Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, California, USA.
San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.
Oncologist. 2020 Jul;25(7):564-571. doi: 10.1634/theoncologist.2019-0282. Epub 2020 Feb 7.
As survival with metastatic colorectal cancer (CRC) and imaging modalities improve, detection of ovarian metastases may be increasing. The ovary may serve as a sanctuary site for malignant cells; however, there is a paucity of data regarding the role for oophorectomy.
This is a single-institution retrospective study of patients with CRC with ovarian metastases from 2009 to 2017. We evaluated patient, disease, and treatment related factors associated with overall survival (OS) from initial diagnosis of metastatic CRC.
Of 108 patients assessed, the median age was 50, 19% had localized disease at initial presentation, 64% had ovarian metastases at initial CRC diagnosis, and 77% underwent oophorectomy. Median OS was 29.6 months across all patients, and it was 36.7 months in patients who underwent oophorectomy versus 25.0 months in patients who did not (hazard ratio [HR] 0.54). In multivariate analysis, the effect of oophorectomy on OS suggested protection but was not statistically significant (HR 0.57). Resection of primary tumor was performed in 71% of patients, which was independently associated with improved OS (HR 0.21). Twelve patients (11%) remained alive at 5 years after diagnosis of metastatic disease.
Although it has been previously reported that patients with CRC with ovarian metastases have poor prognosis, the median OS for this cohort was comparable to existing OS data for patients with metastatic CRC. In patients treated with chemotherapy, we did not find the ovarian metastasis to frequently serve as a sanctuary site of disease. However, we found that in carefully selected patients, oophorectomy may confer a survival benefit.
In colorectal cancer (CRC) ovarian metastasis is not necessarily associated with worse prognosis than metastasis to other sites. In carefully selected patients with ovarian metastases from CRC, oophorectomy may confer a survival benefit. Specifically, development of ovarian metastasis early in the disease course, resection of the primary tumor, and limited extraovarian metastatic disease are clinical features that are potentially associated with benefit from oophorectomy. A subset of patients with ovarian metastasis from CRC have potential to become long-term survivors (>5 years).
随着转移性结直肠癌（CRC）患者的生存时间延长和影像学技术的进步，卵巢转移的检出率可能会升高。卵巢可能是恶性细胞的避难所；然而，关于卵巢切除术作用的数据很少。
这是一项 2009 年至 2017 年期间在一家机构内进行的回顾性研究，入组的患者均为患有 CRC 并伴有卵巢转移的患者。我们评估了与转移性 CRC 初始诊断后总体生存（OS）相关的患者、疾病和治疗相关因素。
在评估的 108 名患者中，中位年龄为 50 岁，19%的患者在初始表现时为局限性疾病，64%的患者在初始 CRC 诊断时已有卵巢转移，77%的患者接受了卵巢切除术。所有患者的中位 OS 为 29.6 个月，接受卵巢切除术的患者中位 OS 为 36.7 个月，未接受卵巢切除术的患者为 25.0 个月（风险比 [HR] 0.54）。多变量分析表明，卵巢切除术对 OS 的影响提示有保护作用，但无统计学意义（HR 0.57）。71%的患者进行了原发性肿瘤切除术，这与 OS 改善独立相关（HR 0.21）。12 名（11%）患者在诊断转移性疾病后 5 年仍存活。
尽管之前有报道称患有 CRC 伴卵巢转移的患者预后较差，但本队列的中位 OS 与转移性 CRC 患者的现有 OS 数据相当。在接受化疗的患者中，我们并未发现卵巢转移经常是疾病的避难所。然而，我们发现，在经过精心选择的患者中，卵巢切除术可能带来生存获益。
在结直肠癌（CRC）中，卵巢转移的预后不一定比转移至其他部位差。在精心选择的 CRC 伴卵巢转移的患者中，卵巢切除术可能带来生存获益。具体而言，疾病早期出现卵巢转移、原发性肿瘤切除术和有限的卵巢外转移疾病是与卵巢切除术获益相关的潜在临床特征。有一部分 CRC 伴卵巢转移的患者有成为长期生存者（>5 年）的潜力。
