Predictive informativeness of risk factors for the development of ovarian cancer of different histological types: a randomized study

BACKGROUND: Given the considerable morphological heterogeneity of invasive epithelial ovarian cancer, characterized by differences in clinical course and rates of progression, investigation of predictors specific to each histological type is of particular relevance.

AIM: This work aimed to identify the predictive significance of hereditary and phenotypic factors modulating the risk of developing different histological types of invasive epithelial ovarian cancer.

METHODS: A total of 620 patients with invasive epithelial ovarian cancer of various histological types were examined in the main group: serous carcinoma (57.7%), endometrioid carcinoma (23.1%), clear cell carcinoma (11.6%), and mucinous ovarian carcinoma (7.6%). The control group consisted of 226 women without cancer. Information on risk factors was obtained from medical records. Comparative analysis of the frequency characteristics of the studied variables between the main and control groups was performed using the Pearson chi-square (χ²) test. The strength of association was assessed using Cramér’s V coefficient.

RESULTS: Compared with the control group, the main group showed higher frequencies of ovarian cancer (7.7% vs. 0%; p < 0.001) and breast cancer (5.0% vs. 0%; p < 0.001) in first-degree relatives; obesity in childhood (11.3% vs. 5.3%; p = 0.002), obesity in adolescence (10.6% vs. 3.5%; p = 0.001), and obesity at the time of primary diagnosis (47.1% vs. 21.7%; p < 0.001). The main group more frequently reported the use of postmenopausal hormone replacement therapy (45.0% vs. 33.6%; p = 0.003) and endometriosis (13.4% vs. 7.5%; p = 0.02), whereas full-term pregnancy (p < 0.001), breastfeeding (p < 0.001), and oral contraceptive use (p < 0.001) were less frequent. For the development of advanced serous ovarian carcinoma, the most substantial predictors were hereditary factors, obesity at the time of diagnosis, and postmenopausal hormone replacement therapy. In comparison with serous carcinoma, the distinguishing predictors were endometriosis, late menopause, and obesity in childhood and adolescence for endometrioid carcinoma; endometriosis for clear cell carcinoma; and obesity in adolescence and smoking for mucinous ovarian carcinoma.

CONCLUSION: In rare histological types of invasive epithelial ovarian cancer, compared with serous carcinoma, the predictive significance of endometriosis, late menopause, smoking, and obesity in childhood and adolescence increases substantially.