Various biologic factors have been associated with prognostic significance in ovarian cancer. The role of ploidy in predicting outcome in ovarian cancer remains controversial. In many studies, diploid tumors have been associated with better survival rates. Recurrence-free survival of patients with DNA-diploid primary ovarian cancer was significantly better compared with that of patients with DNA-aneuploid tumors in univariate analysis (47% versus 18%; P = .01). The tumor-dependent overall survival rate of patients with DNA-diploid tumors was 57% compared with 30% with DNA-aneuploid tumors.62 Mutations of the p53 tumor suppressor genes have been found in epithelial ovarian cancer, but the clinical significance of p53 overexpression in ovarian carcinoma is uncertain. In univariate analysis, p53 overexpression was a significant prognostic factor. However, in multivariate analysis, after adjustment for stage and size of residual tumor following cytoreductive surgery, p53 overexpression did not retain statistical significance. Survival curves for patients with different stages and grades of tumor differentiation did not demonstrate a difference in survival among patients with no p53 overexpression compared with those who demonstrated any degree of p53 overexpression.63 Overexpression of the HER2/neu proto-oncogene occurs in 20% to 30% of ovarian epithelial cancers, in which it may be of prognostic significance. The incidence of HER2/neu amplification in late-stage (III-IV, 77%) is significantly higher than that in early-stage (I-II, 21%) invasive epithelial carcinoma and is associated with a worse prognosis.64 However, use of trastuzumab targeting the HER2/neu amplification has failed to show a benefit.65
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