title: Surgical staging and prognosis in serous borderline ovarian tumours (BOT): a subanalysis of the AGO ROBOT study.
abstract: BACKGROUND
  Incomplete surgical staging is a negative prognostic factor for patients with borderline ovarian tumours (BOT). However, little is known about the prognostic impact of each individual staging procedure.
  
  
  METHODS
  Clinical parameters of 950 patients with BOT (confirmed by central reference pathology) treated between 1998 and 2008 at 24 German AGO centres were analysed. In 559 patients with serous BOT and adequate ovarian surgery, further recommended staging procedures (omentectomy, peritoneal biopsies, cytology) were evaluated applying Cox regression models with respect to progression-free survival (PFS).
  
  
  RESULTS
  For patients with one missing staging procedure, the hazard ratio (HR) for recurrence was 1.25 (95%-CI 0.66-2.39; P=0.497). This risk increased with each additional procedure skipped reaching statistical significance in case of two (HR 1.95; 95%-CI 1.06-3.58; P=0.031) and three missing steps (HR 2.37; 95%-CI 1.22-4.64; P=0.011). The most crucial procedure was omentectomy which retained a statistically significant impact on PFS in multiple analysis (HR 1.91; 95%-CI 1.15-3.19; P=0.013) adjusting for previously established prognostic factors as FIGO stage, tumour residuals, and fertility preservation.
  
