Staging discordance in apparent early-stage ovarian neoplasms: prevalence, prognosis, and practical risk stratification.

Up to 1 in 13 patients with apparent early-stage ovarian neoplasms harbor occult advanced disease, posing a diagnostic dilemma with major therapeutic implications that remains poorly characterized. We conducted a retrospective consecutive cohort study of 106 patients with apparent early-stage ovarian neoplasms at a tertiary gynecological oncology center (2014-2023) to determine the prevalence, consequences, and clinical correlates of staging discordance and develop the first descriptive risk stratification for surgical planning. Staging discordance occurred in 8/106 patients (7.5%), all of whom were upstaged to Stage III disease. All malignant cases (5/106, 4.7%) were discordant, demonstrating universally advanced disease requiring chemotherapy (100% vs. 1.0% concordant, P < 0.001). A five-year follow-up revealed nearly a five-fold higher recurrence rate, indicating a worse prognosis in discordant cases (37.5% vs 8.2%, P = 0.025). Two preoperative features-CA-125 ≥100 U/mL and ascites-were most strongly associated with discordance (both P < 0.01). Risk grouping by these factors showed clear stratification: 1.5% discordance with neither factor, 9.5% with one, and 83.3% with both. In this comprehensive consecutive cohort of apparent early-stage ovarian neoplasms, staging discordance was rare but clinically decisive, identifying patients with universally advanced disease, chemotherapy requirement, and worse prognosis. Two readily available preoperative features offer immediate, pragmatic risk stratification to guide surgical triage, particularly in community or resource-limited settings.