HORMONAL FACTORS AND PROGNOSIS IN EPITHELIAL OVARIAN-CANCER - A MULTIVARIATE-ANALYSIS

When a significantly lower follicle stimulating hormone (FSH) level wa s found in patients with epithelial ovarian carcinoma, it was decided to analyze the influence of hormonal factors on prognosis. Thirteen fa ctors were tested for prognostic significance in 35 women with epithel ial ovarian carcinoma. Age, FIGO-stage, histopathological grade, resid ual tumor, treatment, gonadotrophins and steroid hormones were tested. By univariate log-rank testing a significantly shorter survival time was found for patients with ascending FIGO-stage, residual tumor mass, estradiol <0.10 nmol/l,progesterone <2.0 nmol/l and DHEAS <1300 nmol/ l. In the Cox model the independently significant prognostic factors f ound were residual tumor mass (P<0.001) with a risk estimate of 2.65, progesterone (P<0.05) with a risk estimate of 0.29 for a progesterone level >2.0 nmol/l and total testosterone (P<0.03) with a risk estimate of 0.29 for a total testosterone level >1.15 nmol/l. The present find ings, together with the assumption that an elevated gonadotrophin leve l may induce ovarian tumor growth (the gonadotrophin theory), earlier findings of estrogen and progesterone receptors in human ovarian cance r, and the in vitro demonstration of gonadotrophin-growth-stimulation of human malignant epithelial tumors, justify a thorough investigation of the interaction between steroid hormones and receptors, gonadotrop hins, tumor bulk and survival in future research protocols.