title: Upstaging pathologic stage I ovarian carcinoma based on dense adhesions is not warranted: a clinicopathologic study of 84 patients originally classified as FIGO stage II.
abstract: BACKGROUND
  FIGO stage II ovarian cancer comprises 8% of ovarian cancers. It is a common but not universal practice to upstage densely adherent pathologic stage I tumors to stage II. FIGO guidelines are not clear, and data supporting this practice are sparse.
  
  
  METHODS
  We retrospectively reviewed patients with stage II ovarian cancer and grouped them based upon histologic evidence of extraovarian extension. Tumors densely adherent to extraovarian structures but without histologic tumor outside the ovary were considered pathologic stage I. All others were considered surgical-pathologic stage II. Three histologic patterns of extraovarian tumor involvement were identified.
  
  
  RESULTS
  Eighty-four patients were studied. Twenty-four patients had pathologic stage I disease and 60 had histologic evidence of extraovarian pelvic spread and were surgical-pathologic stage II. The 5-year survival for stage I was 100%, and the median survival was not reached. The 5-year survival for those with surgical-pathologic stage II disease was 56.8% and the median survival was 73 months. There were no differences observed based upon pattern of extraovarian spread. The survival difference between pathologic stage I and surgical-pathologic stage II was significant (p<0.001). There were no differences seen in 5-year survival among surgical-pathologic stage II patients with serous, endometrioid or clear cell histologies (64.5%, 64.8% and 64.3% respectively).
  
  
  CONCLUSIONS
  These retrospective data suggest that the practice of upstaging densely adherent pathologic stage I tumors to stage II may not be warranted. Cell type is not a prognostic factor in stage II.
authors.affiliation: Department of Pathology and Laboratory Medicine, Washington Hospital Center, Washington, DC, USA. jeffrey.d.seidman@medstar.net
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Seidman
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Cosin
authors.forename: Brant G
authors.initials: BG
authors.lastname: Wang
authors.forename: Skylar
authors.initials: S
authors.lastname: Alsop
authors.forename: Anna
authors.initials: A
authors.lastname: Yemelyanova
authors.forename: Abbie
authors.initials: A
authors.lastname: Fields
authors.forename: Charles R
authors.initials: CR
authors.lastname: Boice
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Zaino
mesh_terms: D002448:Cell Adhesion / Q000502:physiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate