title: Prognostic importance of degree of differentiation and cyst rupture in stage I invasive epithelial ovarian carcinoma.
abstract: BACKGROUND
  Previous studies on prognostic factors in stage I invasive epithelial ovarian carcinoma have been too small for robust conclusions to be reached. We undertook a retrospective study in a large international database to identify the most important prognostic variables.
  
  
  METHODS
  1545 patients with invasive epithelial ovarian cancer (International Federation of Gynaecology and Obstetrics [FIGO] stage I) were included. The records of these patients were examined and data extracted for univariate and multivariate analysis of disease-free survival in relation to various clinical and pathological variables.
  
  
  RESULTS
  The multivariate analyses identified degree of differentiation as the most powerful prognostic indicator of disease-free survival (moderately vs well differentiated hazard ratio 3.13 [95% CI 1.68-5.85], poorly vs well differentiated 8.89 [4.96-15.9]), followed by rupture before surgery (2.65 [1.53-4.56]), rupture during surgery (1.64 [1.07-2.51]), FIGO 1973 stage Ib vs Ia 1.70 [1.01-2.85]) and age (per year 1.02 [1.00-1.03]). When the effects of these factors were accounted for, none of the following were of prognostic value: histological type, dense adhesions, extracapsular growth, ascites, FIGO stage 1988, and size of tumour.
  
  
  CONCLUSIONS
  Degree of differentiation, the most powerful prognostic indicator in stage I ovarian cancer, should be used in decisions on therapy in clinical practice and in the FIGO classification of stage I ovarian cancer. Rupture should be avoided during primary surgery of malignant ovarian tumours confined to the ovaries.
authors.affiliation: Department of Gynaecological Oncology, University Hospitals Leuven, Belgium. Ignace.Vergote@UZ.Kuleuven.ac.be
authors.forename: I
authors.initials: I
authors.lastname: Vergote
authors.forename: J
authors.initials: J
authors.lastname: De Brabanter
authors.forename: A
authors.initials: A
authors.lastname: Fyles
authors.forename: K
authors.initials: K
authors.lastname: Bertelsen
authors.forename: N
authors.initials: N
authors.lastname: Einhorn
authors.forename: P
authors.initials: P
authors.lastname: Sevelda
authors.forename: M E
authors.initials: ME
authors.lastname: Gore
authors.forename: J
authors.initials: J
authors.lastname: Kaern
authors.forename: H
authors.initials: H
authors.lastname: Verrelst
authors.forename: K
authors.initials: K
authors.lastname: Sjövall
authors.forename: D
authors.initials: D
authors.lastname: Timmerman
authors.forename: J
authors.initials: J
authors.lastname: Vandewalle
authors.forename: M
authors.initials: M
authors.lastname: Van Gramberen
authors.forename: C G
authors.initials: CG
authors.lastname: Tropé
mesh_terms: D002454:Cell Differentiation; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D010048:Ovarian Cysts / Q000473:pathology; D010051:Ovarian Neoplasms / Q000145:classification / Q000401:mortality / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies