loading page

The attributive value of comprehensive surgical staging in clinically early-stage epithelial ovarian carcinoma: a systematic review and meta-analysis.
  • +3
  • Renée van de Vorst,
  • Jacob Hoogendam,
  • Maaike van der Aa,
  • Petronella Oda Witteveen,
  • Ronald Zweemer,
  • Kees Gerestein
Renée van de Vorst
University Medical Center Utrecht Imaging Division

Corresponding Author:[email protected]

Author Profile
Jacob Hoogendam
UMC Utrecht Cancer center
Author Profile
Maaike van der Aa
IKNL
Author Profile
Petronella Oda Witteveen
University Medical Center Utrecht
Author Profile
Ronald Zweemer
University Medical Centre Utrecht
Author Profile
Kees Gerestein
UMC Utrecht
Author Profile

Abstract

Background: Tumor positivity and upstaging rates from various surgical staging components performed in clinically early-stage epithelial ovarian carcinoma (EOC) vary widely in literature. Objectives: To quantify tumor positivity and upstaging rates for all staging surgery components in EOC patients. Differences between subgroups based on their clinical and histological characteristics are explored. Search strategy: A systematic search using synonyms of ‘ovarian cancer’, ‘neoplasm staging’, and ’neoplasm metastasis’ was conducted in PubMed, Embase, and the Cochrane Library. Selection criteria: Meta-analysis was performed on 23 included studies, comprising 5194 clinical stage I or II EOC patients who underwent comprehensive surgical staging. Data Collection and Analysis: Studies were assessed using the Newcastle-Ottawa Scale risk-of-bias tool. Pooled proportions and 95% confidence intervals were calculated using an inverse variance weighted random-effects model. Main Results: Overall upstaging rate of clinically early-stage EOC patients was 18.7% (95%CI: 14.1-23.4%). Serous histology or high grade EOC showed the highest upstaging rate at 35.3% (95%CI: 21.8-48.7%) and 40.9% (95%CI: 35.6-46.2%). Lymph node involvement resulted in an upstaging rate of 8.7% (95%CI: 6.2-11.3%). Tumor was identified in uterus, cytology, peritoneal biopsies, omentum and appendix in 6.2% (95%CI: 1.8-10.7%), 18.4% (95%CI: 13.8-22.9%), 9.7% (95%CI: 3.8-15.6%), 5.2% (95%CI: 1.7-8.8%) and 3.6% (95%CI: 0.0-7.5%) of EOC patients. The corresponding upstaging rates were 5.9% (95%CI: 1.4-10.4%), 8.5% (95%CI: 1.8-15.2%), 3.5% (95%CI: 1.0-6.0%), 3.9% (95%CI: 1.4-6.3%) and 1.6% (95%CI: 0.0-3.4%), respectively. Conclusion: The attributive value of comprehensive surgical staging in clinically early-stage EOC patients remains substantial, particularly in serous and high grade tumors.