THE PROGNOSTIC-SIGNIFICANCE OF INTRAPERITONEAL GROWTH-CHARACTERISTICSIN EPITHELIAL OVARIAN-CARCINOMA

Maximal cytoreductive surgery in advanced epithelial ovarian carcinoma (EOC) has become commonplace in management despite the inability of p rospective trials to demonstrate a convincing improvement in long-term survival. Optimal cytoreduction is only possible in 23-77% of cases, perhaps due to differences in tumor biology. In a retrospective analys is of 219 women, we have investigated one possible variable in tumor b iology, namely the pattern of intraperitoneal spread. Median survival in the study group was 15.2 months (CI: 13.2-17.3). One hundred women had predominantly localized bulky spread and 119 had seedling spread t o the peritoneum. The number of optimally debulked patients in the two groups was not significantly different (P=0.9). Fifteen patients with bulky disease, had complete macroscopic clearance. Residual disease a nd performance status were highly significant prognostic factors. On u nivariate analysis, patients with seedling spread had a significantly poorer prognosis. Multivariate analysis showed that if for like cases: stage, residual disease, performance status, age, histology and diffe rentiation were compared, the tumors with bulky spread carried a bette r prognosis than those with seedling spread. It has been demonstrated in this analysis that the pattern of spread is an independent prognost ic factor of clinical significance.