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abstract
Highlights
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- Autopsy data challenges epidemiologic knowledge regarding incidence and prevalence of ovarian carcinoma.
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- Previous epidemiological data overestimate incidence because up to 10% of carcinomas in the ovary were metastases from other primary sites.
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- In 16% of autopsies, ovarian carcinoma in its final stage was first diagnosed by autopsy.
Objective
We challenge epidemiologic knowledge regarding ovarian carcinoma (OC) by bridging the gap between clinical and autopsy data.
Methods
Autopsy
reports, histological slides and clinical files from 660 patients in
whom OC was diagnosed from 1975-2005 were studied (autopsy cohort,
n = 233; Clinical Cancer Registry from the local gyneco-oncologic
center, n = 427).
Results
Out of
the autopsy cohort, we identified four distinct subgroups of patients:
1) OC was diagnosed before autopsy, n = 156 (67.0%). 2) OC was an
incidental finding, n = 16 (6.8%). 3) The ovarian tumors were not
primary OC but rather metastases from other primary tumors; this revised
diagnosis was first made by using current histopathological
knowledge/techniques, n = 24 (10.3%). 4) Death was directly due to OC in
its final stage and OC was first diagnosed by autopsy, n = 37 (15.9%);
when these cases were added to the Clinical Cancer Registry to an
adjusted OC incidence model, the autopsy cases comprised 8.8% of the
adjusted cohort and almost doubled the percentage of oldest patients
(≥ 80 years at diagnosis) from 4.9% to 9.3% (p = 0.013).
Conclusions
Epidemiological
data from the 1970s-1990s may overestimate true incidence because up to
10% of carcinomas in the ovary were not properly classified. Patients
who were first diagnosed with OC by autopsy comprise a distinct
subgroup. These are patients who have not been seen by specialized
oncologists and thus play no role in their perception of the disease.
Nevertheless, these cases have impact on prevalence and incidence data
of OC and in an era of reduced autopsy rates will probably be
overlooked.
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