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Barpujari A, Klaas E, Roberts J, Vo KA, Azizi E, Martinez M, Sung E, Lucke-Wold B. Ovarian Cancer Metastasis to the Central Nervous System: A Literature Review. JOURNAL OF GYNECOLOGY, CLINICAL OBSTETRICS AND REPRODUCTIVE MEDICINE 2022; 1:10.37191/Mapsci-JGCORM-1(1)-004. [PMID: 36326265 PMCID: PMC9625854 DOI: 10.37191/mapsci-jgcorm-1(1)-004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Ovarian cancer is one of the leading causes of cancer-related deaths among women in the United States. Metastasis to the central nervous system has become more frequent in the previous decades, however, treatment options remain limited. In this review, we discuss the pathophysiology of ovarian cancer and how metastasis to the central nervous system typically occurs. We then discuss cases of metastasis presented in the literature to evaluate current treatment regimens and protocols. Finally, we highlight emerging treatment options that are being utilized in clinics to provide personalized treatment therapy for a patient's unique diagnosis. This review aims to further the understanding of pathophysiology, stimulate further innovative treatments, and present accessible resources through tables and figures.
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Affiliation(s)
- Arnav Barpujari
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | - Elizabeth Klaas
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | - Jeffery Roberts
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | - Kim-Anh Vo
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | - Esaan Azizi
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | - Melanie Martinez
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | - Eric Sung
- Department of Neurosurgery, University of Florida, Gainesville, USA
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Multani KM, Srinivasan R, Tejwani K, Rajesh BJ. Isolated Thoracic Spine Intramedullary Metastasis from Primary Ovarian Carcinoma: A Rare Case Report. Asian J Neurosurg 2021; 16:575-578. [PMID: 34660371 PMCID: PMC8477811 DOI: 10.4103/ajns.ajns_42_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/08/2021] [Accepted: 03/20/2021] [Indexed: 11/04/2022] Open
Abstract
Ovarian carcinoma is one among the most commonly diagnosed cancer in women. Most commonly it metastasizes within peritoneal cavity by transcoelomic spread; distant metastasis to central nervous system through hematogenous spread is rare, and intramedullary spread is even rarer. Till date, only six reports have identified isolated intramedullary metastasis to spinal cord in a patient who were considered disease free on follow-up after treatment of primary disease; of which only two were in dorsal spine. The average time for diagnosis of intramedullary metastasis after diagnosis of primary disease was 26 months in previous reports. All were on regular follow-up, and clinicians were misleaded by normal CA-125 levels, and patients were considered disease free. This report is third in world literature case of isolated intramedullary dorsal spinal cord metastasis in a patient of primary ovarian carcinoma who was on follow-up with normal CA-125 levels and was treated with myelotomy and gross total resection of lesion + adjuvant chemotherapy and oral steroids. With our experience, we recommend keeping magnetic resonance imaging neuraxis to be done in follow-up of patients treated for high-grade ovarian carcinoma so that early diagnosis and prompt management can be given to patients that can improve their quality of life.
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Affiliation(s)
- Kartik Manoj Multani
- Department of Neurosurgery, Yashoda Superspeciality Hospital, Secunderabad, Telangana, India
| | - Rahul Srinivasan
- Department of Neurosurgery, Medical Trust Hospital, Kochi, Kerala, India
| | - Komal Tejwani
- Department of Obstetrics and Gynecology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
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O'Neill AH, Phung TB, Lai LT. Intramedullary spinal cord metastasis from thyroid carcinoma: Case report and a systematic pooled analysis of the literature. J Clin Neurosci 2017; 49:7-15. [PMID: 29248379 DOI: 10.1016/j.jocn.2017.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 12/03/2017] [Indexed: 11/29/2022]
Abstract
Intramedullary spinal cord metastasis (ISCM) is rare and occurs most commonly in the setting of advanced malignancy. The optimal management pathways are not well defined and treatment outcomes from contemporary therapies remain variable. We report a case of a 49-year-old woman with known primary papillary thyroid carcinoma, who presented with rapidly progressive clinical features of Brown-Sequard syndrome. A detailed pooled analysis of the literature was conducted to characterise the clinical and demographic features, management options, and expected survival outcomes for cases of ISCM. We secondarily performed a subgroup analysis on the incidence, clinical and management characteristics of thyroid carcinoma ISCM.
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Affiliation(s)
- Anthea H O'Neill
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Teik Beng Phung
- Department of Anatomical Pathology, Monash Health, Melbourne, Australia
| | - Leon T Lai
- Department of Neurosurgery, Monash Health, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia.
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Ravindra VM, Mazur MD, Driscoll M, McEvoy S, Schmidt MH. BRCA2-positive spinal intramedullary ovarian metastatic disease: case report. Spine J 2016; 16:e201-7. [PMID: 26552643 DOI: 10.1016/j.spinee.2015.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/09/2015] [Accepted: 10/29/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Ovarian cancer is the fourth leading cause of cancer death in women, but advances in treatment have led to longer survival among these patients. Tied to these advances and increased survival, however, have been new patterns of metastatic spread. PURPOSE The authors discuss the management and surgical decision making in patients with intramedullary ovarian metastatic disease using a case illustration and relevant literature. STUDY DESIGN/SETTING A case report was used. METHODS The authors describe a case of a 59-year-old woman with Breast Cancer gene (BRCA) 2-positive ovarian cancer who developed progressive myelopathy from a T10 to T11 intramedullary metastatic lesion. RESULTS The patient underwent a standard open T10-T11 laminectomy for intramedullary tumor resection. Intraoperative ultrasound was used to direct the dural opening over the lesion. After a posterior midline myelotomy, microsurgical dissection revealed the intramedullary tumor with a discolored fibrous capsule, which was carefully dissected off of the spinal tracts, and a gross total resection was achieved. Postoperative magnetic resonance imaging at 6 months demonstrated no evidence of residual or recurrent intramedullary tumor. The patient underwent adjuvant external beam radiation to the thoracic spine but succumbed to her primary disease 1 year after surgery. CONCLUSION Although central nervous system involvement of ovarian cancer confers a poor prognosis, patients presenting with a solitary lesion and neurologic deficit may benefit from surgical resection followed by steroids and radiation therapy, especially when tissue diagnosis is necessary.
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Affiliation(s)
- Vijay M Ravindra
- Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Marcus D Mazur
- Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Meghan Driscoll
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Sara McEvoy
- Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Meic H Schmidt
- Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
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Sung WS, Sung MJ, Chan JH, Manion B, Song J, Dubey A, Erasmus A, Hunn A. Intramedullary spinal cord metastases: a 20-year institutional experience with a comprehensive literature review. World Neurosurg 2012; 79:576-84. [PMID: 22484768 DOI: 10.1016/j.wneu.2012.04.005] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Revised: 10/30/2011] [Accepted: 04/03/2012] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To review previous reports as well as our institutional experience to address the issues regarding patient management and also to assess the predisposing factors that might influence outcome and survival. METHODS We undertook a 20-year (1989-2009) retrospective study of a series of eight patients diagnosed with intramedullary spinal cord metastases (ISCMs) in our institute. We further reviewed 293 cases of ISCMs reported in the English literature since 1960. Characteristics regarding the site of the primary cancer, location of ISCM, the presence of other metastases, presenting neurological symptoms/signs, duration of symptoms, and the time interval from diagnosis of the primary tumor to ISCM were pooled. We analyzed the different treatment approaches, the functional outcome, and the factors influencing survival. RESULTS Lung and breast cancers appear to be the most frequent source of ISCM with cervical, thoracic, and lumbar spine being equally affected. Motor weakness predominates as the commonest symptom at presentation, followed by pain and sensory disturbance. At diagnosis, most patients with ISCM have a known primary cancer often associated with cerebral and other systemic metastases. Overall survival of ISCM is poor (median: 4 months from the time of diagnosis). Survival in surgical patients is 6 months, compared with 5 months in those conservatively managed. Clinical improvement was observed in more than one-half of those treated surgically, whereas neurological status was maintained in most patients treated conservatively. CONCLUSION ISCM is an unusual site for metastasis. Regardless of the treatment, its prognosis is generally poor as its presence often signifies end-stage cancer. However, with early diagnosis and appropriate treatment, selected patients may benefit from improved neurological outcome and quality of life.
