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Impact of substage and histologic type in stage I ovarian carcinoma survival: a multicenter retrospective observational study
  1. Majdi Imterat1,
  2. Nicolò Bizzarri2,
  3. Robert Fruscio3,
  4. Anna Myriam Perrone4,
  5. Alexander Traut1,
  6. Andreas du Bois1,
  7. Andrea Rosati2,
  8. Debora Ferrari3,
  9. Pierandrea De Iaco4,
  10. Beyhan Ataseven1,5,
  11. Raffaella Ergasti2,
  12. Silvia Volontè3,
  13. Marco Tesei4,
  14. Florian Heitz1,6,
  15. Maria Teresa Perri2,
  16. Nicole Concin1,
  17. Francesco Fanfani2,
  18. Giovanni Scambia2,
  19. Anna Fagotti2 and
  20. Philipp Harter1
  1. 1Department of Gynecology and Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Huyssens-Stiftung, Essen, Nordrhein-Westfalen, Germany
  2. 2Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
  3. 3Clinic of Obstetrics and Gynecology, University of Milan Bicocca, San Gerardo Hospital, Monza, Italy
  4. 4Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Emilia-Romagna, Italy
  5. 5Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
  6. 6Department for Gynecology with the Center for Oncologic Surgery Charité Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
  1. Correspondence to Dr Majdi Imterat, Department of Gynecology and Gynecologic Oncology, Ev, Kliniken Essen-Mitte Evangelische Huyssens-Stiftung/Knappschaft GmbH Klinik fur Gynakologie & Gynakologische Onkologie, Essen, Nordrhein-Westfalen, Germany; magdi_333{at}


Objective This international study aimed to investigate the impact of substage, histological type and other prognostic factors on long-term survival for stage I ovarian carcinoma.

Methods Our study was a retrospective multicenter cohort study that included patients with the International Federation of Gynecology and Obstetrics (FIGO) stage I (IA-IC3) ovarian carcinoma treated at four European referral centers in Germany and Italy. Using Kaplan-Meier survival curves we compared overall and disease-free survival between the different stage I groups.

Results A total of 1115 patients were included. Of these, 48.4% (n=540) were in stage IA, 6.6% (n=73) stage IB, and 45% (n=502) stage IC, of the latter substage IC1, 54% (n=271), substage IC2, 31.5% (n=158), and substage IC3, 14.5% (n=73). Five-year overall and disease-free survival rates for the entire cohort were 94% and 86%, respectively, with no difference between stage IA and IB. However, there was a significantly better overall and disease-free survival for stage IA as compared with stage IC (p=0.007 and p<0.001, respectively). Multivariate analysis revealed incomplete/fertility-sparing staging (HR 1.95; 95% CI 1.27 to 2.99, and HR 3.54; 95% CI 1.83 to 6.86, respectively), and stage IC (HR 2.47; 95% CI 1.63 to 3.75) as independent risk factors for inferior disease-free survival, while low-grade endometrioid (HR 0.42; 95% CI 0.25 to 0.72) and low-grade mucinous (HR 0.17; 95% CI 0.06 to 0.44) histology had superior disease-free survival. Considering overall survival, stage IC (HR 2.41; 95% CI 1.45 to 4.01) and older age (HR 2.41; 95% CI 1.46 to 3.95) were independent risk factors.

Conclusion Although stage I ovarian carcinoma exhibited excellent outcomes, the prognosis of patients with stage IA differs significantly compared with stage IC. Sub-optimal staging as an indicator for quality of care, and tumor biology defined by histology (low-grade endometrioid/mucinous) independently impact disease-free survival.

  • ovarian cancer
  • fallopian tube neoplasms
  • ovarian neoplasms
  • ovariectomy
  • pathology

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors Conceptualization: PH, MI, AdB, AF, GS, NB; Methodology: PH, MI, AdB, AT, NB, FH; Formal analysis: PH, MI, AT, NB; Investigation: PH, AdB, NB, MI, AT, RF, AMP, BA, AF; Resources: PH, AdB, NB, MI, AT, RF, AMP; Writing: PH, AdB, MI, AF, NC, BA; Writing - Review & Editing: all authors. Guarantor: MI.

  • 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 MI wrote the first draft of the manuscript.

  • 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.