Ovarian metastasis from non-gynecologic primary sites: a retrospective analysis of 177 cases and 13-year experience

Abstract BackgroundMetastasis to the ovary is not rare. Generally, the most common non-gynecologic primary site of Ovarian metastasis is gastrointestinal tract. Differential diagnosis between primary malignant ovarian tumor and metastatic ovarian tumor is important, otherwise appropriate treatment cannot be determined. Furthermore, optimal treatment strategy for ovarian metastasis from non-gynecologic primary sites still are needed to explore. This study described the clinicopathologic characteristics of ovarian metastasis from non-gynecologic primary sites and identified the significance of surgical treatment for these patients. Methods One hundred and seventy-seven patients with ovarian metastasis from non-gynecologic primary sites admitted in Peking Union Medical College Hospital between May 2005 and May 2018 were retrospectively evaluated. Results The mean age was 48 years (range 18 - 83). Approximately 60% of patients were premenopausal women. The mostly two common non-gynecologic primary sites of ovarian metastasis were colorectum (68 cases) and stomach (61 cases). Besides the most common symptoms of abdominal distension (39.0%), abdominal pain (37.9%), ascites (27.7%), there were 18.1% of patients presenting with abnormal uterine bleeding. A half of patients who tested serum CA-125 preoperatively had an elevated CA-125 within the range of 35U/ml to 200U/ml. More than 70% of synchronous ovarian metastasis were misdiagnosed as primary ovarian cancer preoperatively. Of patients, 56.5% achieved optimal cytoreductive surgery (the diameter of largest residual lesion < 2 cm). The overall 5-year survival rate and median survival time were 10% and 20 months, respectively. The primary sites, optimal cytoreductive surgery, differentiation of tumor, and postoperative adjuvant treatment were prognostic indicators. Conclusions Colorectum and stomach are the most common non-gynecologic primary sites of ovarian metastasis. Synchronous ovarian metastasis is easy to be misdiagnosed as primary ovarian cancer. Optimal cytoreductive surgery and postoperative adjuvant treatment can be done to confer survival benefit in selected patients.