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Affiliation(s)
- Wen-Shan Sung
- Department of Neurosurgery, Royal Hobart Hospital, Hobart, Tasmania, Australia.
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Wostrack M, Pape H, Kreutzer J, Ringel F, Meyer B, Stoffel M. Surgical treatment of spinal intradural carcinoma metastases. Acta Neurochir (Wien) 2012; 154:349-57. [PMID: 22009015 DOI: 10.1007/s00701-011-1204-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 10/04/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Intradural metastases of nonneurogenic origin represent an extremely rare manifestation of systemic cancer. The respective literature is very scarce. METHODS We retrospectively evaluated nine patients with intradural metastases treated surgically from March 2006 until today at our department. RESULTS Four metastases were intramedullary and five intradural extramedullary. Localisation along the spine involved: cervical n = 3, thoracic n = 3, and conus/cauda n = 3. Five patients were female and four male, with a median age of 71 years. Histology showed: breast cancer n = 2, NSCLC (non-small cell lung cancer) n = 2, SCLC (small cell lung cancer) n = 1, colon carcinoma n = 1, malignant skin melanoma n = 1, squamous cell carcinoma of the skin n = 1, and ovarian carcinoma n = 1. Holospinal dissemination in terms of leptomeningeal carcinomatosis according to MRI or positive CSF (cerebrospinal fluid) cytology, respectively, was found in four patients. Gross total resection was achieved in four patients and debulking in five. Results of surgical decompression were: six patients (67%) exhibited immediate improvement of neurological symptoms and/or pain; four of them even improved according to the McCormick Scale score (44%); two patients (22%) were unchanged, and one (11%) exhibited worsening of neurological symptoms after surgery. Median survival time after surgery was 7.3 months. CONCLUSIONS Intradural metastases are associated with limited survival time. Accordingly, the aim of surgery is strictly palliative. The majority of patients benefit with respect to neurological deficit/pain (67%) independent of the extent of resection. Thus, decompressive surgery is recommended to increase the quality of life.
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Affiliation(s)
- Maria Wostrack
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 18675 Munich, Germany.
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Miranpuri AS, Rajpal S, Salamat MS, Kuo JS. Upper cervical intramedullary spinal metastasis of ovarian carcinoma: a case report and review of the literature. J Med Case Rep 2011; 5:311. [PMID: 21756304 PMCID: PMC3154862 DOI: 10.1186/1752-1947-5-311] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 07/14/2011] [Indexed: 11/21/2022] Open
Abstract
Introduction Currently there is no generalized approach to treating patients with intra-medullary spinal metastasis. High cervical spinal cord lesions can be particularly challenging cases, and may even be considered inoperable by some. Case report We present what is, to the best of our knowledge, the first reported case of ovarian carcinoma (managed primarily with surgery) in a 65-year-old Caucasian woman metastasizing to the upper cervical spinal cord; we also review the relevant literature and discuss management strategies. Conclusions Due to improving systemic cancer therapies, patients with cancer now often survive longer and are more likely to develop central nervous system metastases. Therefore, neurosurgical oncologists are often challenged with difficult decisions about how to surgically manage these patients. We recommend individualized multidisciplinary management based on patient functional status, the need for definitive diagnosis for possible additional adjuvant therapies, and consideration of extent of systemic disease impacting on desirable quality and length of survival.
