European Journal of Obstetrics & Gynecology and Reproductive Biology
The role of cytoreductive surgery for non-genital tract metastatic tumors to the ovaries
Introduction
The ovaries are frequent targets of metastasis for malignant tumors [1]. Distinction between primary and metastatic ovarian tumors is important because misinterpretation of a metastatic tumor as primary tumor may lead to inappropriate management and suboptimal treatment outcome [2]. It has been reported that gastrointestinal tract and breast cancers are the most common non-genital tumors that metastasize to the ovaries [3], [4], [5], [6]. The diagnosis of non-genital ovarian metastasis generally has a poor prognosis. The 5-year survival has been reported to be from 10% to 36%; worse than the 40% generally reported for primary ovarian cancer [4], [7], [8]. Survival is better for patients with metastatic tumors to the ovary from genital rather than non-genital origin [1], [3]. Among the metastatic tumors to the ovaries, the Krukenberg tumor, which can account for 30% to 40% of metastatic cancers to the ovaries [9], [10], is generally defined as an ovarian carcinoma that contains a significant component of mucin-filled signet ring cells typically lying within a cellular stroma derived from the ovarian stroma [11], [12].
While the value of surgical cytoreduction to a low volume of residual tumor and adjuvant chemotherapy has been proven in the treatment of primary epithelial ovarian cancer, there is only a little information on the outcome of patients with tumors metastatic to the ovary who undergo cytoreduction. According to McGill et al. [13] and Young and Devita [14], surgery and chemotherapy had a survival benefit. By contrast, there was no survival benefit reported by Mrad et al. [15] and Savey et al. [16]. Therefore, the benefit of surgical cytoreduction and chemotherapy are controversial. In addition, there is no report comparing survival in patients with Krukenberg and non-Krukenberg metastatic tumors to the ovaries.
The purpose of this study was to evaluate the role of surgery in the management of metastatic tumors to the ovaries and to compare survival in patients with Krukenberg and non-Krukenberg metastatic tumors to the ovaries. We evaluated the clinical presentation, surgical management, chemotherapy and outcome of the patients by reviewing the medical records.
Section snippets
Materials and methods
One hundred and fifty-eight patients with metastases to the ovary from non-genital primary sites were identified at Samsung Medical Center between 1994 and 2006. The data were obtained from the medical records and pathology reports. Patients’ records were reviewed regarding the following parameters: age, menopausal status, chief complaint, operative findings, primary site of the tumor, surgical treatment modalities, adjuvant treatment (chemotherapy and/or radiation) and survival in months. The
Results
During the past 13 years, we have had 158 cases of histologically confirmed metastatic ovarian tumors at SMC, accounting for 16.1% (158/978) of malignant ovarian tumors (Table 1). The median age of the cases was 43 years (range 13–80). The primary origin of the tumors was stomach (73/158, 46.2%), colon (61/158, 38.6%), appendix (10/158, 6.3%), breast (3/158, 1.9%), biliary duct (1/158, 0.6%), and unknown (10/158, 6.3%). Krukenberg tumors (pathologically proven signet ring cell carcinoma) were
Discussion
The gastrointestinal tract was the most common primary site of the metastatic ovarian tumors (stomach 46.2% and colon 38.6%) in the current study. This incidence was much larger than that reported by Webb et al., who reported the gastrointestinal tract as the primary site in 47% (stomach 8%, colon 29%, rectum 9%); with the breasts and other gynecologic organs accounting for 31% and 18%, respectively [3]. These differences may be due to the higher incidence of stomach cancer in Korea.
The mean
Acknowledgments
The authors thank Dr. Young Suk Park (Division of Hematology–Oncology, Samsung Medical Center), Dr. Chel Hun Choi (Department of Obstetrics and Gynecology, Samsung Medical Center) for their cooperation.
References (28)
- et al.
Metastatic ovarian tumors: a review of 64 cases
Gynecol Oncol
(2003) - et al.
Incidence of metastasis to the ovaries from nongenital tract primary tumors
Gynecol Oncol
(2004) - et al.
Nongenital cancers metastatic to the ovary
Gynecol Oncol
(1992) - et al.
The role of cytoreductive surgery in nongenital cancers metastatic to the ovaries
Gynecol Oncol
(2005) - et al.
Prognostic factors of Krukenberg's tumor
Gynecol Oncol
(2001) - et al.
Management of Krukenberg tumor: an 11-year experience and review of the literature
Prim Care Update Obstet Gyns
(1998) - et al.
Ovarian involvement in extragenital cancer
Gynecol Oncol
(1989) - et al.
Colon cancer with metastasis to the ovary at time of initial diagnosis
Gynecol Oncol
(1997) - et al.
Complete cytoreductive surgery is feasible and maximizes survival in patients with advanced epithelial ovarian cancer: a prospective study
Gynecol Oncol
(1998) - et al.
Surgical treatment for patients with different origins of Krukenberg tumors: outcomes and prognostic factors
Eur J Surg Oncol
(2009)