Clinical characteristics of uterine metastasis in epithelial ovarian cancer

Clinical characteristics of uterine metastasis in epithelial ovarian cancer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical characteristics of uterine metastasis in epithelial ovarian cancer TianMei Wang, Cong Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2465403/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Ovarian epithelial malignant tumor spreads directly and easily spreads to the serous surface of the uterus. However, whether invasion and metastasis occur in the uterine parenchyma is unknown. Its metastasis rate and its related clinical characteristics reveal that ovarian cancer surgery with uterus preservation provides objective data support. Methods The data of patients with ovarian cancer who underwent hysterectomy from January 1, 2017, to March 31, 2022, were collected retrospectively, and the distribution of actual uterine metastasis and possible factors related to clinical characteristics were analyzed. Results A total of 464 patients were included, and the uterine metastasis rate was 38.58%, with 29.09% confirmed by pathology, including 4.96% of myometrial metastasis and 1.51% of endometrial metastasis. The occurrence of metastasis is positively related to the Ca125, HE4, unilateral or bilateral ovarian lesions, diameter of the ovarian tumor, clinical stage, whether the fallopian tube is metastatic, pathological type, pathological grade, degree of differentiation, ascites/ peritoneal washout evidence, the timing of surgery, and whether there is extrauterine organ metastasis in the pelvic cavity, and negatively related to whether there is endometriosis. Conclusion The incidence of uterine myometrial metastasis of ovarian cancer is 4.96%. The assessment of risk factors, such as unilateral or bilateral ovarian lesions, oviduct metastasis and pelvic metastasis may provide assistance to patients undergoing fertility-preserving surgical treatment. Trial registration number:2020-636 ovarian epithelial cancer uterus metastasis Figures Figure 1 Introduction Ovarian cancer (OC) is one of the most common gynecological malignant tumors, which can occur at any age. According to NCCN recommendations, the treatment of ovarian cancer is mainly surgery, and only for some patients with indications, that is, early patients who want to retain fertility or patients with low-risk malignant tumors (early epithelial ovarian cancer, low-grade malignant potential tumors, germ cell tumors or malignant stromal tumors). This mainly takes into account that ovarian cancer is characterized by extensive dissemination in the abdominal cavity, which can be metastasized through direct spread to surrounding tissues and organs, planting dissemination, and lymph node metastasis. Therefore, the uterus, fallopian tube, greater omentum, retroperitoneal lymph nodes, and other parts are most often involved. Because of this, to achieve the goal of tumor reduction, hysterectomy is routinely performed for both patients who undergo comprehensive staging surgery in the early stage and patients who undergo tumor cell reduction in the middle and late stages (Salvo et al. 2021 ). However, with the postponement of the childbearing age, some patients may be diagnosed with malignant ovarian tumors before childbearing, and radical surgery may be difficult for them to accept. Moreover, hysterectomy not only affects women's reproductive function but also causes many other problems that affect women's quality of life and physical and mental health (Pereira et al. 2017). Hysterectomy will affect the pelvic floor function of patients, causing pelvic organ prolapse, abnormal urination, and defecation. In addition, it will also have an impact on women's psychology, causing them to have psychogenic sexual dysfunction (Monterrosa-Castro et al. 2018 ). Due to the differences in cultural backgrounds between China and the West, Chinese women, especially premenopausal women, are more dissatisfied with their self-image after hysterectomy, resulting in adverse psychological reactions (Gabriel et al. 2021 ). This requires that doctors should constantly explore the possibility of more care while ensuring the oncological outcome of patients. At present, some studies believe that FSS is safer for patients of childbearing age with 1–2 stage I EOC. At the same time, in clinical practice, we found that in some patients in the middle and late stages, when suspected uterine metastasis was found by imaging and intraoperative observation before surgery, no microscopic metastasis could still be found by postoperative examination. So should hysterectomy be routinely performed in all cases of OC? This issue remains to be discussed. Material And Methods 1.1 Research Objective: Data were collected retrospectively who underwent hysterectomy for ovarian cancer in our department from January 1, 2017, to March 31, 2022. Patients with metastatic ovarian cancer, patients who had their uteri removed for other diseases before surgery, patients who had undergone another comprehensive staging operation in our hospital after tumor removal in other hospitals, and patients with other incomplete data were excluded. All effective follow-up patients were informed consent to this clinical retrospective analysis, and through the Ethics Committee of First Affiliated Hospital of Chongqing Medical University (NO.2020 − 636). The informed consent was obtained from the study participants and the guidelines outlined in the Declaration of Helsinki were followed. 