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.
Keywords: early-stage; ovarian cancer; staging; adnex; tuba;
uterus; cytology; peritoneum; omentum; appendix; lymph nodes; tumor
positivity; upstaging; histopathological subtype; differentiation grade
Tweetable abstract: Upstaging rate in early-stage epithelial
ovarian carcinoma justifies comprehensive surgical staging