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Affiliation(s)
- Amrendra S Miranpuri
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
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Kodama M, Kawaguchi H, Komoto Y, Takemura M. Coexistent intramedullary spinal cord and choroidal metastases in ovarian cancer. J Obstet Gynaecol Res 2010; 36:199-203. [PMID: 20178552 DOI: 10.1111/j.1447-0756.2009.01102.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Involvement of intramedullary spinal cord and the choroid by ovarian cancer is rare, and coexistence of metastases at these sites is extremely rare and has never been reported. This condition rapidly progresses to a neurological emergency; however, an efficient standard treatment method is not available for this rare condition. The case presented herein is of a female patient with stage II, poorly differentiated serous cystadenocarcinoma of the ovary. She presented with blindness and other neurologic complaints during the course of treatment for a recurrence at 50 months after the primary surgical treatment for the tumor. Magnetic resonance imaging (MRI) revealed intramedullary spinal cord metastasis and choroidal metastasis, coexisting with multiple brain metastases and intra-abdominal lesions. Neurological emergency was prevented by administering whole-brain irradiation therapy followed by systemic chemotherapy. Early diagnosis and multidisciplinary treatment, including radiotherapy and chemotherapy, may offer good palliation for such unusual metastases of ovarian cancer.
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Affiliation(s)
- Michiko Kodama
- Department of Gynecology and Obstetrics, Osaka General Medical Center, Osaka, Japan.
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Dam-Hieu P, Seizeur R, Mineo JF, Metges JP, Meriot P, Simon H. Retrospective study of 19 patients with intramedullary spinal cord metastasis. Clin Neurol Neurosurg 2008; 111:10-7. [PMID: 18930587 DOI: 10.1016/j.clineuro.2008.06.019] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 06/21/2008] [Accepted: 06/30/2008] [Indexed: 11/16/2022]
Abstract
OBJECT Intramedullary spinal cord metastasis (ISCM) is a rare but devastating complication of cancer. Due to both widespread MRI availability and longer survival of cancer patients, the probability of discovering an ISCM during the course of the disease has increased and raised issues regarding the management of these patients, and particularly the place of surgery. In this study, we assess predictive factors for surgical outcome and survival. PATIENTS AND METHODS We retrospectively reviewed a series of 19 patients consecutively admitted in our institution from 1993 to 2006 for ISCM, representing the second largest series published in the literature. MRI was performed on all patients. Thirteen underwent microsurgical excision of ISCM. Functional outcome was evaluated and factors influencing survival were statistically analyzed. RESULTS Median survival was statistically longer when surgery was performed (7.4 vs. 2.6 months). Preoperative neurological status, nature of primary cancer, presence of systemic and/or CNS metastases influenced survival, but differences were without statistical significance. Neurological status improved in 58% (11/19) of operated patients. CONCLUSIONS Optimal management of patients with ISCM is difficult due to the wide variety of clinical situations and the lack of controlled studies on the results of different therapeutic options. Diagnosis should be made as early as possible and surgical resection should be considered as the primary treatment whenever feasible, particularly in the case of rapidly progressive neurological deficits and when a clear cleavage plane exists. Our study shows that surgery could result in both increased survival rate and significant improvement of neurological function.
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Affiliation(s)
- Phong Dam-Hieu
- Department of Neurosurgery, University of Bretagne Occidentale, School of Medicine and University Medical Center, Brest, France.
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Zannoni GF, Vellone VG, Distefano MG, Fadda G, Scambia G. Ovarian serous carcinoma presenting with mediastinal lymphadenopathy 20 months before the intraabdominal mass: Role of immunohistochemistry. Gynecol Oncol 2007; 104:497-500. [PMID: 17126890 DOI: 10.1016/j.ygyno.2006.09.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Revised: 09/15/2006] [Accepted: 09/23/2006] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Metastatic involvement of the mediastinal lymph nodes is an extremely uncommon finding in epithelial ovarian cancers. CASE REPORT A 63-year-old woman was admitted to hospital for dyspnoea due to an anterior mediastinal mass. The surgical biopsy showed a 6-cm metastatic lymph node with a papillary pattern, scattered psammomas and immunoreactivity for WT1, Cytokeratin 7, EMA and negative for E-cadherin, GCFDP-15, Thyroglobulin, Cytokeratin 20, Cytokeratin 5/6, CEA, Vimentin, Calretinin, TTF1. After 20 months a follow-up CT identified an ovarian mass with the same histological pattern and immunoreactivity of the mediastinal nodule. RESULTS Immunohistochemistry, especially WT1, is useful in assessing the ovarian origin of an unusual metastasis particularly if it is the first presentation of the disease.
