Prognostic importance of degree of differentiation and cyst rupture in stage I invasive epithelial ovarian carcinoma

Vergote, Ignace; De Brabanter, Joseph; Fyles, A; Bertelsen, K; Einhorn, N; Sevelda, P; Gore, ME; Kaern, J; Verrelst, Herman; Sjövall, K; Timmerman, Dirk; Vandewalle, Joos; Van Gramberen, M; Tropé, CG

doi:10.1016/S0140-6736(00)03590-X

Prognostic importance of degree of differentiation and cyst rupture in stage I invasive epithelial ovarian carcinoma

Author:

Vergote, Ignace

De Brabanter, Joseph ; Fyles, A ; Bertelsen, K ; Einhorn, N ; Sevelda, P ; Gore, ME ; Kaern, J ; Verrelst, Herman ; Sjövall, K ; Timmerman, Dirk ; Vandewalle, Joos ; Van Gramberen, M ; Tropé, CG

Keywords:

Cell Differentiation, Disease-Free Survival, Female, Humans, Middle Aged, Multivariate Analysis, Ovarian Cysts, Ovarian Neoplasms, Prognosis, Retrospective Studies, SISTA, Science & Technology, Life Sciences & Biomedicine, Medicine, General & Internal, General & Internal Medicine, ADJUVANT TREATMENT, CANCER, SURVIVAL, NEOPLASMS, SPREAD, TRIALS, 11 Medical and Health Sciences, 32 Biomedical and clinical sciences, 42 Health sciences

Abstract:

BACKGROUND: Previous studies on prognostic factors in stage I invasive epithelial ovarian carcinoma have been too small for robust conclusions to be reached. We undertook a retrospective study in a large international database to identify the most important prognostic variables. METHODS: 1545 patients with invasive epithelial ovarian cancer (International Federation of Gynaecology and Obstetrics [FIGO] stage I) were included. The records of these patients were examined and data extracted for univariate and multivariate analysis of disease-free survival in relation to various clinical and pathological variables. FINDINGS: The multivariate analyses identified degree of differentiation as the most powerful prognostic indicator of disease-free survival (moderately vs well differentiated hazard ratio 3.13 [95% CI 1.68-5.85], poorly vs well differentiated 8.89 [4.96-15.9]), followed by rupture before surgery (2.65 [1.53-4.56]), rupture during surgery (1.64 [1.07-2.51]), FIGO 1973 stage Ib vs Ia 1.70 [1.01-2.85]) and age (per year 1.02 [1.00-1.03]). When the effects of these factors were accounted for, none of the following were of prognostic value: histological type, dense adhesions, extracapsular growth, ascites, FIGO stage 1988, and size of tumour. INTERPRETATION: Degree of differentiation, the most powerful prognostic indicator in stage I ovarian cancer, should be used in decisions on therapy in clinical practice and in the FIGO classification of stage I ovarian cancer. Rupture should be avoided during primary surgery of malignant ovarian tumours confined to the ovaries.