Surgery

Patients with advanced disease should undergo a total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, node sampling, and aggressive cytoreductive surgery. Patients with stage III or IV disease with no gross residual tumor had a survival rate of 100% in some series, regardless of the follow-up duration.[1,2] Patients with gross residual disease had a 7-year survival rate of only 69% in a large series, [3] and survival appeared to be inversely proportional to the length of follow-up.[3]

Chemotherapy and/or radiation therapy are not indicated for patients with more advanced-stage disease and microscopic or gross residual disease. Scant evidence exists that postoperative chemotherapy or radiation therapy alters the course of this disease in any beneficial way.[1,3-6] In a retrospective study of 364 patients without residual tumor, adjuvant therapy had no effect on disease-free or corrected survival when stratified for disease stage.[7] Patients without residual tumor who received no adjuvant treatment had a survival rate equal to or greater than the treated groups. No controlled studies have compared postoperative treatment with no postoperative treatment.

In a review of 150 patients with borderline ovarian tumors, the survival of patients with residual tumors smaller than 2 cm was significantly better than survival for those with residual tumors measuring 2 cm to 5 cm or tumors measuring larger than 5 cm (P < .05).[8] It is not clear whether invasive implants imply a worse prognosis. Some investigators have correlated invasive implants with a poor prognosis,[9] while others have not.[2,10] Some studies have suggested DNA ploidy of the tumors can identify patients who will develop aggressive disease.[11,12] One study could not correlate DNA ploidy of the primary serous tumor with patient survival, but found that aneuploid invasive implants were associated with a poor prognosis.[13] No evidence indicates that treating patients with aneuploid tumors would have an impact on survival. No significant associations were found between TP53 and HER2/neu overexpression and tumor recurrence or patient survival.[14]