The role of cytoreductive surgery for non-genital tract metastatic tumors to the ovaries

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Abstract

Objective

The aim of this study was to investigate prognostic factors of patients with metastases to the ovaries from non-genital organs.

Study design

From September 1994 to December 2006, 158 patients with pathologically confirmed metastatic tumors to the ovaries at Samsung Medical Center (SMC) were included in this study. The data were obtained from the patients’ medical records and pathology reports.

Results

The primary tumor origin was mostly stomach (73 cases) and colon (61 cases). Krukenberg tumor (pathologically proven signet ring cell carcinoma) was found in 34 cases: stomach (25), colon (2), appendix (1), and unknown (6). Residual disease after surgery was >2 cm in 65 (41.1%) cases and <2 cm in 93 (58.9%) cases. The overall 5-year survival was 7.2% and the median survival time was 15 months. The median survival times according to the primary tumor site showed significant differences (p = 0.002) and were as follows: stomach 12 months, colon 17 months. The median survival in cases with residual disease <2 cm vs. >2 cm was 26 months vs. 15 months (p = 0.017) and the median survival with vs. without adjuvant chemotherapy was 16 months vs. 10 months (p = 0.001). However, age, bilateral tumors, chronology of diagnosis and mass size did not affect survival.

Conclusion

Cytoreductive surgery and post-operative adjuvant chemotherapy had a beneficial effect on survival in selected patients.

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.

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