Colorectal cancer ovarian metastases

Abstract

ObjectiveOvarian metastases occur in 3%–5% of patients with colorectal cancer. The role of oophorectomy in that setting continues to be debated. We aimed to assess the survival of women treated with metastasectomy for ovarian metastasis.MethodsRetrospective cohort study of patients in the California Cancer Registry (2000–2012) with stage IV colorectal cancer and ovarian metastases. Pathology other than adenocarcinoma was excluded. Adjusted Cox-proportional hazard analysis was applied to assess the risk of death.ResultsA total of 756 patients with synchronous ovarian metastases and 516 patients with metachronous ovarian metastases form the basis of this analysis. Median follow-up for the synchronous cohort was 21 months (IQR: 8–36). Median overall survival was 23 months (IQR: 10–42). Estimated 5-year survival reached 17% and 10-year survival was 8%. There was a significant difference in unadjusted survival between patients with solitary ovarian metastasis (median overall survival: 51 months) compared with those who had both ovarian and extraovarian metastases (20 months) (log-rank test, P<0.0001). For patients with solitary ovarian metastases, the 5- and 10-year survival was 46% and 31%, respectively. Among patients with synchronous ovarian metastases, longer unadjusted survival was observed after oophorectomy (median overall survival: 24 months) compared with no oophorectomy (18 months, log-rank P=0.01). For patients with metachronous diagnoses of colorectal cancer ovarian metastasis, the median disease-free survival was 19 months. The median survival after resection of metachronous ovarian metastases was 25 months, with the survival directly related to the disease-free interval until metastasis. For patients with resected metachronous ovarian metastases, the 5- and 10-year post-metastasectomy survival was 14% and 5%, respectively.ConclusionsPatients with colorectal cancer ovarian metastasis have favorable long-term survival. Survival rates are higher if the tumor is isolated to the ovary or if metachronous to the primary cancer.

A propensity score‐matched analysis of oncological outcome after systemic therapy for stage IV colorectal cancer: Impact of synchronous ovarian metastases

“…36 Some studies found that OM occurs independently from lymphatic dissemination. 37,38 The present data showed that after propensity score matching, a significant difference between the two samples was found regarding the presence of positive lymph nodes. However, since the two samples in the (original) total study population, before propensity score matching, were not significantly different and no impact on survival was found within the multivariate analyses, this finding seems to be of minor clinical relevance.…”

“…Furthermore, the exact mechanism of dissemination from the colon to ovary is unknown, although several metastatic pathways have been proposed including hematogenous, peritoneal and lymphatic spread 36 . Some studies found that OM occurs independently from lymphatic dissemination 37,38 . The present data showed that after propensity score matching, a significant difference between the two samples was found regarding the presence of positive lymph nodes.…”

“…17,36,39,40 Some studies found a better survival for metachronous OM compared to synchronous OM. 25,38,41 Other previous studies, that focused on different metastatic sites in CRC patients, found that survival for metachronous metastases is equivalent or better compared to synchronous metastases. [42][43][44][45] Therefore, based on those studies, no further decrease in overall survival for patients with OM compared to patients with unaffected ovaries would be expected if patients with metachronous metastases had been added to the present data.…”

“…Information on patients with metachronous metastases remains lacking, although they account for 0.9% to 7% of OM, according to previous single‐center studies 17,36,39,40 . Some studies found a better survival for metachronous OM compared to synchronous OM 25,38,41 . Other previous studies, that focused on different metastatic sites in CRC patients, found that survival for metachronous metastases is equivalent or better compared to synchronous metastases 42‐45 .…”

Second Primary Cancers following Colorectal Cancer in Sicily, Italy

“…The short latency period among the two cancer diagnoses may be related to the misclassification of ovary cancer as primary instead of a metastasis from CRC [ 23 ]. Indeed, 3–5% of CRC patients develop ovarian metastases [ 24 ]. Noticeably, recent surgeons’ classification of metastases distinguishes early (≤12 months of diagnosis from primary disease) and late (>12 months from diagnosis) metachronous metastases [ 25 ].…”