1.2 Methods: Clinical information includes age, menopause, fertility, tumor marker value, and postoperative pathological results, all of which come from our electronic medical record system. Exclusion criteria include Patients with endometrial carcinoma (those with different pathological types of endometrium and ovary); no operative; the uterus has been removed due to benign diseases in the past (including total hysterectomy and subtotal hysterectomy); incomplete data. Finally, 464 patients were included in the analysis. 1.3 Statistical processing: SPSS 26.0 statistics software were used for data analysis. Data information included both measurement data and count data. Measurement data obeying normal distribution were expressed as mean ± standard deviation and used two independent samples t-test, while non-normally distributed measurement data were expressed by median, maximum and minimum values with Mann-Whitney U rank-sum test; count data were tested by chi-square (χ 2 ) test and ordinal categorical variable were tested by Mann-Whitney U rank-sum test. Binary logistic multifactorial regression was used to analyze the risk factors for uterine metastasis of ovarian cancer. All statistical analyses were performed using a two-sided test, and P < 0.05 were considered statistically significant. Result 2.1 The incidence of uterine metastasis in ovarian epithelial malignant tumors: Among 464 cases, the uterine metastasis rate was 38.58%. The metastasis of the uterine serous surface (including the adhesion of uterine serous surface, sacral ligament, main ligament, para uterine serous surface, and tumor) accounted for 32.11%.However, only 29.09% of them were confirmed by pathology, and the remaining 9.48% were staged just due to the adhesion of the uterus. 4.96% of patients with myometrial metastasis, the rate of metastasis to the mucosal surface with full layer metastasis was 1.51%. So the overall rate of uterine metastasis confirmed by pathology was 29.09% (serous metastasis 22.63%, muscular metastasis4.96%, full layer metastasis 1.51%) ( Fig. 1 ). 2.2 Clinical characteristics of epithelial ovarian malignant tumors: Two groups were divided by uterine metastasis or not, and analyzed the clinical characteristics of the two groups (Table 1). Uterine metastasis of ovarian cancer is related to ovarian tumor diameter, unilateral or bilateral ovarian lesions, clinical stage, whether the fallopian tube is metastatic, surgical opportunity, pathological type, pathological grade, whether there is extrauterine organ metastasis in the pelvic cavity, and whether there is endometriosis. It was not related to the age of onset, menopause, times of pregnancy and childbirth, and history of breast cancer. It can be seen that there was statistical significance between the patient's history of endometriosis for uterine metastasis of ovarian cancer. At the same time, there is a negative correlation between the patient's history of endometriosis. Previous history of endometriosis may be possible protective factors. 2.3 Multi-factor coupling of ovarian cancer with uterine metastasis: The 12 variables that were statistically different in our table 1 were subjected to binary logistic regression analysis (Table 2). From Logistic regression result, ovarian lesions location (OR = 3.183), oviduct metastasis (OR = 2.771) and pelvic metastasis (OR = 4.360) were the main independent risk factors for uterine metastasis of ovarian cancer. Table 2 Logistic regression analysis of risk factors for uterine metastasis of ovarian cancer OR(95%CI) P value Ca125 NS 0.371 HE4 NS 0.202 Ovarian location 3.183(1.753–5.781) < 0.001 Diameter NS 0.964 Stage NS 0.463 G3 NS 0.851 Pathological type NS 0.273 Oviduct metastasis 2.771(1.578–4.866) < 0.001 Ascites/ Peritoneal washout evidence NS 0.319 Pelvic metastasis 4.360(1.665–11.421) 0.003 PDS/IDS NS 0.160 Endometriosis NS 0.211 NS = non significant; OR = Odds Ratio; CI = Confidence Interval. Discussion 3.1 Analysis of clinical characteristics of possible low-risk factors of uterine metastasis It can be seen from this result that the clinical main independent risk factors related to uterine metastasis of ovarian cancer include, ovarian lesions location, oviduct metastasis and pelvic metastasis. In clinical practice, if there are patients with a strong desire to retain the uterus, preoperative