[Value of prognostic factors in early stage ovarian carcinoma]

Only 20-30% of all ovarian cancers are diagnosed in stage I. To achieve a correct pathohistological stage I disease a staginglaparotomy has to be performed. This surgery consists of a bilateral oophorectomy, salpingectomy and total abdominal hysterectomy, an omentectomy, peritoneal lavage, multiple biopsies of the peritoneum and a retroperitoneal lymph node dissection. The most important established prognostic factor for survival is the histologic grading. Well differentiated tumors do not get any further adjuvant treatment, but moderately well differentiated tumors or undifferentiated tumors are treated with adjuvant cytotoxic polychemotherapy. All other prognostic factors like FIGO staging, puncture of the tumor and/or rupture of the tumor and histologic subtypes do have just a minor relevance for survival prognosis. In addition to grading the following factors also seem to have an influence on further survival, according to the results of different study groups: tumor ploidy, dense adhesions of the tumor and preoperative tumor marker CA-125. New prognostic factors like her-2 neu, int-2, epidermal growth factor, insulin like growth factor, angiogenesis and proteases have to demonstrate their value for survival prognosis yet before they can be established in routine diagnosis.