Prognostic factors in patients with stage I epithelial ovarian cancer

Article Abstract:

Between 15 and 25 percent of women with epithelial ovarian cancer have stage I disease, defined as cancer that has not spread beyond the ovaries. Removal of the tumor often cures the disease, but many stage I patients relapse. The factors associated with relapse have not been clearly delineated, and, to better understand them, records from patients with histologically proved ovarian cancer were reviewed. Patients came from either the Princess Margaret Hospital, Toronto, Canada (252 patients) or the Norwegian Radium Hospital in Oslo (267). The diagnosis of stage I disease can be further subdivided into stage Ia, tumors on one side; Ib, tumors on both sides; and Ic, presence of tumor cells in the peritoneum (abdominal cavity) and penetration of the ovarian capsule. The majority of patients with well-differentiated tumors received no postoperative treatment, and biopsy of lymph nodes was rarely undertaken. Histological material was reviewed and graded according to tumor type and degree of differentiation (extent to which cells retained their original organ-specific features), and tumor attributes were recorded. An extensive discussion is presented of cancer staging (classification of tumors) and results from both sources. The five-year relapse-free rates in both centers were similar and close to 80 percent. In general, the extent of tumor differentiation was the best predictor of relapse, with well-differentiated tumors presenting the lowest relapse rate (98 percent). The presence of dense adherence (fibrous tissue associated with the tumor) and large amounts of ascites (fluid in the abdomen) also predicted recurrence. In fact, given the lack of prognostic value of factors such as bilaterality, tumor size, capsular penetration, rupture, patient age, or postoperative therapy, it appears that the staging procedure could be simplified to take into account only these three factors. Patients with stage I tumors without dense adherence or ascites do not benefit from postoperative treatment, while those with more advanced disease may benefit as well from surgery or pelvic radiation treatment as from chemotherapy. For this group, however, effective therapy to improve survival has not been developed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Identification and classification

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Prognostic factors for outcome of and survival after second-look laparotomy in patients with advanced ovarian carcinoma

Article Abstract:

Second-look laparotomy is exploratory abdominal surgery performed on patients with ovarian cancer who have undergone chemotherapy. Results from the surgery are used to adjust or discontinue chemotherapy, as appropriate, and the procedure is generally accepted as a standard part of treatment. However, the relevance and benefit of laparotomy have been questioned. After second-look laparotomy in women who had undergone one of two chemotherapeutic protocols for ovarian cancer, treatment variables and laparotomy results were evaluated in 109 patients and survival was evaluated in 131 patients. The average survival of all patients was 62 months. Sixty percent of the women whose cancers apparently responded well to chemotherapy were alive six years after laparotomy, while those with only partial responses or progressive disease survived an average of two years. Residual disease, observable at laparotomy, was associated with lack of removal of the uterus, ovaries, Fallopian tubes, and part of the abdominal wall (omentum), and with the stage of the cancer. Prolonged survival after laparotomy was associated with smaller secondary residual tumor size remaining after initial surgery, low stage of cancer, and good response to chemotherapy. The information about residual tumor size obtained during laparotomy was helpful in improving estimates of patient outcome, but the benefit for patient survival remains uncertain. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery, Abdomen, Laparotomy

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