The prognostic significance of intraperitoneal growth characteristics in epithelial ovarian carcinoma

Maximal cytoreductive surgery in advanced epithelial ovarian carcinoma (EOC) has become commonplace in management despite the inability of prospective trials to demonstrate a convincing improvement in long-term survival. Optimal cytoreduction is only possible in 23-77% of cases, perhaps due to differences in tumor biology. In a retrospective analysis of 219 women, we have investigated one possible variable in tumor biology, namely the pattern of intraperitoneal spread. Median survival in the study group was 15.2 months (CI: 13.2-17.3). One hundred women had predominantly localized bulky spread and 119 had seedling spread to the peritoneum. The number of optimally debulked patients in the two groups was not significantly different (P=0.9). Fifteen patients with bulky disease, had complete macroscopic clearance. Residual disease and performance status were highly significant prognostic factors. On univariate analysis, patients with seedling spread had a significantly poorer prognosis. Multivariate analysis showed that if for like cases: stage, residual disease, performance status, age, histology and differentiation were compared, the tumors with bulky spread carried a better prognosis than those with seedling spread. It has been demonstrated in this analysis that the pattern of spread is an independent prognostic factor of clinical significance.