determination of no other lesions in the uterus, or high-risk patients with surgical anesthesia risk, it can be considered to retain the uterus during the operation. Or if an ovarian malignant tumor is found accidentally after an operation, whether the uterus is retained in the subsequent staging operation can also be further discussed. At the same time, univariate analysis found that patients with pelvic endometriosis in the past had a low uterine metastasis rate, which was statistically significant compared with the control group, suggesting that it may be protective factors for uterine metastasis, or because patients need to see doctors repeatedly due to related diseases, their ovarian cancer was easy to identify early, and the risk of metastasis in other parts was reduced. 3.2 possible effects for diagnosis of epithelial ovarian cancer: Ovarian cancer is classified as the surgical and pathological stage. Its staging is based on surgical pathology. According to FIGO staging in 2014, stage IIA refers to the tumor spreading to and/or planting in the uterus and/or fallopian tube and/or ovary. Stage II ovarian cancer is still controversial and difficult to define (Janda et al. 2019 ). It includes a group of patients with ovarian cancer, whose tumor directly spread to other pelvic organs, but there is no evidence of spread, and it cannot be confirmed by the results of disease examination after surgery (Doubeni et al. 2016 ). Therefore, the staging of Phase II was diagnosed generally based on the following: before operation: ultrosound, CT or MRI were certain judgment basis. During operation: the description of the scope of pelvic and peritoneal lesions such as: the serous surface of the uterus was generally presence of bladder and peritoneal reflux lesions, the presence of lesions in the posterior wall of the uterus, the presence of lesions in the rectum and uterine recess, the dense adhesion between uterine ligaments and lesions, thickening and shortening. After operation: pathologic confirm whether tumor involvement one by one according to the remarks during the operation. So if the patient has preoperative neoadjuvant chemotherapy or has had incomplete staging surgery in the past, the positive rate of the medical examination results will also be affected, which poses a challenge to whether there is uterine metastasis in advanced ovarian cancer. Among the 104 patients of stage II included in our study, there were 24 patients in stage IIA, including 14 patients in stage IIA due to uterine metastasis, 10 patients in stage IIA due to intraoperative uterine adhesions, and 4 patients (2 in muscular layer, 2 in a full layer) confirmed by pathology, which could not be statistically analyzed due to the small number of patients, and were not listed in the results. More stage II staging was due to the involvement of organs outside the pelvic uterus, such as intestines, bladder, and other organs. Some scholars believe that the disease of stage II intestinal metastasis that invades intestinal mucosa through the intestinal wall should be upgraded to stage IVB (Javadi et al. 2016 ). According to the analysis of the involved parts of the uterus, the involvement of the serous surface is consistent with the biological behavior of the direct spread of ovarian cancer. According to the purpose of tumor cell reduction, as long as the operation achieves no residual lesions with the naked eye, it is not necessarily necessary to remove and change the involved organs. For patients with endometrial invasion indicated by preoperative imaging, the presence of tumor involvement can be confirmed by hysteroscopy before surgery, and the occurrence of ovarian cancer combined with endometrial cancer can be ruled out. Therefore, in the case of uterine substantial metastasis, the uterus needs to be removed for myometrial metastasis, which is conducive to the reduction of tumor focus. This retrospective analysis found that 4.96% of patients with myometrial metastasis were confirmed after surgery, which is a small probability event. 3.3 possible effects for the treatment of epithelial ovarian cancer: The age of patients with fertility preservation brings hope. Early epithelial ovarian cancer and low malignant potential tumors can be operated on with fertility preservation (Nasioudis et al. 2020 ), that is, unilateral adnexectomy or bilateral adnexectomy can be performed to preserve the uterus (Goeckenjan et al. 2020 ). For young patients who hope to retain their reproductive function, the affected side can be resected + fully staged surgery in IA stage; In stage IB, bilateral adnexectomy (uterus preservation) and comprehensive staged operation are feasible (Baek et al. 2020 ). However, in the actual clinical work, patients diagnosed with stage II during the operation only removed bilateral fallopian tubes and ovaries, while there were few cases of reserving the uterus. Ovarian cancer occurred at a slightly