Advanced stage mucinous adenocarcinoma of the ovary is both rare and highly lethal

A Gynecologic Oncology Group Study


  • The following Gynecologic Oncology Group member institutions participated in this study: United States: Roswell Park Cancer Institute, University of Alabama at Birmingham, Duke University Medical Center, Abington Memorial Hospital, Walter Reed Army Medical Center, University of Minnesota Medical School, University of Mississippi Medical Center, Colorado Gynecologic Oncology Group P.C., University of California at Los Angeles, University of Washington, University of Pennsylvania Cancer Center, Milton S. Hershey Medical Center, University of Cincinnati, University of North Carolina School of Medicine, University of Iowa Hospitals and Clinics, University of Texas Southwestern Medical Center at Dallas, Indiana University School of Medicine, Wake Forest University School of Medicine, University of California Medical Center at Irvine, Tufts-New England Medical Center, Rush-Presbyterian-St. Luke's Medical Center, Magee Women's Hospital, SUNY Downstate Medical Center, University of Kentucky, University of New Mexico, The Cleveland Clinic Foundation, State University of New York at Stony Brook, Southwestern Oncology Group, Washington University School of Medicine, Cooper Hospital/University Medical Center, Columbus Cancer Council, MD Anderson Cancer Center, University of Massachusetts Medical School, Fox Chase Cancer Center, Women's Cancer Center, University of Virginia Health Sciences Center, University of Chicago, Tacoma General Hospital, Thomas Jefferson University Hospital, Mayo Clinic, Case Western Reserve University, Tampa Bay Cancer Consortium, Gynecologic Oncology Network, Ellis Fischel Cancer Center, Fletcher Allen Health Care, Yale University, University of Wisconsin Hospital, Cancer Trials Support Unit, University of Texas-Galveston, Women and Infants Hospital, Community and Clinical Oncology Program. Australasia: Australian New Zealand Gynaecological Oncology and Australian New Zealand Gynaecological Oncology Group/NHMRC Clinical Trial Centre. United Kingdom: Yeovil, Hull, Aberdeen Royal Infirmary, Airedale General Hospital, Bronglais General Hospital, Broomfield Hospital, Chelsea & Westminster Hospital, Cheltenham General Hospital, Christie Hospital, Churchill Hospital, City Hospital, Birmingham, Derbyshire Royal Infirmary, Derriford Hospital, Essex County Hospital, Guy's and St. Thomas' Hospital, Huddersfield Royal Infirmary, Ipswich Hospital NHS Trust, James Cook University Hospital, Lincoln County Hospital, Maidstone Hospital, Manor Hospital Mount Vernon Hospital, New Cross Hospital, Newcastle General Hospital, North Devon District Hospital, Northampton General Hospital, Nottingham City Hospital Trust, Oldchurch Hospital, Pilgrim Hospital, Queen Elizabeth Hospital, Queen Elizabeth the Queen Mother's Hospital, Royal Devon and Exeter Hospital, Russell Hall Hospital, part of the Dudley Group of Hospitals, St. Bartholomew's Hospital, St. George's Hospital, St. James's University Hospital, St. Mary's Hospital-Portsmouth, Torbay Hospital UCLH Gynaecological Cancer Centre, Velindre Hospital NHS Trust, Weston Park Hospital, and Wexham Park Hospital. Italy: Bari, IEO, Monza “San Gerardo” Pavoda, Palermo “Cervello” Rimini, Thiene, Treviglio, and Gallarate.

  • See editorial on pages 451-3, this issue.



Primary mucinous adenocarcinomas of the ovary are uncommon, and their biological behavior is uncertain. Retrospective studies have suggested that many mucinous carcinomas initially diagnosed as primary to the ovary have in fact metastasized from another site. A prospective randomized trial provided an opportunity to estimate the frequency of mucinous tumors, diagnostic reproducibility, and clinical outcomes.


A phase 3 trial enrolled 4000 women with stage III or IV ovarian carcinoma, treated by surgical staging and debulking, with randomization to one of five chemotherapeutic arms. Slides and pathology reports classified as primary mucinous carcinoma were reviewed independently by three pathologists. Cases were reclassified as primary or metastatic to the ovary according to two methods. Overall survival (OS) of reclassified groups was compared within the groups and with that of patients with serous carcinomas.


Forty-four cases were classified as mucinous adenocarcinoma upon review. Using either method, only about one third were interpreted by the three reviewers as primary mucinous carcinomas. Reproducibility of interpretations among the reviewers was high, with unanimity of opinion in 30 (68%) cases. The median survival (MS) did not differ significantly between the groups interpreted as primary or metastatic, but the OS was significantly less than that for women with serous carcinoma (14 vs 42 months, P < 0.001).


Advanced stage mucinous carcinoma of the ovary is very rare and is associated with poor OS. Many mucinous adenocarcinomas that are diagnosed as primary ovarian neoplasms appear to be metastatic to the ovary. Cancer 2011. © 2010 American Cancer Society.