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Affiliation(s)
- Gian Franco Zannoni
- Department of Pathology, Faculty of Medicine Agostino Gemelli, Catholic University, 00168 Rome, Italy.
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Rastelli F, Benedetti G, Di Tommaso L, Mazzoli M, Calbucci F, Crinò L. Intramedullary spinal metastasis from ovarian cancer. Lancet Oncol 2005; 6:123-5. [PMID: 15683822 DOI: 10.1016/s1470-2045(05)01742-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kumar L, Barge S, Mahapatra AK, Thulkar S, Rath GK, Kumar S, Mishra R, Dawar R, Singh R. Central nervous system metastases from primary epithelial ovarian cancer. Cancer Control 2003; 10:244-53. [PMID: 12794622 DOI: 10.1177/107327480301000309] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Lalit Kumar
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
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Cormio G, Rossi C, Cazzolla A, Resta L, Loverro G, Greco P, Selvaggi L. Distant metastases in ovarian carcinoma. Int J Gynecol Cancer 2003; 13:125-9. [PMID: 12657111 DOI: 10.1046/j.1525-1438.2003.13054.x] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Distant metastases are unusual at presentation and during the course of ovarian carcinoma. The aim of the present study was to determine the incidence and prognostic factors of distant metastases consistent with stage IV disease in ovarian cancer patients. A retrospective chart review was conducted on 162 patients with epithelial ovarian carcinoma treated at our Unit between 1991 and 2000. Pertinent clinical information, pathologic data, treatment, and prognostic factors for survival following documentation of distant metastatic disease were collected. The significance of the association between metastatic status and various clinical variables was assessed using the standard chi-square test. Survival time was calculated from the time of diagnosis of ovarian cancer and from the time of diagnosis of the distant metastases. A logistic regression procedure was used to estimate the odds of metastatic status given the presence of certain clinical variables. A total of 67 metastatic sites were diagnosed in 50 patients. Thirteen patients (8%) had distant metastatic disease at the time of diagnosis, 37 patients (22%) had distant metastases at the time of recurrent of progressive disease. Site of metastases were: liver, 21; pleura, 11; lung, 8; central nervous system and skin, 7 each; extra-abdominal lymph nodes and spleen, 5 each; bone, 2; and breast, 1. Significant risk factors for the development of distant metastases were stage, grade, and lymph node involvement. Median interval time between diagnosis of ovarian cancer and documentation of metastatic disease was 44 months (range 3-105), and at the time of diagnosis of distant disease, 36 of 50 patients (72%) had other sites of disease (intra-abdominal or extra-abdominal). Median survival from diagnosis of distant disease was 12 months (range 1-58). In univariate analysis performance status (P = 0.03), the presence of other sites of disease (P = 0.04) and interval time between diagnosis of ovarian cancer and documentation of distant metases (P = 0.03) were the only factors significantly associated with survival. Long interval time remained significant for prognosis in multivariate analysis also (P = 0.04). Distant metastasis consistent with stage IV disease is a late complication that occurs in about one third of ovarian cancer patients. Prognosis after documentation of distant metastases is poor. We conclude the most important prognostic factor associated with survival is the interval time between diagnosis of ovarian cancer and documentation of distant metastases.
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Affiliation(s)
- G Cormio
- Gynecologic Oncology Unit, University of Bari, Bari, Italy.
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