older age, and patients often had a child. It was rare for patients to insist on reserving the uterus because of the requirement of reproduction. Patients removed bilateral ovaries, and there was no consensus on the preservation of eggs in ovarian cancer. These factors will reduce the possibility of reserving the uterus. At the same time, based on the patient's fear of being located in a malignant tumor, they hope to be resected to the maximum extent. Even young patients may give up childbearing and choose simultaneous hysterectomy of double appendages. It may also be that as a routine gynecological operation, hysterectomy does not increase the difficulty of the operator. Therefore, in the choice of cutting or not cutting, simultaneous resection is selected to a large extent. And whether the retention of the uterus will affect the five-year survival of patients, there is no definite answer. Retrospective analysis of 9017 patients (Bercow et al. 2021 ) showed that the 5-year survival period of ovarian cancer patients aged 15–44 years was lower than that of the whole population group, and its influencing factors might be the way of fertility-preserving surgery, but more high-risk factors came from the period, so it was impossible to simply analyze the proportion of fertility-preserving surgery on the 5-year survival rate. Meta-analysis found that (Liu et al. 2020 ): HR of patients undergoing fertility-preserving surgery in Phase I patients of 2223 patients in 8 centers decreased slightly, but there was no statistical significance, and also there was no statistical difference in the specific stage and pathological type, while there was no difference in the overall survival. In the true clinical events, there are still a few patients with ovarian epithelial malignant tumors who have undergone hysterectomy. For those patients who have retained fertility, the five-year survival time of most patients with borderline tumors and germ cell tumors is lower than that of those who have undergone radical surgery (Canlorbe et al. 2021 ). The follow-up study on the fertility and prognosis of 25 cases of borderline epithelial ovarian tumors found that (Kim et al. 2021): the risk of premature ovarian failure in fertility-preserving patients was higher than that in the control group, and the number of people who needed assisted reproductive technology increased. There was no significant impact on fertility, but there was no confirmed data for the long-term five-year survival. The report on the re-pregnancy rate of 153 patients with fertility preservation can be seen (Nitecki et al. 2021 ), of which epithelial ovarian cancer accounts for 55%. There is no difference in the postoperative pregnancy outcome, delivery mode, newborn, and non-tumor patients. According to this retrospective analysis, the rate of uterine parenchyma metastasis of ovarian cancer is low. After improving the preoperative examination when necessary, including curettage under hysteroscope and other methods to further exclude uterine lesions, for patients with fertility requirements, young patients, patients who have the desire to retain the uterus, or patients who are difficulty removing the uterus during surgery, or patients who are confirmed to be ovarian cancer patients who have not been fully staged after surgery, the uterus should be retained when making the next operation plan, Whether it will affect the five-year survival period of patients. 3.4 The influence of hysterectomy on patients' quality of life: Take hysterectomy for benign diseases such as uterine leiomyoma as an example, the impact of hysterectomy on the quality of life, exercise ability, and sexual function of patients has also attracted attention. Compared to women with no hysterectomy, women with hysterectomy-bilateral oophorectomy were at increased risk of substantial PF limitations versus minimal PF limitations over 18 years of follow-up (Wilson et al. 2018 ). At the 17-year follow-up, the route of hysterectomy is not associated with a difference in recurrence, grade, or subsequent treatment of prolapse when the indication for hysterectomy is considered. Prolapse, as an indication of hysterectomy, increases the risk for recurrence. Women planning a hysterectomy should be counseled appropriately about the risk of subsequent prolapse (Wilson et al. 2018 ). The prevalence of hysterectomy is disproportionately higher among women with self-reported disabilities compared with women without disabilities, with these differences most pronounced in women of childbearing age (Scime et al. 2021 ). Conclusion The incidence of uterine myometrial metastasis of ovarian cancer is 4.96%, ovarian lesions location, oviduct metastasis and pelvic metastasis are the main independent risk factors for uterine metastasis of ovarian cancer. The Ca125, HE4, lesion location, diameter, stage, pathological type, degree of differentiation and ascites/ peritoneal washout evidence are