The Clinical significance of DNA ploidy
as a prognostic factor in patients with
Borderline Ovarian Tumor
Retrospective study
Ji Young Lee, MD, PhD, David Marchetti, MD, M Steven Piver, MD
Department of Obstetrics and Gynecology
Sisters of Charity Hospital, Buffalo, NY
INTRODUCTION
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
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.
DNA Ploidy
The most important prognostic factor
in 370 patients with the borderline ovarian tumor
Int J Gynecol Oncol 1993 3: 349
A Review of the Literature
OBJECTIVES
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
MATERIALS & METHODS
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
Histology
Definition Malignant characteristics of epithelial hyperplasia
or stratification, mitotic activity, and cellular/nuclear atypia
No Stromal Invasion
MUCINOUS TYPE
DNA Flow Cytometry
by USLABS (Irvine, CA)
Diploid ( DI=1.0, single peak)
Aneuploid (DI;1.1-1.9), Multi-peak
RESULTS
….and DISCUSSION
Patients (No.)
Age Distribution
of Borderline Ovarian Tumor
8
MEAN AGE 54.5 yo
7
6
5
4
3
2
1
0
20-29
30-39
40-49
50-59
60-69
70-79
80-89
Age
Age distribution of Borderline Ovarian Tumor
Sep 1993 – Sep 2004 in Sweden
Int J Gynecol Cancer 2008;18:453–459.
Patients (No.)
Histology and Age Distribution
of Borderline Ovarian Tumor
5
4
Serous
3
Mucinous
2
Mixed
1
0
20-29
30-39
40-49
50-59
60-69
70-79
80-89
Age
Patients (No.)
DNA Ploidy and Age at Diagnosis
6
Diploid
5
4
Aneuploid
3
2
1
0
20-29
30-39
40-49
50-59
60-69
70-79
80-89
Age
The relationship of Histopathology
and FIGO stage of disease
Serous
Mucinous
Mixed
Total
IA
8(50%)
4(50%)
2
14
IB
1(8%)
1
1
3
Stage (%)
IC
4(21%)
0
0
4
Total
II
0
1
1
2
III
3(21%)
1
0
4
NA
0
1
2
3
16
8
6
30
The relationship of DNA ploidy and
Histology of disease
DNA ploid
Aneuploidy
Diploidy
Histology
Serous Mucinous Mixed
4 (45%) 2 (22%) 3 (33%)
12 (58%) 6 (28%) 3 (14%)
Total
9 (100%)
21 (100%)
Patients (No.)
DNA ploidy and Histologic type
14
12
58%
10
8
28%
6
14%
4
2
0
Serous-Diploid
Serous-Aneuploid Mucinous-Diploid
MucinousAneuploid
Mixed-Diploid
Mixed-Aneuploid
Histology-DNA Ploidy
The relationship of DNA ploidy and
FIGO stage of disease
DNA ploid
Aneuploidy
Diploidy
FIGO Stage
IA
IB
IC
II
III
Unstaged
Total
2
1
2
1
2
1
9 (30%)
12
2
2
1
2
2
21 (70%)
pl
oi
d
lo
id
-D
ip
-A
ne
up
lo
Un
id
sta
ge
dDi
Un
pl
sta
oi
d
ge
dAn
eu
pl
oi
d
III
III
lo
id
IIAn
eu
p
IIDi
IC
-A
ne
up
lo
id
lo
id
-D
ip
IC
IB
-A
ne
up
lo
id
lo
id
IB
-D
ip
lo
id
IA
-A
ne
up
IA
-D
ip
lo
id
Patients (No.)
DNA Ploidy and Disease Stage
14
12
Diploid
10
8
Aneuploid
6
4
2
0
Stage-DNA Ploidy
Characteristics of 30 patients
Characteristics
Age
< 50
≥ 50
Ethnicity
Caucasian
African-American
FIGO Stage
IA
IB
IC
II-III
Unstaged
Pelvic Cytology
positive
Negative
Histology
Serous
Mucinous
Mixed
Chemotherapy
Yes
No
TOTAL
(n=30)
Diploid
(n=21)
Aneuploid
(n=9)
p value
11
19
5
16
6
3
0.09
29
1
21
8
1
0.002
14
3
4
6
3
12
2
2
3
2
2
1
2
3
1
0.007
6
24
4
17
2
7
0.1
16
8
6
12
6
3
4
2
3
0.4
4
26
3
18
1
8
Histology
Borderline Ovarian Tumor
Tropé CG. Seminars in surgical oncology 2000 9(1)69 –75
The relation of histopathology
to ploidy status
Histopathology
Serous
Mucinous
Endometrioid
Clear cell
Mixed
Total
Number
of cases (%)
219 (54.9)
171 (42.9)
5 (1.2)
1 (0.2)
3 (0.8)
399
Diploid Aneuploid
No FCM
167
127
3
—
2
27
32
2
1
1
25
12
—
—
—
299
63
37
Int J Gynecol Cancer 2008;18:453–459.
Overall Recurrence and survival
in Borderline ovarian tumor
Stage I
Stage II & III
Total
N
686
219
905
Recurred
29
40
69(7.6%)
Died
9
22
31(3.4%)
Rubin SC, Sutton GP
(2001,Ovarian cancer 2nd edition)
DNA Ploidy and Prognosis
in Borderline Ovarian Tumor (I)
Cancer 1992 69(10): 2510
DNA Ploidy and Prognosis
in Borderline Ovarian Tumor (II)
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
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)
CONCLUSION
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

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ACKNOWLEDGEMENT
M Steven Piver, MD
David Marchetti, MD
Judine Davis, MD
Anthony Pivarunas, DO
Pathology Department
USLABS, CA