Lai Yen-Ling, Kang Jun-Hyeok, Hsu Che-Yu, Lee Jung-Il, Cheng Wen-Fang, Chen Yu-Li, Lee Yoo-Young
Department of Obstetrics and Gynecology, Hsin-Chu Branch, National Taiwan University Hospital, Hsin-Chu, Taiwan.
Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.
Front Oncol. 2021 Aug 27;11:719936. doi: 10.3389/fonc.2021.719936. eCollection 2021.
Central nervous system (CNS) metastases from epithelial ovarian cancer (EOC) are rare. We investigated the clinico-pathological prognostic factors of patients with CNS metastases from EOC and compared the outcomes of various treatment modalities. We retrospectively reviewed the records of patients with CNS metastases from EOC between 2000 and 2020. Information on the clinical and pathological characteristics, treatment, and outcomes of these patients was retrieved from Samsung Medical Center and National Taiwan University Hospital. A total of 94 patients with CNS metastases were identified among 6,300 cases of EOC, resulting in an incidence of 1.49%. Serous histological type [hazard ratio (HR): 0.49 (95% confidence interval [CI] 0.25-0.95), =0.03], progressive disease [HR: 2.29 (95% CI 1.16-4.54), =0.01], CNS involvement in first disease relapse [HR: 0.36 (95% CI 0.18-0.70), =0.002], and gamma knife radiosurgery (GKS)-based combination treatment for EOC patients with CNS lesions [HR: 0.59 (95% CI 0.44-0.79), <0.001] significantly impacted survival after diagnosis of CNS metastases. In a subgroup analysis, superior survival was observed in patients with CNS involvement not in first tumor recurrence who underwent GKS-based combination therapeutic regimens. The survival benefit of GKS-based treatment was not significant in patients with CNS involvement in first disease relapse, but a trend for longer survival was still observed. In conclusion, GKS-based combination treatment can be considered for the treatment of EOC patients with CNS metastases. The patients with CNS involvement not in first disease relapse could significantly benefit from GKS-based combination strategies.
上皮性卵巢癌（EOC）发生中枢神经系统（CNS）转移的情况较为罕见。我们调查了EOC发生CNS转移患者的临床病理预后因素，并比较了各种治疗方式的疗效。我们回顾性分析了2000年至2020年间EOC发生CNS转移患者的病历。这些患者的临床和病理特征、治疗及预后信息取自三星医疗中心和台湾大学附属医院。在6300例EOC病例中，共识别出94例发生CNS转移的患者，发生率为1.49%。浆液性组织学类型[风险比（HR）：0.49（95%置信区间[CI] 0.25 - 0.95），P = 0.03]、疾病进展[HR：2.29（95% CI 1.16 - 4.54），P = 0.01]、初次疾病复发时CNS受累[HR：0.36（95% CI 0.18 - 0.70），P = 0.002]以及对EOC合并CNS病变患者采用基于伽玛刀放射外科（GKS）的联合治疗[HR：0.59（95% CI 0.44 - 0.79），P < 0.001]对CNS转移诊断后的生存有显著影响。在亚组分析中，对于初次肿瘤复发时未发生CNS受累且接受基于GKS联合治疗方案的患者，观察到其生存期更长。对于初次疾病复发时CNS受累的患者，基于GKS治疗的生存获益不显著，但仍观察到生存期延长的趋势。总之，对于EOC合并CNS转移的患者，可考虑采用基于GKS的联合治疗。初次疾病复发时未发生CNS受累的患者可从基于GKS的联合策略中显著获益。
