Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
Int J Clin Oncol. 2020 Oct;25(10):1822-1829. doi: 10.1007/s10147-020-01730-w. Epub 2020 Jun 26.
This study aimed to improve the management of ovarian metastases (OM) in colorectal cancer (CRC) by evaluating the clinicopathological characteristics, therapeutic strategies, and prognostic factors associated with OM originating from CRC.
Medical records of patients who were histopathologically diagnosed with OM of CRC origin were reviewed from January 2011 to December 2018 in our medical center. Data related to clinicopathological characteristics, therapeutic strategies, and survival time were recorded and analyzed. Survival and prognosis analyses were carried out to identify variables significantly associated with the outcomes.
Forty-six patients were included in the study with a median follow-up of 14 months. Premenopausal (< 50 years) and colon cancer patients were more likely to develop OM. Synchronous OM was found in 34 patients and elevated carbohydrate antigen 125 value could be seen in 67.4% of patients. Bilateral ovarian involvement (27/46, 58.8%) and combined extra-ovarian metastases (32/46, 69.6%) were common in included patients. Complete cytoreduction surgery (R0 resection) was finally achieved in 19 of included patients and 41 patients received postoperative chemotherapy. However, the overall prognosis remains poor, with a median survival time of only 12 months. In univariate analysis, histological types (P = 0.002), peritoneal metastasis (P < 0.0001), the extent of metastatic lesions (P = 0.0001), and completeness of cytoreduction surgery (P < 0.0001) were found to be closely related to prognosis. Finally, completeness of cytoreduction surgery was considered to be the independent determinant of patients' outcome (HR 0.186, 95% CI 0.047-0.727, P = 0.016) by multivariate analysis.
In multitudinous factors, complete cytoreduction surgery (R0 resection) may provide survival benefits in patients with OM of CRC origin. Thus, it is reasonable to recommend aggressive surgery with curative intent even if extra-ovarian metastases are present. Furthermore, postoperative chemotherapy may exert a positive effect on the treatment, but needs to be confirmed by large-scale trials with more participants in the future.
本研究旨在通过评估与结直肠癌（CRC）来源的卵巢转移（OM）相关的临床病理特征、治疗策略和预后因素，来改善卵巢转移（OM）的管理。
回顾性分析 2011 年 1 月至 2018 年 12 月在我院经组织病理学诊断为 CRC 来源 OM 的患者的病历资料。记录并分析与临床病理特征、治疗策略和生存时间相关的数据。进行生存和预后分析，以确定与结局显著相关的变量。
本研究共纳入 46 例患者，中位随访时间为 14 个月。绝经前（<50 岁）和结肠癌患者更易发生 OM。34 例患者为同期 OM，67.4%的患者可出现糖链抗原 125 升高。纳入患者中双侧卵巢受累（27/46，58.8%）和合并卵巢外转移（32/46，69.6%）较为常见。最终，19 例患者实现了完全肿瘤细胞减灭术（R0 切除），41 例患者接受了术后化疗。然而，总体预后仍然较差，中位生存时间仅为 12 个月。单因素分析显示，组织学类型（P=0.002）、腹膜转移（P<0.0001）、转移病灶范围（P=0.0001）和肿瘤细胞减灭术的完整性（P<0.0001）与预后密切相关。最后，多因素分析显示，肿瘤细胞减灭术的完整性是影响患者结局的独立决定因素（HR 0.186，95%CI 0.047-0.727，P=0.016）。
在众多因素中，完全肿瘤细胞减灭术（R0 切除）可能为 CRC 来源 OM 患者带来生存获益。因此，即使存在卵巢外转移，推荐积极的以治愈为目的的手术也是合理的。此外，术后化疗可能对治疗有积极影响，但需要在未来通过更多参与者的大规模试验来证实。
