PROGNOSTIC IMPORTANCE OF INTRAOPERATIVE RUPTURE OF MALIGNANT OVARIAN EPITHELIAL NEOPLASMS

Objective: To determine whether rupture of malignant ovarian epithelia l tumors at the time of operation influences the patient's overall pro gnosis. Methods: Between 1975 and 1990, 79 patients with stage I invas ive epithelial ovarian cancer were treated at Massachusetts General Ho spital. Patients were identified from the tumor registry, and charts w ere reviewed retrospectively. In 71 of the 79 cases, pathologic slides were evaluated. Of the 79 patients, 36 had stage Ia tumors, 20 stage Ic secondary to intraoperative rupture (Ic-rupture), and 17 stage Ic s econdary to capsular invasion-serosal disease or positive ascites or w ashings (stage Ic-other). Survival analysis was performed to compare t he three groups of patients. Results: There were four recurrences and deaths among the 20 women with stage Ic-rupture tumors (20%), compared to one (3%) among the 36 women with stage Ia. The recurrence-free sur vival at the median follow-up time for the two groups was 97 +/- 3 and 78 +/- 10 months, respectively (P = .03); overall survival was 97 +/- 3 and 73 +/- 12 months (P = .04). There were two recurrences (12%) an d one death (6%) among the 17 women with stage Ic-other, giving recurr ence-free and overall survivals of 88 +/- 8 and 94 +/- 6 months, respe ctively. The survival experience of this last group was not significan tly different from that in the Ic-rupture group (P =.2). The hazard ra tios for overall survival associated with stage Ic-rupture and each po tential confounder, except for bloating, exceeded 6.5, with P less tha n or equal to.10. All deaths occurred in the 28 patients with grade 2 or 3 tumors. Even in this smaller group, the hazard ratio for stage Ic -rupture was 6.8 (P =.09). Conclusion: Intraoperative rupture of malig nant epithelial ovarian neoplasms may worsen the prognosis of patients with stage I ovarian canter.