title: Long-term survival of patients with apparent early-stage (FIGO I-II) epithelial ovarian cancer: a population-based study.
abstract: BACKGROUND
  Women with presumed early-stage epithelial ovarian cancer (EOC) who have not received comprehensive surgical staging are at risk for recurrence. The aim of our study was to analyze the overall long term survival of EOC patients with a presumed early stage EOC.
  
  
  METHODS
  A population-based cancer registry was used to identify patients with an early-stage EOC cancer diagnosed between 1989 and 1997. The area under study has no surgical gynecologic oncologist and no tertiary referral center. We categorized patients into two subgroups: low-risk (Ia-Ib well and moderately differentiated) and high-risk (Ia-Ib poorly differentiated or IC-II). Survival curves were calculated from the time of surgery using Kaplan-Meier methods and statistical comparisons were performed using the log-rank test and the Cox proportional hazards regression model.
  
  
  RESULTS
  Fifty patients having an apparent early-stage disease (FIGO I-II) were evaluated. Forty-one patients have been operated by obstetrician-gynecologists and 9 by general surgeons. Twenty-one (42%) have been categorized as low-risk and 29 (58%) as high-risk. An optimal, modified, minimal and inadequate surgical staging was performed in 6, 10, 26 and 58, respectively. The median follow-up time was 147 months (range: 2.5-165). The 5- and 10-year overall survival was 95 and 89% for low-risk and 72 and 33% for high-risk subgroups, respectively.
  
  
  CONCLUSIONS
  The surgical staging is frequently incomplete when performed in small hospitals with few patients by nonspecialists. Women in the high-risk group and incompletely staged have a less favorable prognosis than those reported in the literature.
authors.affiliation: Gynecologic Oncology and Senology Service, University Hospitals of Geneva, Geneva, Switzerland. patrick.petignat@hcuge.ch
authors.forename: Patrick
authors.initials: P
authors.lastname: Petignat
authors.forename: Daniel
authors.initials: D
authors.lastname: de Weck
authors.forename: Frederic
authors.initials: F
authors.lastname: Goffin
authors.forename: Georges
authors.initials: G
authors.lastname: Vlastos
authors.forename: Reto
authors.initials: R
authors.lastname: Obrist
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Luthi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery*; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome