title: Micropapillary serous ovarian carcinoma: surgical management and clinical outcome.
abstract: OBJECTIVE
  The objectives of this study were to characterize the prognostic features of micropapillary serous ovarian carcinoma (MPSC), examine the clinical impact of surgical staging, and define the role of cytoreductive surgery for patients with advanced disease.
  
  
  METHODS
  Fifty-one patients with MPSC were identified from hospital and tumor registry databases. Demographic, operative, pathologic, and follow-up data were abstracted retrospectively. Survival curves were generated using the Kaplan-Meier method, and statistical comparisons were performed using the log rank test, logistic regression analysis, and the Cox proportional hazards regression model.
  
  
  RESULTS
  The median age at diagnosis was 45 years, and follow-up extended to a median of 43.0 months. Stage I/II disease was present in 25.5% of patients and no disease-related deaths were observed in this group. Stage III disease was discovered in 29.4% of patients with tumor clinically confined to the ovaries. Stage III/IV disease (74.5% of cases) was associated with median progression-free and overall survival times of 32.8 and 114.2 months, respectively. Menopausal status and the anatomic extent of disease were significantly associated with survival outcome. However, the strongest independent predictor of survival for patients with advanced disease was the amount of residual tumor. Median overall survival for patients with optimal cytoreduction (residual disease </=1 cm) was 115.4 months compared to 43.1 months for those with >1 cm residual tumor (P < 0.0002).
  
  
  CONCLUSIONS
  MPSC carries a significant risk of extraovarian spread; however, adequately sampled Stage I/II disease is associated with a favorable prognosis. Optimal cytoreduction is associated with improved survival and should be the primary therapeutic objective for patients with advanced-stage MPSC.
authors.affiliation: The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA. rbristo@jhmi.edu
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
authors.forename: Dana R
authors.initials: DR
authors.lastname: Gossett
authors.forename: David R
authors.initials: DR
authors.lastname: Shook
authors.forename: Mariana L
authors.initials: ML
authors.lastname: Zahurak
authors.forename: Rafael S
authors.initials: RS
authors.lastname: Tomacruz
authors.forename: Deborah K
authors.initials: DK
authors.lastname: Armstrong
authors.forename: F J
authors.initials: FJ
authors.lastname: Montz
mesh_terms: D000328:Adult; D018283:Cystadenocarcinoma, Papillary / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome