Clinical significance of the histological type of tumor in determining the extent of surgical staging in early-stage ovarian cancer

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Abstract

Background. Surgery is the standard treatment for patients with stage IA–IIA ovarian cancer (OC). In early-stage disease, the operative approach aims at complete removal of the primary tumor and comprehensive surgical staging. Accumulated international data demonstrate differences in the patterns and frequency of metastatic spread depending on the histological subtype of OC, which underscores the relevance of targeted investigation of these features.

Aim. To assess the frequency and pattern of metastatic spread in early-stage ovarian adenocarcinomas according to their histological subtype.

Materials and methods. A retrospective study was conducted including 183 patients with early-stage ovarian cancer (FIGO 2014 stages IA–IIA) who underwent surgery at the N. N. Blokhin National Medical Research Center of Oncology between 2010 and 2024. The analysis included patients after primary surgery (n = 74 (40.4 %)) and restaging procedures (n = 109 (59.6 %)). All patients underwent surgical staging with lymphadenectomy followed by histological and cytological examination. Statistical analysis was performed using the χ² test and nonparametric methods.

Results. Analysis of metastatic patterns showed the following frequency of metastasis detection: in the contralateral ovary – 22 (12 %) cases, fallopian tube – 16 (8.7 %), uterine body – 7 (3.8 %), omentum – 9 (4.9 %), peritoneal biopsies – 7 (3.8 %), pelvic lymph nodes – 5 (2.7 %), para-aortic lymph nodes – 3 (1.7 %), and in both pelvic and para-aortic lymph nodes simultaneously – 1 (0.5 %) case. Tumor cells in peritoneal washings or ascitic fluid were identified in 35 patients (19 %). Postoperative upstaging occurred in 32.7 % (n = 60) of patients, primarily due to the detection of tumor cells in peritoneal washings or ascitic fluid (stage IC3).

Conclusion. Surgical staging is an essential component of treatment for early-stage OC. Nevertheless, further accumulation of clinical data is needed to better characterize the metastatic patterns associated with different histological subtypes of OC, which is crucial for resolving the ongoing debate regarding the optimal extent of surgical staging.

About the authors

Ekaterina А. Malysheva

N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia

Author for correspondence.
Email: idk.alen@vk.com
ORCID iD: 0000-0002-5085-3947
Russian Federation, 24 Kashirskoe Shosse, Moscow 115522

A. S. Shevchuk

N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia; Russian National Research Medical University named after N. I. Pirogov, Ministry of Health of Russia

Email: idk.alen@vk.com
ORCID iD: 0000-0002-9259-4525

Department of Oncology and Radiation Therapy, Institute of Surgery, Russian National Research Medical University named after N. I. Pirogov, Ministry of Health of Russia

Russian Federation, 24 Kashirskoe Shosse, Moscow 115522; 1 Ostrovityanova St., Moscow 117997

M. N. Tikhonovskaya

N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia

Email: idk.alen@vk.com
ORCID iD: 0000-0003-3349-0854
Russian Federation, 24 Kashirskoe Shosse, Moscow 115522

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