Early Stage Epithelial Ovarian Cancer

At diagnosis, approximately one third of patients with epithelial ovarian cancer have early-stage disease that is confined to the ovary or pelvis. Although the 5-year survival for patients with early-stage ovarian cancer is much better than that for those with advanced disease, relapse rates ranging from 20% to 30% have been quoted for patients with poor prognostic factors. Classic clinical and pathologic prognostic factors, such as degree of differentiation, FIGO substage, histologic type, dense adhesions, large-volume ascites, rupture before or during surgery, bilaterality, positive peritoneal cytology extracapsular growth, and age of the patient have been identified as prognostic characteristics.54,55 The main limitation of the conclusions derived from previous retrospective analyses is that the sample sizes of most were too small for some independent prognostic variables to be detectable with sufficient power.

Vergote and colleagues56 conducted a large retrospective study of 1545 patients with stage I disease. In this study, the degree of differentiation was the most powerful prognostic indicator of disease-free survival (moderately versus well-differentiated hazard ratio 3.13, poorly versus well-differentiated hazard ratio 8.89). The study also confirmed that cyst rupture before surgery was an independent poor prognostic factor. Similarly, intraoperative cyst rupture also seemed to confer an unfavorable impact on survival, underscoring the importance of avoiding rupture during surgery (Table 7-2, Fig. 7-23).

Table 7-2. Significant Variables for Actuarial Disease-Free Survival in Final Multivariate Model

Hazard Ratio (95% CI) on

Characteristic Multivariate Analysis P Value

Degree of differentiation

Hazard Ratio (95% CI) on

Characteristic Multivariate Analysis P Value

Degree of differentiation

Good*

Moderate

3.13 (1.68-5.85) 8.89 (4.96-15.9)

.0003 .0001

Rupture before surgery

2.65 (1.53-4.56)

.0005

Rupture during surgery

1.64 (1.07-2.51)

.022

FIGO stage 1973

IA IB

1.70 (1.01-2.85)

.046

Age (per year)

1.02 (1.00-1.03)

.053

* Reference category.

From Vergote I, De Brabanter J, Fyles A, et al: Prognostic importance of degree of differentiation and cyst rupture in stage I invasive epithelial ovarian carcinoma. Lancet 357:176-182, 2001, Table 3.

* Reference category.

From Vergote I, De Brabanter J, Fyles A, et al: Prognostic importance of degree of differentiation and cyst rupture in stage I invasive epithelial ovarian carcinoma. Lancet 357:176-182, 2001, Table 3.

Degree of differentiation

Degree of differentiation

Time since surgery (months)
Number at risk:

Well differentiated 529

491

469

427

362

302

Moderately 473

415

364

319

273

216

differentiated

Poorly differentiated 347

274

223

189

153

122

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