Prognostic factors in stage I ovarian carcinoma

Most studies on prognostic factors in stage I ovarian carcinoma have been hampered by a relative small number of patients included. In this study we identified the most important independent clinical and pathological prognostic factors in stage I epithelial invasive ovarian carcinoma in a large data base of 1545 patients with stage I epithelial ovarian carcinoma. The patients were treated in 6 different countries but were analysed in the same way. Because of the increasing use of endoscopy to remove possibly malignant cysts and the reports on rapid spread of ovarian carcinoma in the peritoneal cavity after laparoscopic removal of ovarian cancers, special attention was made to the presence and timing of the cysts before or during surgery. The multivariate analyses identified degree of differentiation as the most powerful prognostic indicator of disease-free survival, followed by rupture before surgery, rupture during surgery, International Federation of Gynaecology and Obstetrics (FIGO) 1973 stage and age. When the effects of these factors were accounted for, none of the following were of prognostic value for disease-free survival: histological type, dense adhesions, extracapsular growth, ascites, FIGO stage 1988, and size of tumour. In conclusion, degree of differentiation was the most powerful prognostic indicator in Stage I ovarian cancer and should be used when deciding therapy in clinical practice. We also strongly advocate the inclusion of degree of differentiation in a new FIGO classification of stage I ovarian carcinoma. In addition, rupture before and during surgery, FIGO Stage 1973 (Ib versus Ia) and age were shown to be independent prognostic factors. Hence, every effort should be made to avoid rupture during primary surgery of malignant ovarian tumours confined to the ovaries.