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Outcomes of patients with early stage mucinous ovarian carcinoma: a Dutch population-based cohort study comparing expansile and infiltrative subtypes
  1. Marc Daniël Algera1,2,3,
  2. Koen K Van de Vijver4,
  3. Willemien J van Driel5,
  4. Brigitte F M Slangen1,3,
  5. Fabienne C Lof6,
  6. Maaike van der Aa7,
  7. R F P M Kruitwagen1,3 and
  8. Christianne A R Lok5
    1. 1 Maastricht University GROW School for Oncology and Reproduction, Maastricht, The Netherlands
    2. 2 Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands
    3. 3 Department of Gynaecologic Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
    4. 4 Department of Diagnostic Sciences, Pathology, Ghent University Hospital, Ghent, Belgium
    5. 5 Department of Gynaecologic Oncology, Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute, Amsterdam, The Netherlands
    6. 6 Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
    7. 7 IKNL, Utrecht, The Netherlands
    1. Correspondence to Marc Daniël Algera, Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, Netherlands; m.algera{at}


    Objective This study aimed to assess the outcomes of patients with early stage mucinous ovarian carcinoma based on subtype (expansile vs infiltrative).

    Methods We retrospectively analyzed all surgically treated patients with mucinous ovarian carcinoma in the Netherlands (2015–2020), using data from national registries. Subtypes were determined, with any ambiguities resolved by a dedicated gynecologic pathologist. Patients with International Federation of Gynecology and Obstetrics (FIGO) stage I were categorized into full staging, fertility-sparing, or partial stagings. Outcomes were overall survival and recurrence free survival, and recurrence rates.

    Results Among 409 identified patients, 257 (63%) had expansile and 152 (37%) had infiltrative tumors. Patients with expansile tumors had FIGO stage I more frequently (n=243, 95% vs n=116, 76%, p<0.001). For FIGO stage I disease, patients with expansile and infiltrative tumors underwent similar proportions of partial (n=165, 68% vs n=78, 67%), full (n=32, 13% vs n=23, 20%), and fertility-sparing stagings (n=46, 19% vs n=15, 13%) (p=0.139). Patients with expansile FIGO stage I received less adjuvant chemotherapy (n=11, 5% vs n=24, 21%, p<0.001), exhibited better overall and recurrence free survival (p=0.006, p=0.012), and fewer recurrences (n=13, 5% vs n=16, 14%, p=0.011). Survival and recurrence rates were similar across the expansile extent of staging groups. Patients undergoing fertility-sparing staging for infiltrative tumors had more recurrences compared with full or partial stagings, while recurrence free survival was similar across these groups. Full staging correlated with better overall survival in infiltrative FIGO stage I (p=0.022).

    Conclusions While most patients with FIGO stage I underwent partial staging, those with expansile had better outcomes than those with infiltrative tumors. Full staging was associated with improved overall survival in infiltrative, but not in expansile FIGO stage I. These results provide insight for tailored surgical approaches.

    • ovarian cancer
    • cystadenocarcinoma, mucinous
    • surgery

    Data availability statement

    Data are available upon reasonable request.

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    Data availability statement

    Data are available upon reasonable request.

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    • Presented at This work was previously presented as an abstract at the European Society of Gynaecological Oncology (ESGO) 2023 conference in Istanbul, Turkey.

    • Contributors MDA was the principal author, guarantor, and performed the analyses and interpretation of data. CARL conceptualized the study, performed revision of analyses, and revision of the manuscript. KVdV performed revision of pathology records, defined the Dutch Pathology Registry search, and performed revision of the manuscript. WJvD, BS, and RK performed revision of the manuscript and interpreted the data. FCL performed analyses and revision of the manuscript. MvdA reviewed the Netherlands Cancer Registration search and performed revision of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.