Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
World J Surg. 2021 Oct;45(10):3157-3164. doi: 10.1007/s00268-021-06209-x. Epub 2021 Jul 8.
Pancreatic ductal adenocarcinoma (PDAC) has a high propensity for systemic dissemination. Ovarian metastases are rare and poorly described.
We identified PDAC cases with ovarian metastasis from a prospectively maintained registry. We reported on the association between outcomes and clinicopathologic factors. Recurrence-free (RFS) and overall survival (OS) were calculated using Kaplan-Meier analysis.
Twelve patients with PDAC and synchronous or metachronous ovarian metastases were identified. Nine patients (75%) underwent pancreatectomy for localized PDAC and developed metachronous ovarian recurrence. The median OS for all patients was 25.4 (IQR:15.4-82.9) months. For the nine patients with metachronous ovarian metastasis, the median RFS and OS were 14.2 (IQR:7.2-58.3) and 44.6 (IQR:18.6-82.9) months, respectively. Nodal disease, poor grade, vascular invasion in the pancreatic primary, and bilateral ovarian disease tended to confer worse outcomes.
Patients with resected PDAC and ovarian recurrence tend to have a comparable disease course to more common patterns of recurrence. Primaries with nodal disease, poorer grade, vascular invasion, and bilateral ovarian disease were indicative of more aggressive disease biology. The ideal management remains largely unknown, and future collaborative efforts should optimize therapeutic strategies.
胰腺导管腺癌（PDAC）具有很高的全身扩散倾向。卵巢转移较为罕见且描述不佳。
我们从一个前瞻性维护的登记处中确定了 PDAC 病例伴卵巢转移。我们报告了结局与临床病理因素之间的关联。使用 Kaplan-Meier 分析计算无复发生存（RFS）和总生存（OS）。
确定了 12 例 PDAC 伴同步或异时性卵巢转移的患者。9 例（75%）患者因局限性 PDAC 而行胰腺切除术，并发生异时性卵巢复发。所有患者的中位 OS 为 25.4（IQR：15.4-82.9）个月。对于 9 例发生异时性卵巢转移的患者，中位 RFS 和 OS 分别为 14.2（IQR：7.2-58.3）和 44.6（IQR：18.6-82.9）个月。淋巴结疾病、低分化、胰腺原发灶血管侵犯和双侧卵巢疾病倾向于导致更差的结局。
接受 PDAC 切除术和卵巢复发的患者往往与更常见的复发模式具有相似的病程。伴有淋巴结疾病、低分化、血管侵犯和双侧卵巢疾病的原发性肿瘤提示具有更具侵袭性的疾病生物学。理想的管理仍在很大程度上未知，未来的协作努力应优化治疗策略。
