Clinically apparent early stage invasive epithelial ovarian carcinoma: Should all be treated similarly?

Objectives. The role of adjuvant therapy in patients with early stage ovari an carcinoma has not been clearly defined. Most randomized trials examining this issue have not used the vigorous staging exploration accepted as toda y's standard. This report examines the natural history of patients after su rgically documented stage 1 ovarian carcinoma followed expectantly. Methods. A retrospective chart review was carried out using strict criteria to include only patients who had an adequate staging procedure performed b y gynecologic oncologists following a fixed protocol from 1987 to 1997. Pat ients' demographic data as well as current disease status were abstracted a nd analyzed. Results. A total of 80 comprehensive surgical staging procedures were carri ed out over a 10-year period for apparent stage 1 ovarian cancer at the tim e of exploratory laparotomy. Fifty cases were true surgicopathological stag e 1. It was found that serous and anaplastic tumors were more likely than o ther subtypes to be upstaged by the procedure. Further follow-up confirmed the excellent prognosis of early stage serous, endometrioid, and mucinous t umor with only one recurrence noted in an extraabdominal location in a pati ent with serous histology with no postoperative adjuvant therapy. Clear cel l histology stands out as a significant recurrence risk (33%) despite an in itially negative surgical assessment. Conclusion. Careful surgical exploration can identify a group of patients w ith early stage epithelial ovarian carcinoma who will benefit little from f urther adjuvant therapy. Patients with clear cell histology prove to be at a high risk for recurrence even at an early stage such that chemotherapy sh ould be considered. (C) 1999 Academic Press.