secondary risk factors. The history of endometriosis may be the low risk factors of uterine metastasis. Whether the diagnosis and surgical scope of ovarian cancer need to be adjusted individually or not needs to be confirmed by subsequent clinical experiments. Declarations FINANCIAL DISCLAIMER/CONFLICT OF INTEREST: NONE Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript Competing Interests The authors have no relevant financial or non-financial interests to disclose. Author Contributions All authors contributed to the study conception and design. Data collection and analysis were performed by Tianmei Wang. The first draft of the manuscript was written by Tianmei Wang and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Data Availability All data generated or analysed during this study are included in this published article. Ethics approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of First Affiliated Hospital of Chongqing Medical University (Date 2022-10-14/ NO.2020-636). Consent to participate Informed consent was obtained from all individual participants included in the study. References Baek MH, Park JY, Kim DY, et al (2020) Feasibility and safety of fertility-sparing surgery in epithelial ovarian cancer with dense adhesion: a long-term result from a single institution. J Gynecol Oncol 31(6):e85 https://doi.org/10.3802/jgo.2020.31.e85 Bercow A, Nitecki R, Brady PC, et al (2021) Outcomes after Fertility-sparing Surgery for Women with Ovarian Cancer: A Systematic Review of the Literature. J Minim Invasive Gynecol 28(3):527-536.e1 https://doi.org/10.1016/j.jmig.2020.08.018 Canlorbe G, Chabbert-Buffet N, Uzan C (2021) Fertility-Sparing Surgery for Ovarian Cancer. J Clin Med 10(18):4235 https://doi.org/10.3390/jcm10184235 Doubeni CA, Doubeni AR, Myers AE (2016) Diagnosis and Management of Ovarian Cancer. Am Fam Physician 93(11):937-944 Goeckenjan M, Freis A, Glaß K, et al (2020) Motherhood after cancer: fertility and utilisation of fertility-preservation methods. Arch Gynecol Obstet 301(6):1579-1588 https://doi.org/10.1007/s00404-020-05563-w Gabriel I, Kalousdian A, Brito LG, et al (2021) Pelvic organ prolapse after 3 modes of hysterectomy: long-term follow-up. Am J Obstet Gynecol 224(5):496.e1-496.e10 https://doi.org/10.1016/j.ajog.2020.11.008 Javadi S, Ganeshan DM, Qayyum A, et al (2016) Ovarian Cancer, the Revised FIGO Staging System, and the Role of Imaging. AJR Am J Roentgenol 206(6):1351-1360 https://doi.org/10.2214/AJR.15.15199 Janda M, McGrath S, Obermair A (2019) Challenges and controversies in the conservative management of uterine and ovarian cancer. Best Pract Res Clin Obstet Gynaecol 55:93-108 https://doi.org/10.1016/j.bpobgyn.2018.08.004 Kim SS (2021) Fertility preservation for women with borderline ovarian tumors: fertility-sparing surgery. Fertil Steril 115(1):83-84 https://doi.org/10.1016/j.fertnstert.2020.09.129 Liu D, Cai J, Gao A, et al(2020) Fertility sparing surgery vs radical surgery for epithelial ovarian cancer: a meta-analysis of overall survival and disease-free survival. BMC Cancer 20(1):320 https://doi.org/10.1186/s12885-020-06828-y Monterrosa-Castro A, Monterrosa-Blanco A, Beltrán-Barrios T (2018) Insomnia and sexual dysfunction associated with severe worsening of the quality of life in sexually active hysterectomized women. Sleep Sci 11(2):99-105 https://doi.org/10.5935/1984-0063.20180019 Nasioudis D, Mastroyannis SA, Haggerty AF, et al (2020) Fertility preserving surgery for high-grade epithelial ovarian carcinoma confined to the ovary. Eur J Obstet Gynecol Reprod Biol 248:63-70 https://doi.org/10.1016/j.ejogrb.2020.01.039 Nitecki R, Clapp MA, Fu S, et al (2021) Outcomes of the First Pregnancy After Fertility-Sparing Surgery for Early-Stage Ovarian Cancer. Obstet Gynecol 137(6):1109-1118 https://doi.org/10.1097/AOG.0000000000004394 Pereira N, Schattman GL (2017) Fertility Preservation and Sexual Health After Cancer Therapy. J Oncol Pract 13(10):643-651 https://doi.org/10.1200/JOP.2017.023705 Salvo G, Falconer H, Pareja R (2021) Beyond oncologic outcomes: fertility and ovarian preservation as key priorities. Int J Gynecol Cancer 31(3):313 https://doi.org/10.1136/ijgc-2021-002435 Scime NV, Brown HK, Metcalfe A, et al (2021) Prevalence of Hysterectomy by Self-Reported Disability Among Canadian Women: Findings from a National Cross-Sectional Survey. Womens Health Rep (New Rochelle) 2(1):557-565 https://doi.org/10.1089/whr.2021.0069 Wilson LF, Pandeya N, Byles J, et al (2018) Hysterectomy and perceived physical function in middle-aged Australian women: a 20-year population-based prospective cohort study. Qual Life Res 27(6):1501-1511 https://doi.org/10.1007/s11136-018-1812-9 Wilson L, Pandeya N, Byles J, et al (2018) Hysterectomy and incidence of depressive symptoms in midlife women: the Australian Longitudinal Study on Women's Health. Epidemiol Psychiatr Sci 27(4):381-392 https://doi.org/10.1017/S2045796016001220 Table 1 Table 1 