Abstract
BackgroundTo explore the outcomes and prognostic factors of ovarian metastasectomy intervention on overall survival from extragenital primary cancer.MethodsPatients with ovarian metastases from extragenital primary cancer confirmed by laparotomy surgery and ovarian metastases resection were retrospectively collected in a single institution during an 8-year period. A total of 147 cases were identified and primary tumor sites were colorectal region (49.0%), gastric (40.8%), breast (8.2%), biliary duct (1.4%) and liver (0.7%). The pathological and clinical features were evaluated. Patients’ outcome with different primary tumor sites and predictive factors for overall survival were also investigated by univariate and multivariate analysis.ResultsMetachronous ovarian metastasis occurred in 92 (62.6%) and synchronous in 55 (37.4%) patients. Combined metastases occurred in 40 (27.2%). Bilateral metastasis was found in 97 (66%) patients. The median ovarian metastasis tumor size was 9 cm. There were 39 (26.5%) patients with massive ascites ≥ 1000 mL on intraoperative evaluation. With a median follow-up of 48 months, the median OS after ovarian metastasectomy for all patients was 8.2 months (95% CI 7.2-9.3 months). In univariate analyses, there is significant (8.0 months vs. 41.0 months, P = 0.000) difference in OS between patients with gastrointestinal cancer origin from breast origin, and between patients with gastric origin from colorectal origin (7.4 months vs. 8.8 months, P = 0.036). In univariate analyses, synchronous metastases, locally invasion, massive intraoperative ascites (≥ 1000 mL), and combined metastasis, were identified as significant poor prognostic factors. In multivariate analyses combined metastasis (RR, 1.72; 95% CI, 1.09-2.69, P = 0.018), locally invasion (RR, 1.62; 95% CI, 1.03-2.54, P = 0.038) and massive intraoperative ascites (RR, 1.58; 95% CI, 1.02-2.49, P = 0.04) were independent factors for predicting unfavorable overall survival.ConclusionOvarian metastases are more commonly originated from primary gastrointestinal tract. The prognosis of ovarian metastasis is dismal and the benefit of ovarian metastatectomy is limited. Combined metastasis outside ovaries, locally invasion and massive intraoperative ascites were independent factors for predicting unfavorable overall survival. The identification of the primary tumor is required to plan for adequate treatment for this group of patients.
Highlights
To explore the outcomes and prognostic factors of ovarian metastasectomy intervention on overall survival from extragenital primary cancer
As the biological behavior and clinical outcome of the ovarian metastatic lesions from extragenital cancer origins are rarely summarized, we presented in this study the characteristics and outcomes for all patients with surgically confirmed ovarian metastases from extragenital primary cancer in a single institution during an 8-year period
Using Cox regression, multivariate analyses demonstrated that combined metastasis (RR, 1.72; 95% confidence intervals (95% CI), 1.09-2.69, P = 0.018), local invasion (RR, 1.62; 95% CI, 1.03-2.54, P = 0.038) and massive intraoperative ascites ≥ 1000 mL (RR, 1.58; 95% CI, 1.02-2.49, P = 0.04) were independent factors for predicting unfavorable overall survival (Table 3)
Summary
To explore the outcomes and prognostic factors of ovarian metastasectomy intervention on overall survival from extragenital primary cancer. The diagnosis and management of patients with ovarian metastastic extragenital primary cancer are typically challenging where inaccurate diagnosis has been reported in as many as 50% of the cases even with thorough preoperative work-up due to the presenting atypical symptoms [1,2,3,4]. As the biological behavior and clinical outcome of the ovarian metastatic lesions from extragenital cancer origins are rarely summarized, we presented in this study the characteristics and outcomes for all patients with surgically confirmed ovarian metastases from extragenital primary cancer in a single institution during an 8-year period
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