Abstract
Introduction: Metastatic malignant struma ovarii (MSO) is an extremely rare disease that lacks treatment consensus and accurate prognosis. The objective of this study was to present the clinical, pathological, and treatment characteristics of metastatic MSO, while also investigate the overall survival (OS) rate and factors affecting prognosis in this population.Materials and Methods: A total of 79 cases of metastatic MSO were reviewed, including four cases of metastatic MSO from our hospital and 75 cases selected from the literature. Logistic regression was used to identify potential factors affecting disease free survival (DFS). The Kaplan-Meier method and log-rank test were used to determine OS; further Cox regression was used to evaluate factors affecting OS.Results: The mean age of all the patients at diagnosis was 43.8 years. The most common metastatic sites were peritoneum, bone, liver, omentum and lung in descending order. Only two patients (2.6%) coexisted with local primary thyroid cancer. Follicular carcinoma (41.8%) as the most prevalent subtype, followed by papillary carcinoma, follicular variant of papillary carcinoma, and mixed follicular-papillary carcinoma. 36.7% of the patients received conservative surgery, 43.0% of them underwent aggressive surgery, and 15.2% of them did not receive any surgery. 74.7% of patients who received adjuvant therapy underwent radioiodine therapy (RAI). Logistics regression revealed that FIGO stage IV was the only prognostic factor in predicting DFS (P = 0.002; Odds Ratio [OR] 5.333; 95% confidence interval [CI]: 1.839–15.471). Only seven deaths occurred. The OS rates at 5, 10, 15 years were 89.3, 82.4, 65.9%, respectively. Multivariate analysis showed age over 55 years (P = 0.006; OR 9.362; 95%CI: 1.895–46.246) was the only risk factor for OS.Conclusion: Patients with metastatic MSO have an excellent disease-specific OS rate, FIGO stage IV and age over 55 years were two factors affecting disease prognosis. Conservative surgery with residual ablation by RAI after total thyroidectomy should be preferred since the benefits of aggressive surgery are uncertain.
Highlights
Metastatic malignant struma ovarii (MSO) is an extremely rare disease that lacks treatment consensus and accurate prognosis
A study done by McGill et al recommended a total thyroidectomy in conjunction with radioiodine therapy (RAI) therapy in the case of metastatic struma ovarii [17], but they did not mentioned which exact surgical approach should be applied in this population
Our study presents the largest cohort of patients diagnosed with metastatic MSO and reveals that MSO prognosis is still satisfactory even after metastasis, regardless of the treatment strategies used
Summary
Metastatic malignant struma ovarii (MSO) is an extremely rare disease that lacks treatment consensus and accurate prognosis. Previous publications advise aggressive treatment in combination with a total thyroidectomy, postoperative radioiodine therapy (RAI), and thyroid hormone suppressive therapy, regardless of the presence or absence of metastasis at diagnosis [11,12,13,14]. In these studies, conservative surgery was optional in childbearing patients, while they recommended comprehensive staging surgery including total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic washings, and pelvic lymph node sampling if fertility preservation was not a desired option [14, 15]. Another study from Marti et al showed that extensive pelvic surgery and a prophylactic total thyroidectomy might be beneficial in patients with metastatic MSO [18]
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