is available in Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2465403","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":166770220,"identity":"60e84445-56f3-4a62-8bc8-c9d578424d6e","order_by":0,"name":"TianMei Wang","email":"","orcid":"","institution":"First Affiliated Hospital of Chongqing Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"TianMei","middleName":"","lastName":"Wang","suffix":""},{"id":166770221,"identity":"cfeca74e-5634-4cbb-89b0-0f05334024aa","order_by":1,"name":"Cong Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAs0lEQVRIie3PMQrCMBTG8YRAu3ylaws9RLZSKNajBASn6hkKBV16gErv4ZyQwSXoWujiEdILiKuL8Nwc8pvfH77HWBD8ISnSp1aokcYdNYkHrn2xL/JBUxM4Ycba1nLeEpMyO2iL9gE2M+7XlpBU41FZuAV86kR+uVKGzUraZFggCh2JhJ687ogyRU2ck2aEBshJdT4p7bFDBtPTfimFsF5h0zS33viVknzg3W/3QRAEwXdvKk05UGP8avIAAAAASUVORK5CYII=","orcid":"","institution":"First Affiliated Hospital of Chongqing Medical University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Cong","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2023-01-11 04:44:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2465403/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2465403/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":31504858,"identity":"63a67e0d-ba7d-40ae-9839-39c0fd38377e","added_by":"auto","created_at":"2023-01-12 21:32:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":76769,"visible":true,"origin":"","legend":"\u003cp\u003eIncidence of uterine metastasis in ovarian epithelial malignant tumors\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-2465403/v1/331f9356a670046e7888d323.png"},{"id":31505079,"identity":"937a2700-64c2-4c0d-b47a-45264697c77c","added_by":"auto","created_at":"2023-01-12 21:41:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":250832,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2465403/v1/8ef0db13-cd79-4968-bbb2-f4161625d881.pdf"},{"id":31505078,"identity":"de30f402-b388-49e7-9f96-66c2d71ef3c4","added_by":"auto","created_at":"2023-01-12 21:40:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":250832,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2465403/v1/18632331-d3fa-4522-a315-9adce78965cf.pdf"},{"id":31505077,"identity":"10a8b78c-81f3-4603-bf88-07171c6621d7","added_by":"auto","created_at":"2023-01-12 21:40:54","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":24208,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-2465403/v1/32082e53d2336264a6e31bb8.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical characteristics of uterine metastasis in epithelial ovarian cancer","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOvarian cancer (OC) is one of the most common gynecological malignant tumors, which can occur at any age. According to NCCN recommendations, the treatment of ovarian cancer is mainly surgery, and only for some patients with indications, that is, early patients who want to retain fertility or patients with low-risk malignant tumors (early epithelial ovarian cancer, low-grade malignant potential tumors, germ cell tumors or malignant stromal tumors). This mainly takes into account that ovarian cancer is characterized by extensive dissemination in the abdominal cavity, which can be metastasized through direct spread to surrounding tissues and organs, planting dissemination, and lymph node metastasis. Therefore, the uterus, fallopian tube, greater omentum, retroperitoneal lymph nodes, and other parts are most often involved. Because of this, to achieve the goal of tumor reduction, hysterectomy is routinely performed for both patients who undergo comprehensive staging surgery in the early stage and patients who undergo tumor cell reduction in the middle and late stages (Salvo et al. \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, with the postponement of the childbearing age, some patients may be diagnosed with malignant ovarian tumors before childbearing, and radical surgery may be difficult for them to accept. Moreover, hysterectomy not only affects women's reproductive function but also causes many other problems that affect women's quality of life and physical and mental health (Pereira et al. 2017). Hysterectomy will affect the pelvic floor function of patients, causing pelvic organ prolapse, abnormal urination, and defecation. In addition, it will also have an impact on women's psychology, causing them to have psychogenic sexual dysfunction (Monterrosa-Castro et al. \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Due to the differences in cultural backgrounds between China and the West, Chinese women, especially premenopausal women, are more dissatisfied with their self-image after hysterectomy, resulting in adverse psychological reactions (Gabriel et al. \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). This requires that doctors should constantly explore the possibility of more care while ensuring the oncological outcome of patients. At present, some studies believe that FSS is safer for patients of childbearing age with 1–2 stage I EOC. At the same time, in clinical practice, we found that in some patients in the middle and late stages, when suspected uterine metastasis was found by imaging and intraoperative observation before surgery, no microscopic metastasis could still be found by postoperative examination. So should hysterectomy be routinely performed in all cases of OC? This issue remains to be discussed.