ovarian carcinoma. Prognostic importance of degree of differentiation and cyst rupture in stage I invasive epithelial ovarian carcinoma. Lancet. 2001; 357 176-182
- 93 Vergote I B, Kaern J, Abeler V. et al . Analysis of prognostic factors in stage I epithelial ovarian cancer: Importance of degree of differentiation and deoxyribonucleic acid ploidy in predicting relapse. Am J Obstet Gynecol. 1993; 169 40-52
- 94 Walter A J, Magrina J F. Contralateral pelvic and aortic lymph node metastasis in clinical stage I epithelial ovarian cancer. Gynecol Oncol. 1999; 74 128-129
- 95 Watson J M, Sensintaffar J L, Berek J S, Martinez-Maza O. Constitutive production of interleukin 6 by ovarian cancer cell lines and by primary ovarian tumor cultures. Cancer Res. 1990; 50 6959-6965
- 96 Wong C, Wellman T L, Lounsbury K M. VEGF and HIF-1alpha expression are increased in advanced stages of epithelial ovarian cancer. Gynecol Oncol. 2003; 91 513-517
- 97 Wu P C, Qu J Y, Lang J H. Lymph node metastasis of ovarian cancer: a preliminary survey of 74 cases of lymphadenectomy. Am J Obstet Gynecol. 1986; 155 1103-1108
- 98 Yokoyama Y, Charnock-Jones D S, Licence D. et al . Vascular endothelial growth factor-D is an independent prognostic factor in epithelial ovarian carcinoma. Br J Cancer. 2003; 88 237-244
- 99 Zeimet A G. et al . Ascitic Interleucin-12 is an independent prognostic factor in ovarian cancer. J Clin Oncol. 1998; 16 1861-1866
Dr. Jalid Sehouli
Universitätsklinikum Charité · Klinik für Frauenheilkunde und Geburtshilfe · Campus Virchow-Klinikum
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