Prognostic Factors among Brain Metastases in Newly Diagnosed Ovary Cancer: A Large Real-world Study

Abstract

Background: Population-based data on the prognosis of brain metastases at initial diagnosis of ovary cancer (OCBM) are currently lacking. Besides, the effective treatment for OCBM patients is still controversial now. The study aimed to explore the prognostic factors among OCBM. Methods: We retrospectively reviewed the OCBM patients from the Surveillance, Epidemiology, and End Result (SEER) database of the National Cancer Institute to investigate predictors of the presence of OCBM and its' prognostic factors related to all-cause mortality. We employed multivariable logistic and Cox regression analysis. Furthermore, to minimize the impact of potential confounding factors, we conducted a 1:1 propensity score matching (PSM) analysis. Results: A total of 29,512 cases of OC patients entered into the study, including 89 patients with brain metastases of ovarian cancer, which accounted for 0.30% of the entire cohort and 12.02% of the metastatic disease subset. We identified eight factors, including laterality, histology, surgery, radiotherapy, chemotherapy, and extracranial metastatic sites to bone, liver, and lung, as predictors of OCBM based on multivariable logistic regression among the entire cohort. The median survival time of OCBM was 2.0 months, and the interquartile range was 2.0-10.0 mo. The patients who received comprehensive treatment had better prognosis. Based on the multivariable Cox model, marital status, surgery, chemotherapy, and extensive therapy (including RSC, SC, and RC) were identified as predictors of OS. Besides, a new factor (brain metastasis) was identified by 1:1 PSM -based multiple Cox regression, apart from the above prognostic factors for OS. Conclusions: This study provided a population-based estimate of the proportion and prognosis for newly diagnosed ovary cancer with brain metastases. These findings may add materials to guidelines for preliminary screening and optimal treatment of OCBM patients.

Gamma Knife Radiosurgery-Based Combination Treatment Strategies Improve Survival in Patients With Central Nervous System Metastases From Epithelial Ovarian Cancer: A Retrospective Analysis of Two Academic Institutions in Korea and Taiwan

“…There was difference in survival among ovarian cancer patients with different CNS metastatic timing. In our study, patients with CNS metastases in first relapse had better survival outcomes compared with those with CNS metastases in late relapse, while patients with brain metastases at initial diagnosis of ovarian cancer had very poor outcomes with median survival of 2 months (43). Like our results, Xi et al found that survivals of patients with brain metastases in newly diagnosed ovarian cancer can benefit from combined treatment (43).…”

“…However, we observed that one-third of patients in our study developed CNS metastatic tumors during the first episode of recurrence. A large population-based study also found 0.3% of patients with newly diagnosed ovarian cancers already had brain metastases (43). There was difference in survival among ovarian cancer patients with different CNS metastatic timing.…”

Single-Cell Proteomics Analysis of Recurrent Low-Grade Serous Ovarian Carcinoma and Associated Brain Metastases

“…This supports the hypothesis that brain mets can be established early during the course of disease but may take a long period of time to adapt to the brain microenvironment and progress to cause symptoms. This hypothesis is also supported by the clinical impression that brain mets have become slightly more frequent with the improvement in the systemic treatment of EOC ( 2 – 7 ) and the increase in overall survival. Thus, confirming this hypothesis in a larger cohort of patients with EOC brain mets will be critical to identify and implement effective prevention and therapeutic strategies against EOC brain mets.…”

“…The incidence of brain metastases (brain mets) in epithelial ovarian cancer (EOC) patients is about 2%–6% and invariably results in death ( 1 ). This represents a clinical challenge, since there are currently no established guidelines for the detection and treatment of this severe and irreversible condition ( 2 – 7 ). Previous studies in EOC have shown that brain mets display a unique phenotype and do not respond to systemic therapy in the same way as extracranial tumors ( 1 , 8 , 9 ).…”

Nomogram Models for Predicting Risk and Prognosis of Newly Diagnosed Ovarian Cancer Patients with Liver Metastases - A Large Population-Based Real-World Study

“…Regrettably, the tool quantifying risk of LM development is not available. Earlier studies focusing on OC with bone and brain metastases suggested that advanced T stage, N stage, tumor grade, and metastases to other distant organs were predictive factors for bone and brain metastases 9 , 24 . Previous population-based studies determined older age, race, unmarried status, bilateral tumor location, non-serous histology, advanced T and N stages, grades, and elevated CA-125 were risks for liver metastases 5 , 7 , our study supported this association.…”