Prognostic impact of iatrogenic rupture in early stage ovarian cancer: an ancillary study of GORILLA-3002.

Objective: To evaluate whether intraoperative rupture affect oncologic outcomes in patients with early-stage epithelial ovarian cancer (EOC). Methods: A multi-center retrospective study was conducted with early-stage EOC patients based on surgical and final pathologic reports between 2007 to 2021. Oncologic outcome was analyzed between unruptured group (International Federation of Gynecology and Obstetrics [FIGO] stage IA/IB) and ruptured group (FIGO stage IC1). Primary endpoint was progression-free survival (PFS). To adjust imbalance in the prognostic factors between the group, propensity score matching (PSM) was used. Results: Overall, 197 (58.3%) were in the unruptured group (FIGO stage IA/IB) and 141 (41.7%) were in the intraoperatively ruptured group (FIGO stage IC1). There was no significant difference in 5-year PFS between the 2 groups before PSM (92.65% vs. 92.80%, p=0.93). After PSM, 5-year PFS was clinically meaningful decreased in the ruptured group compared to the unruptured group, although the observed difference in PFS did not reach statistical significance (96.90% vs. 89.82%, p=0.061). This trend was particularly discernible in cases with aggressive tumor characteristics; intraoperative rupture remained an independent prognostic factor for shorter PFS in patients with high grade histology (adjusted hazard ratio=14.4; 95% confidence interval=2.8-74.1). Conclusion: Although not statistically significant, intraoperative rupture appears to negatively affect PFS in these patients after PSM. Therefore, rupture during surgery should be avoided as it can cause upstaging and unnecessary chemotherapy. [ABSTRACT FROM AUTHOR]