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. 2001 Jan 20;357(9251):176-82.
doi: 10.1016/S0140-6736(00)03590-X.

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

I Vergote  1 , J De Brabanter, A Fyles, K Bertelsen, N Einhorn, P Sevelda, M E Gore, J Kaern, H Verrelst, K Sjövall, D Timmerman, J Vandewalle, M Van Gramberen, C G Tropé
Affiliations

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

I Vergote et al. Lancet. .

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.

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Comment in

  • Prospects for improving staging of ovarian cancers.
    Trimble EL. Trimble EL. Lancet. 2001 Jan 20;357(9251):159-60. doi: 10.1016/S0140-6736(00)03583-2. Lancet. 2001. PMID: 11213087 No abstract available.
  • Cyst rupture during surgery.
    Campo R, Gordts S, Borsens I. Campo R, et al. Lancet. 2001 Jul 7;358(9275):72-3. doi: 10.1016/s0140-6736(00)05284-3. Lancet. 2001. PMID: 11458937 No abstract available.
  • Cyst rupture during surgery.
    Ben-Arie A, Lavie O. Ben-Arie A, et al. Lancet. 2001 Jul 7;358(9275):72; author reply 73. doi: 10.1016/S0140-6736(00)05283-1. Lancet. 2001. PMID: 11458938 No abstract available.

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