Iwagoi Yutaka, Motohara Takeshi, Hwang Sangyoon, Fujimoto Koichi, Ikeda Tokunori, Katabuchi Hidetaka
Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto, 860-8556, Japan.
Department of Clinical Laboratory, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, Fukuoka, 814-0180, Japan.
Int J Clin Oncol. 2021 May;26(5):995-1004. doi: 10.1007/s10147-021-01866-3. Epub 2021 Jan 29.
Epithelial ovarian cancer has a clear predilection for the omentum as the site of metastasis; however, its contribution to clinical outcomes remains unresolved. This study aimed to evaluate the prognostic significance and efficacy of chemotherapy in the presence of omental metastasis.
A retrospective cohort study was performed in 56 patients with stage III-IV ovarian cancer who underwent primary debulking surgery between 2004 and 2018 at Kumamoto University Hospital.
Thirty-six (64.3%) patients were categorized into the omental metastasis-positive group, whereas 20 (35.7%) patients were in the omental metastasis-negative group. The 5-year overall survival rates were 43.4% in the omental metastasis-positive group and 93.8% in the omental metastasis-negative group. Statistically significant differences were observed in overall survival (p = 0.002) and progression-free survival (p = 0.036) between the omental metastasis-positive and metastasis-negative groups. Notably, multivariate analysis demonstrated that the existence of omental metastasis is an independent risk factor for overall survival in patients with stage III-IV ovarian cancer (hazard ratio 8.90, 95% confidence interval 1.16-69.77; p = 0.038). Furthermore, the omental metastasis-positive group had significantly lower overall response rates to chemotherapy for recurrent disease, compared to the omental metastasis-negative group (31.6% vs. 85.7%, p = 0.026).
Our present data demonstrated that omental metastasis is closely associated with an unfavorable prognosis due to increased chemoresistance in patients with stage III-IV ovarian cancer. Elucidating the biological mechanism of omental metastasis will shed light on novel therapeutic approaches for the management of advanced ovarian cancer patients.
上皮性卵巢癌明显倾向于将大网膜作为转移部位；然而，其对临床结局的影响仍未明确。本研究旨在评估大网膜转移情况下化疗的预后意义和疗效。
对2004年至2018年在熊本大学医院接受初次肿瘤细胞减灭术的56例III-IV期卵巢癌患者进行回顾性队列研究。
36例（64.3%）患者被归入大网膜转移阳性组，而20例（35.7%）患者为大网膜转移阴性组。大网膜转移阳性组的5年总生存率为43.4%，大网膜转移阴性组为93.8%。大网膜转移阳性组和阴性组在总生存（p = 0.002）和无进展生存（p = 0.036）方面存在统计学显著差异。值得注意的是，多因素分析表明，大网膜转移的存在是III-IV期卵巢癌患者总生存的独立危险因素（风险比8.90，95%置信区间1.16-69.77；p = 0.038）。此外，与大网膜转移阴性组相比，大网膜转移阳性组对复发性疾病化疗的总缓解率显著更低（31.6%对85.7%，p = 0.026）。
我们目前的数据表明，大网膜转移与III-IV期卵巢癌患者化疗耐药增加导致的不良预后密切相关。阐明大网膜转移的生物学机制将为晚期卵巢癌患者的新治疗方法提供线索。