  
  CONCLUSIONS
  Individual surgical staging procedures contribute to the prognosis for patients with serous BOT. In this analysis, recurrence risk increased with each skipped surgical step. This should be considered when re-staging procedures following incomplete primary surgery are discussed.
authors.affiliation: Universitaetsklinikum Hamburg-Eppendorf, Klinik und Poliklinik fuer Gynaekologie, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Trillsch
authors.affiliation: Universitaetsklinikum Hamburg-Eppendorf, Klinik und Poliklinik fuer Gynaekologie, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Mahner
authors.affiliation: Universitaetsklinikum Hamburg-Eppendorf, Institut fuer Medizinische Biometrie und Epidemiologie, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Vettorazzi
authors.affiliation: Universitaetsklinikum Hamburg-Eppendorf, Klinik und Poliklinik fuer Gynaekologie, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Woelber
authors.affiliation: Philipps-Universitaet Marburg, Koordinierungszentrum fuer Klinische Studien, Karl-von-Frisch-Str. 4, 35043 Marburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Reuss
authors.affiliation: Universitaetsklinikum Giessen u. Marburg GmbH, Klinik fuer Gynaekologie, Gyn. Endokrinologie und Onkologie, Baldingerstr., 35043 Marburg, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Baumann
authors.affiliation: Rheinische Friedrich-Wilhelms-Universitaet, Universitaets-Frauenklinik, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
authors.forename: M-D
authors.initials: MD
authors.lastname: Keyver-Paik
authors.affiliation: Technische Universitaet Dresden, Klinik und Poliklinik fuer Frauenheilkunde und Geburtshilfe, Fetscherstr. 74, 01307 Dresden, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Canzler
authors.affiliation: Universitaetsklinikum Magdeburg, Universitaets-Frauenklinik, Gerhart-Hauptmann-Str. 35, 39108 Magdeburg, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Wollschlaeger
authors.affiliation: Sana-Klinikum Remscheid, Klinik fuer Frauenheilkunde und Geburtsmedizin, Burger Strasse 211, 42859 Remscheid, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Forner
authors.affiliation: 1] Staedtisches Klinikum Solingen gGmbH, Klinik fuer Gynaekologie und Geburtshilfe, Gotenstrasse 1, 42653 Solingen, Germany [2] Zentrum fuer Gynaekologische Onkologie, Herzog-Friedrich-Str. 21, 24103 Kiel, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Pfisterer
authors.affiliation: GYNAEKOLOGICUM Bremen, Schwachhauser Heerstrasse 367, 28211 Bremen, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Schroeder
authors.affiliation: Universitaetsklinikum Giessen, Zentrum fuer Frauenheilkunde und Geburtshilfe, Klinikstrasse 33, 35352 Giessen, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Muenstedt
authors.affiliation: Elblandkliniken Meissen-Radebeul GmbH & Co. KG, Frauenklinik, Heinrich-Zille-Str. 13, 01445 Radebeul, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Richter
authors.affiliation: Charité, Campus Virchow Klinikum, Frauenklinik, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Fotopoulou
authors.affiliation: Klinikum rechts der Isar der Technischen Universitaet, Frauen- und Poliklinik, Ismaninger Str. 22, 81675 Munich, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Schmalfeldt
authors.affiliation: Klinikum der Universitaet Muenchen, Campus Grosshadern, Klinik und Poliklinik fuer Frauenheilkunde und Geburtshilfe, Marchioninistr.15, 81377 Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Burges
authors.affiliation: Dr Horst Schmidt Klinik GmbH, Klinik fuer Gynaekologie und gynaekologische Onkologie, Ludwig-Erhard-Str. 100, 65199 Wiesbaden, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Ewald-Riegler
authors.affiliation: Universitaetsklinikum Ulm, Frauenklinik, Prittwitzstrasse 43, 89075 Ulm, Germany.
authors.forename: N
authors.initials: N
authors.lastname: de Gregorio
authors.affiliation: Universitaetsklinikum Schleswig-Holstein, Campus Kiel, Klinik fuer Gynaekologie und Geburtshilfe, Michaelisstrasse 16, 24105 Kiel, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Hilpert
authors.affiliation: 1] Universitaetsklinikum Tuebingen, Department fuer Frauengesundheit, Calwerstrasse 7, 72076 Tuebingen, Germany [2] Universitaetsklinikum Duesseldorf, Universitaetsfrauenklinik, Moorenstrasse 5, 40225 Duesseldorf, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Fehm
authors.affiliation: Evangelisches Krankenhaus, Frauenklinik, Kirchfeldstrasse 40, 40217 Duesseldorf, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Meier
authors.affiliation: Medizinische Hochschule Hannover, Frauenklinik, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Hillemanns
authors.affiliation: 1] Klinikum der J.W. Goethe-Universitaet, Zentrum fuer Frauenheilkunde und Geburtshilfe, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany [2] Universitaetsklinikum Schleswig-Holstein, Campus Luebeck, Klinik fuer Gynaekologie und Geburtshilfe, Ratzeburger Allee 160, 23562 Luebeck, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Hanker
authors.affiliation: Universitaetsklinikum Freiburg, Frauenklinik, Hugstetter Str. 55, 79106 Freiburg im Breisgau, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Hasenburg
authors.affiliation: Universitaetsklinikum Halle (Saale), Universitaetsklinik und Poliklinik fuer Gynaekologie, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany.
authors.forename: H-G
authors.initials: HG
authors.lastname: Strauss
authors.affiliation: Georg-August-Universitaet Goettingen, Gynaekologie und Geburtshilfe, Robert-Koch-Str. 40, 37075 Goettingen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Hellriegel
authors.affiliation: 1] Technische Universitaet Dresden, Klinik und Poliklinik fuer Frauenheilkunde und Geburtshilfe, Fetscherstr. 74, 01307 Dresden, Germany [2] Universitaetsklinikum Essen, Klinik fuer Frauenheilkunde und Geburtshilfe, Essen, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Wimberger
authors.affiliation: 1] Dr Horst Schmidt Klinik GmbH, Klinik fuer Gynaekologie und gynaekologische Onkologie, Ludwig-Erhard-Str. 100, 65199 Wiesbaden, Germany [2] Universitaetsklinikum Tuebingen, Department fuer Frauengesundheit, Calwerstrasse 7, 72076 Tuebingen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Kommoss
authors.affiliation: Institut fuer Pathologie, Referenzzentrum fuer Gynaekopathologie, A2,2, 68159 Mannheim, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Kommoss
authors.affiliation: 1] Universitaetsklinikum Halle (Saale), Universitaetsklinik und Poliklinik fuer Gynaekologie, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany [2] Institut fuer Pathologie Trier-Dueren-Duesseldorf, Roonstrasse 30, 52351 Dueren, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Hauptmann
authors.affiliation: Kliniken Essen-Mitte, Klinik fuer Gynaekologische Onkologie, Henricistrasse 92, 45136 Essen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: du Bois
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018293:Cystadenoma, Serous / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D055815:Young Adult