\u003c/p\u003e "},{"header":"Material And Methods","content":"\u003cp\u003e1.1 Research Objective:\u003c/p\u003e\u003cp\u003eData were collected retrospectively who underwent hysterectomy for ovarian cancer in our department from January 1, 2017, to March 31, 2022. Patients with metastatic ovarian cancer, patients who had their uteri removed for other diseases before surgery, patients who had undergone another comprehensive staging operation in our hospital after tumor removal in other hospitals, and patients with other incomplete data were excluded. All effective follow-up patients were informed consent to this clinical retrospective analysis, and through the Ethics Committee of First Affiliated Hospital of Chongqing Medical University (NO.2020 − 636). The informed consent was obtained from the study participants and the guidelines outlined in the Declaration of Helsinki were followed.\u003c/p\u003e\u003cp\u003e1.2 Methods:\u003c/p\u003e\u003cp\u003eClinical information includes age, menopause, fertility, tumor marker value, and postoperative pathological results, all of which come from our electronic medical record system. Exclusion criteria include Patients with endometrial carcinoma (those with different pathological types of endometrium and ovary); no operative; the uterus has been removed due to benign diseases in the past (including total hysterectomy and subtotal hysterectomy); incomplete data. Finally, 464 patients were included in the analysis.\u003c/p\u003e\u003cp\u003e1.3 Statistical processing:\u003c/p\u003e\u003cp\u003eSPSS 26.0 statistics software were used for data analysis. Data information included both measurement data and count data. Measurement data obeying normal distribution were expressed as mean ± standard deviation and used two independent samples t-test, while non-normally distributed measurement data were expressed by median, maximum and minimum values with Mann-Whitney U rank-sum test; count data were tested by chi-square (χ\u003csup\u003e2\u003c/sup\u003e) test and ordinal categorical variable were tested by Mann-Whitney U rank-sum test. Binary logistic multifactorial regression was used to analyze the risk factors for uterine metastasis of ovarian cancer. All statistical analyses were performed using a two-sided test, and P \u0026lt; 0.05 were considered statistically significant.\u003c/p\u003e"},{"header":"Result","content":"\u003cp\u003e2.1 The incidence of uterine metastasis in ovarian epithelial malignant tumors:\u003c/p\u003e\n\u003cp\u003eAmong 464 cases, the uterine metastasis rate was 38.58%. The metastasis of the uterine serous surface (including the adhesion of uterine serous surface, sacral ligament, main ligament, para uterine serous surface, and tumor) accounted for 32.11%.However, only 29.09% of them were confirmed by pathology, and the remaining 9.48% were staged just due to the adhesion of the uterus. 4.96% of patients with myometrial metastasis, the rate of metastasis to the mucosal surface with full layer metastasis was 1.51%. So the overall rate of uterine metastasis confirmed by pathology was 29.09% (serous metastasis 22.63%, muscular metastasis4.96%, full layer metastasis 1.51%) ( \u003cstrong\u003eFig.\u0026nbsp;1\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e2.2 Clinical characteristics of epithelial ovarian malignant tumors:\u003c/p\u003e\n\u003cp\u003eTwo groups were divided by uterine metastasis or not, and analyzed the clinical characteristics of the two groups (Table 1). Uterine metastasis of ovarian cancer is related to ovarian tumor diameter, unilateral or bilateral ovarian lesions, clinical stage, whether the fallopian tube is metastatic, surgical opportunity, pathological type, pathological grade, whether there is extrauterine organ metastasis in the pelvic cavity, and whether there is endometriosis. It was not related to the age of onset, menopause, times of pregnancy and childbirth, and history of breast cancer.\u003c/p\u003e\n\u003cp\u003eIt can be seen that there was statistical significance between the patient\u0026apos;s history of endometriosis for uterine metastasis of ovarian cancer. At the same time, there is a negative correlation between the patient\u0026apos;s history of endometriosis. Previous history of endometriosis may be possible protective factors.