Quantitative Prognostic Features in FIGO I Ovarian Cancer Patients without Postoperative Treatment

To identify FIGO I ovarian cancer patients at high risk, prognostic values of quantitative pathological features (volume percentage of epithelium, mitotic activity index, mean (MNA) and standard deviation of nuclear profile area, and volume-weighted mean nuclear volume (MNV) have been investigated in comparison with clinical features, histological grade, and type in 102 adequately staged patients with FIGO Ia, Ib, and Ic ovarian cancer of the common epithelial types. None of these patients received any postoperative treatment. Overall survival of patients alive and well was 78%, and 90% were alive. Of the clinical features, FIGO substage was the strongest prognosticator (Mantel–Cox = 7.2,p= 0.03, hazard ratio (HR) = 4.6). Histologic grade had significant prognostic value as well (Mantel–Cox = 9.7,p= 0.008, HR = 5.9), but histologic type did not. MNA and MNV were the strongest single prognostic factors for overall survival (Mantel–Cox = 12.3 for both;p= 0.0004 and 0.0005). If MNA ≤ 55.6 μm2, none of the patients (n= 52) died; if MNA >55.6 μm2, 6-year overall survival was 69%. For MNV ≤460 μm2, none of the patients (n= 53) died; if MNV >460 μm2, 6-year overall survival was 70%. A multivariate combination of MNA and FIGO (early cancer of the ovary prognostic score, ECOPS) had the strongest prognostic value (p< 0.0001 and Mantel–Cox value = 22.8, HR = 29.2). If ECOPS ≤ 5.4 (n= 66), 6-year overall survival was 97%; if ECOPS >5.4 (n= 36), 6-year overall survival was 54%. The results from this and earlier studies emphasize the strong prognostic value of easy to assess and highly reproducible morphometric nuclear features in ovarian tumors and offer a useful instrument for the definition of patient groups for future clinical trials.