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.
The attributive value of comprehensive surgical staging in clinically early-stage epithelial ovarian carcinoma: A systematic review and meta-analysis