Rs. Delacuesta et al., PROGNOSTIC IMPORTANCE OF INTRAOPERATIVE RUPTURE OF MALIGNANT OVARIAN EPITHELIAL NEOPLASMS, Obstetrics and gynecology, 84(1), 1994, pp. 1-7
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.