J Gynecol Oncol.  2010 Sep;21(3):191-195. 10.3802/jgo.2010.21.3.191.

Uterine metastases in ovarian carcinoma: frequency and survival in women who underwent hysterectomy

• Menczer J
• Chetrit A
• Sadetzki S
• The National Israel Ovarian Cancer Group

• KMID: 1980857
• DOI: http://doi.org/10.3802/jgo.2010.21.3.191

Abstract

OBJECTIVE
Possible reasons for hysterectomy in the initial surgical management of advanced invasive epithelial ovarian carcinoma (EOC) might be a high frequency of uterine involvement and its impact on survival. The aim of the present study was to describe the frequency of uterine involvement and its association with survival in an unselected population of EOC patients who underwent hysterectomy.
METHODS
All incident cases of EOC diagnosed in Israeli Jewish women between March 1994 to June 1999, were identified within the framework of a nationwide case-control epidemiological study. The target population of the present report includes all stage II-IV EOC patients who had a uterus at the time of diagnosis. Of the 822 such patients, 695 fulfilled the inclusion criterion. Excluded were 141 patients for various reasons. The present analysis is based on the remaining 554 patients.
RESULTS
Uterine involvement was present in 291 (52.5%) of the patients and it was macroscopic in only 78 (14.1%). The serosa was the most common site of isolated metastases. Multivariate analysis showed that advanced stage significantly increased the risk for uterine involvement. The overall median survival with any uterine involvement was significantly lower compared to those with no involvement (38.9 months vs. 58.0 months; p<0.001).
CONCLUSION
There is an association between uterine involvement, whether macro- or microscopic, and lower survival even after hysterectomy although residual tumor could not be included in the analysis. Further studies are required to establish whether uterine involvement itself is an unfavorable risk factor or merely a marker of other unfavorable prognostic factors.

Keyword

Epithelial ovarian carcinoma; Uterine involvement; Survival

MeSH Terms

Case-Control Studies
Epidemiologic Studies
Female
Health Services Needs and Demand
Humans
Hysterectomy
Multivariate Analysis
Neoplasm Metastasis
Neoplasm, Residual
Risk Factors
Serous Membrane
Uterus

Reference

1. Marsden DE, Friedlander M, Hacker NF. Current management of epithelial ovarian carcinoma: a review. Semin Surg Oncol. 2000. 19:11–19.

2. Trope C, Kaern J. Primary surgery for ovarian cancer. Eur J Surg Oncol. 2006. 32:844–852.

3. Leitao MM Jr, Chi DS. Operative management of primary epithelial ovarian cancer. Curr Oncol Rep. 2007. 9:478–484.

4. Fader AN, Rose PG. Role of surgery in ovarian carcinoma. J Clin Oncol. 2007. 25:2873–2883.

5. Modan B, Hartge P, Hirsh-Yechezkel G, Chetrit A, Lubin F, Beller U, et al. Parity, oral contraceptives, and the risk of ovarian cancer among carriers and noncarriers of a BRCA1 or BRCA2 mutation. N Engl J Med. 2001. 345:235–240.

6. Julian CG, Goss J, Blanchard K, Woodruff JD. Biologic behavior of primary ovarian malignancy. Obstet Gynecol. 1974. 44:873–884.

7. Rose PG, Piver MS, Tsukada Y, Lau TS. Metastatic patterns in histologic variants of ovarian cancer: an autopsy study. Cancer. 1989. 64:1508–1513.

8. Reed E, Zerbe CS, Brawley OW, Bicher A, Steinberg SM. Analysis of autopsy evaluations of ovarian cancer patients treated at the National Cancer Institute, 1972-1988. Am J Clin Oncol. 2000. 23:107–116.

9. Hess KR, Varadhachary GR, Taylor SH, Wei W, Raber MN, Lenzi R, et al. Metastatic patterns in adenocarcinoma. Cancer. 2006. 106:1624–1633.

10. Guth U, Huang DJ, Bauer G, Stieger M, Wight E, Singer G. Metastatic patterns at autopsy in patients with ovarian carcinoma. Cancer. 2007. 110:1272–1280.

11. Dvoretsky PM, Richards KA, Angel C, Rabinowitz L, Stoler MH, Beecham JB, et al. Distribution of disease at autopsy in 100 women with ovarian cancer. Hum Pathol. 1988. 19:57–63.

12. Heintz AP, Odicino F, Maisonneuve P, Beller U, Benedet JL, Creasman WT, et al. Carcinoma of the ovary. Int J Gynaecol Obstet. 2003. 83:Suppl 1. 135–166.

13. McComas BC, Farnum JB, Donaldson RC. Ovarian carcinoma presenting as a cervical metastasis. Obstet Gynecol. 1984. 63:593–596.

14. Mazur MT, Hsueh S, Gersell DJ. Metastases to the female genital tract: analysis of 325 cases. Cancer. 1984. 53:1978–1984.

15. Lemoine NR, Hall PA. Epithelial tumors metastatic to the uterine cervix: a study of 33 cases and review of the literature. Cancer. 1986. 57:2002–2005.

16. Lyon DS, Kaminski PF, Wheelock JB. Significance of a positive Papanicolaou smear in a well screened population. South Med J. 1989. 82:190–192.

17. Guidozzi F, Sonnendecker EW, Wright C. Ovarian cancer with metastatic deposits in the cervix, vagina, or vulva preceding primary cytoreductive surgery. Gynecol Oncol. 1993. 49:225–228.

18. Tarraza HM, Muntz HG, De Cain M, Jones MA. Cervical metastases in advanced ovarian malignancies. Eur J Gynaecol Oncol. 1993. 14:274–278.

19. Zaino R, Whitney C, Brady MF, DeGeest K, Burger RA, Buller RE. Simultaneously detected endometrial and ovarian carcinomas: a prospective clinicopathologic study of 74 cases: a gynecologic oncology group study. Gynecol Oncol. 2001. 83:355–362.

20. Williams MG, Bandera EV, Demissie K, Rodriguez-Rodriguez L. Synchronous primary ovarian and endometrial cancers: a population-based assessment of survival. Obstet Gynecol. 2009. 113:783–789.

21. Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol. 2002. 20:1248–1259.

22. Memarzadeh S, Berek JS. Advances in the management of epithelial ovarian cancer. J Reprod Med. 2001. 46:621–629.

23. Eisenkop SM, Spirtos NM, Friedman RL, Lin WC, Pisani AL, Perticucci S. Relative influences of tumor volume before surgery and the cytoreductive outcome on survival for patients with advanced ovarian cancer: a prospective study. Gynecol Oncol. 2003. 90:390–396.

24. Heintz AP. Surgery in advanced ovarian carcinoma: is there proof to show the benefit? Eur J Surg Oncol. 1988. 14:91–99.

25. Covens AL. A critique of surgical cytoreduction in advanced ovarian cancer. Gynecol Oncol. 2000. 78:269–274.

26. Menczer J. Cytoreductive surgery in the treatment of advanced ovarian carcinoma: some controversial aspects. Eur J Gynaecol Oncol. 1992. 13:246–255.

27. Hunter RW, Alexander ND, Soutter WP. Meta-analysis of surgery in advanced ovarian carcinoma: is maximum cytoreductive surgery an independent determinant of prognosis? Am J Obstet Gynecol. 1992. 166:504–511.