Metastasis patterns of the spleen and association with survival outcomes in advanced ovarian-tubal-peritoneal epithelial cancer.

Abstract

To evaluate the significance of parenchymal, hilar and capsular involvement of the spleen with regard to survival. All patients who underwent primary cytoreductive surgery for advanced ovarian-tubal-peritoneal (OTP) epithelial cancer were reviewed retrospectively. Stage 3C patients who had an upper abdomen involvement and who were optimally debulked were included. Patients who had abdomen-confined disease, but were upstaged to stage 4B due to splenic parenchymal metastases were also included. Seventy four patients eligible with the inclusion criteria who underwent splenectomy and 69 patients who did not undergo splenectomy were included. The median follow-up time was 39.1months. The median overall survival of the study group was 61.4months. Patients who underwent splenectomy were grouped according to the involved site of the spleen: parenchyma subgroup, hilus subgroup, capsule subgroup and benign subgroup. The median overall survival of patients in the hilus subgroup was 41.1months. The median overall survival of patients who were not in the hilus subgroup was 65.5months. Patients in the hilus subgroup showed significantly shorter survival (p = 0.035). Hilus subgroup was associated with a statistically significant increase in mortality risk (hazard ratio 1.971; 95% confidence interval 1.1-3.531). Splenic hilus involvement predicts poorer survival outcomes among stage 3C epithelial OTP cancer patients with disease expansion to upper abdomen. According to current study and many published studies, hilar involvement had a higher incidence rate compared to parenchymal involvement. Thus, hilar involvement would be a beneficial clinical predictor of survival for larger number of patients.