Outcome and prognostic factors of unexpected ovarian carcinomas

Abstract

Background: We investigated risk factors influencing the outcome of unexpected ovarian carcinomas.

Methods: We reviewed the ovarian carcinoma patients treated at atertiary medical institution between 2000 and 2017 and analyze the clinico-pathological characteristics, treatment strategies, recurrence status, and outcome.

Results: A total of 112 women (65 primary laparoscopic surgery [LSC] and 47 laparotomic surgery [LAPA]) were included in the analysis. The LSC group had smaller ovarian tumors (10.5 ± 7.3 cm vs. 16.6 ± 8.7 cm, p = 0.031) and higher incidence of subsequent staging surgery (56.9% vs. 25.5%, p = 0.0001) compared to the LAPA group. There were 98/112 (86.6%) of early stages (I/II) diseases. The difference between the recurrent rate (27.7% vs. 31.9%), disease-free survival (DFS), and overall survival (OS) were not significant among surgical groups. In the multivariate analysis, FIGO stage (stage II hazard ratio [HR] 6.61, p = 0.007; stage III HR 8.40, p = 0.002) was the only prognostic factor for DFS. FIGO stage (stage II HR 20.78, p = 0.0001; stage III HR 7.99, p = 0.017), histological type (mucinous HR 12.49, p = 0.036), and tumor grade (grade 3 HR 35.01, p = 0.003) were independent prognostic factors for OS, while women with latency >28 days from primary to staging surgery had significantly poorer OS (p = 0.008). Women with latency >28 days between primary surgery and adjuvant chemotherapy had similar DFS (p = 0.31) and a trend of poorer OS (p = 0.064).

Conclusions: The prognosis of unexpected ovarian cancer is independent from the primary surgical procedure and comprehensive staging surgery should be performed at close proximity after the diagnosis of unexpected ovarian malignancy.

Keywords: chemotherapy; laparoscope; laparotomy; outcome; ovarian cancer; prognostic factor; unexpected ovarian cancer.

FIGURE 1

Survival curves for 112 women with unexpected EOC receiving different treatment modalities. (A) 5‐year disease‐free survival (DFS). No staging surgery or adjuvant chemotherapy 74.2% (95% CI 64.9–83.5), staging surgery alone 71.4% (95% CI 54.3–88.5), adjuvant chemotherapy alone 59.1% (95% CI 49.9–68.3), staging surgery with adjuvant chemotherapy 64.8% (95% CI 56.6–73.0), p = 0.56. (B) 5‐yearoverall survival (OS). No staging surgery or adjuvant chemotherapy 74.7% (95% CI 64.8–84.6), staging surgery alone 83.3% (95% CI 68.1–98.5), adjuvant chemotherapy alone 78.8% (95% CI 71.0–86.6), staging surgery with adjuvant chemotherapy 62.2% (95% CI 53.6–70.8), p = 0.37.

FIGURE 2

Influence of surgical latency between primary and staging surgeries on the outcome of unexpected EOC in 112 women. (A) 5‐year disease‐free survival (DFS). Observation, staging <28 days, or chemotherapy alone72.9% (95% CI 68.0–77.8). Staging >28 days 58.8% (95% CI 46.9–70.7), p = 0.13. (B) 5‐year overall survival (OS). Observation, staging <28 days, or chemotherapy alone 86.5% (95% CI 82.7–90.3). Staging >28 days 60.2% (95% CI 47.3–73.1), p = 0.008.

FIGURE 3

Influence of chemotherapy latency between primary surgery and adjuvant chemotherapy on the outcome of unexpected EOC in 112 women. (A) 5‐year disease‐free survival (DFS). Observation, chemotherapy <28 days, or staging alone 73.8% (95% CI 68.6–79.0). Chemotherapy >28 days 62.5% (95% CI 53.3–71.7), p = 0.21. (B) 5‐yearoverall survival (OS). Observation, chemotherapy <28 days, or staging alone 86.9% (95% CI 82.8–91.0). Chemotherapy >28 days 71.5% (95% CI 62.8–80.2), p = 0.064.