Transabdominal biopsy is a poor prognostic factor in stage-IV ovarian carcinoma

This study investigates the clinical, pathologic, and treatment-related factors in patients with stage-IV ovarian-type carcinomas and the related prognosis. The University of Iowa Hospitals and Clinics (Iowa City, IA) Gynecologic Oncology Tumor data bank was analyzed for cases of stage-IV epithelial ovarian carcinoma and peritoneal carcinoma during the 10-year period from January 1987 through and including December 1996. Patient charts were abstracted for pertinent data including demographic variables, clinical features, and histopathologic characteristics. Thirty five cases of stage-IV ovarian and peritoneal carcinoma were treated during the 10-year period concluding in December 1996. Five of these patients had transabdominal biopsy of a solid lesion via a laparoscope or a percutaneous needle prior to referral. The mean survival of the transabdominal biopsy group was significantly less than that of the other stage-IV patients, 9.4 versus 37.0 months (p = 0.004). Laparoscopic trocar site metastases were not found to confer an adverse prognosis. In a multi-variable analysis using traditional factors affecting survival, only transabdominal biopsy remained as a significant predictor of survival time (p = 0.014). Transabdominal biopsy of a solid lesion for diagnosis of a stage-IV ovarian carcinoma is significantly associated with poor survival. This risk is independent of factors associated with selection bias.