Journal Article

Impact of substage and histologic type in stage I ovarian carcinoma survival: a multicenter retrospective observational study

Rosati, Andrea, Harter, Philipp, Scambia, Giovanni, Volontè, Silvia, Bizzarri, Nicolò, Tesei, Marco, Perrone, Anna Myriam, Ferrari, Debora, Ergasti, Raffaella, Traut, Alexander, Ataseven, Beyhan, Heitz, Florian, Concin, Nicole, Perri, Maria Teresa, Imterat, Majdi, Fruscio, Robert, De Iaco, Pierandrea, Fagotti, Anna, du Bois, Andreas, Fanfani, Francesco

2023

Overview

ObjectiveThis international study aimed to investigate the impact of substage, histological type and other prognostic factors on long-term survival for stage I ovarian carcinoma.MethodsOur study was a retrospective multicenter cohort study that included patients with the International Federation of Gynecology and Obstetrics (FIGO) stage I (IA-IC3) ovarian carcinoma treated at four European referral centers in Germany and Italy. Using Kaplan-Meier survival curves we compared overall and disease-free survival between the different stage I groups.ResultsA total of 1115 patients were included. Of these, 48.4% (n=540) were in stage IA, 6.6% (n=73) stage IB, and 45% (n=502) stage IC, of the latter substage IC1, 54% (n=271), substage IC2, 31.5% (n=158), and substage IC3, 14.5% (n=73). Five-year overall and disease-free survival rates for the entire cohort were 94% and 86%, respectively, with no difference between stage IA and IB. However, there was a significantly better overall and disease-free survival for stage IA as compared with stage IC (p=0.007 and p<0.001, respectively). Multivariate analysis revealed incomplete/fertility-sparing staging (HR 1.95; 95% CI 1.27 to 2.99, and HR 3.54; 95% CI 1.83 to 6.86, respectively), and stage IC (HR 2.47; 95% CI 1.63 to 3.75) as independent risk factors for inferior disease-free survival, while low-grade endometrioid (HR 0.42; 95% CI 0.25 to 0.72) and low-grade mucinous (HR 0.17; 95% CI 0.06 to 0.44) histology had superior disease-free survival. Considering overall survival, stage IC (HR 2.41; 95% CI 1.45 to 4.01) and older age (HR 2.41; 95% CI 1.46 to 3.95) were independent risk factors.ConclusionAlthough stage I ovarian carcinoma exhibited excellent outcomes, the prognosis of patients with stage IA differs significantly compared with stage IC. Sub-optimal staging as an indicator for quality of care, and tumor biology defined by histology (low-grade endometrioid/mucinous) independently impact disease-free survival.

• Publisher: BMJ Publishing Group Ltd,Elsevier Inc,BMJ,Elsevier Limited
• Subject: Age / Cancer / Carcinoma, Ovarian Epithelial / Carcinoma, Ovarian Epithelial - pathology / Chemotherapy / Cohort Studies / Dissection / fallopian tube neoplasms / fallopian tube neoplasms; ovarian cancer; ovarian neoplasms; ovariectomy; pathology / Female / Genital cancers / Gynecological cancer / Gynecology / Histology / Humans / Hysterectomy / Laparotomy / Lymphatic system / Medical prognosis / Neoplasm Staging / Observational studies / Oncology / Oophorectomy / Original research / Ovarian cancer / Ovarian Neoplasms / Ovarian Neoplasms - pathology / ovariectomy / Ovaries / pathology / Patients / Prognosis / Regression analysis / Retrospective Studies / Statistical analysis / Surgery / Tumors