\u003c/p\u003e\n\u003cp\u003e2.3 Multi-factor coupling of ovarian cancer with uterine metastasis:\u003c/p\u003e\n\u003cp\u003eThe 12 variables that were statistically different in our table 1 were subjected to binary logistic regression analysis (Table\u0026nbsp;2). From Logistic regression result, ovarian lesions location (OR\u0026thinsp;=\u0026thinsp;3.183), oviduct metastasis (OR\u0026thinsp;=\u0026thinsp;2.771) and pelvic metastasis (OR\u0026thinsp;=\u0026thinsp;4.360) were the main independent risk factors for uterine metastasis of ovarian cancer.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable border=\"1\" id=\"Tab2\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eLogistic regression analysis of risk factors for uterine metastasis of ovarian cancer\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR(95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCa125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.371\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHE4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.202\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOvarian location\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.183(1.753\u0026ndash;5.781)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiameter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.964\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.463\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eG3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.851\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePathological type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.273\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOviduct metastasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.771(1.578\u0026ndash;4.866)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAscites/ Peritoneal washout evidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.319\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePelvic metastasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.360(1.665\u0026ndash;11.421)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePDS/IDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.160\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndometriosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.211\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eNS\u0026thinsp;=\u0026thinsp;non significant; OR\u0026thinsp;=\u0026thinsp;Odds Ratio; CI\u0026thinsp;=\u0026thinsp;Confidence Interval.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e3.1 Analysis of clinical characteristics of possible low-risk factors of uterine metastasis\u003c/p\u003e\n\n\u003cp\u003eIt can be seen from this result that the clinical main independent risk factors related to uterine metastasis of ovarian cancer include, ovarian lesions location, oviduct metastasis and pelvic metastasis. In clinical practice, if there are patients with a strong desire to retain the uterus, preoperative determination of no other lesions in the uterus, or high-risk patients with surgical anesthesia risk, it can be considered to retain the uterus during the operation. Or if an ovarian malignant tumor is found accidentally after an operation, whether the uterus is retained in the subsequent staging operation can also be further discussed.\u003c/p\u003e\u003cp\u003eAt the same time, univariate analysis found that patients with pelvic endometriosis in the past had a low uterine metastasis rate, which was statistically significant compared with the control group, suggesting that it may be protective factors for uterine metastasis, or because patients need to see doctors repeatedly due to related diseases, their ovarian cancer was easy to identify early, and the risk of metastasis in other parts was reduced.\u003c/p\u003e\u003cp\u003e3.2 possible effects for diagnosis of epithelial ovarian cancer:\u003c/p\u003e\u003cp\u003eOvarian cancer is classified as the surgical and pathological stage. Its staging is based on surgical pathology. According to FIGO staging in 2014, stage IIA refers to the tumor spreading to and/or planting in the uterus and/or fallopian tube and/or ovary. Stage II ovarian cancer is still controversial and difficult to define (Janda et al. \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). It includes a group of patients with ovarian cancer, whose tumor directly spread to other pelvic organs, but there is no evidence of spread, and it cannot be confirmed by the results of disease examination after surgery (Doubeni et al. \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTherefore, the staging of Phase II was diagnosed generally based on the following: before operation: ultrosound, CT or MRI were certain judgment basis. During operation: the description of the scope of pelvic and peritoneal lesions such as: the serous surface of the uterus was generally presence of bladder and peritoneal reflux lesions, the presence of lesions in the posterior wall of the uterus, the presence of lesions in the rectum and uterine recess, the dense adhesion between uterine ligaments and lesions, thickening and shortening. After operation: pathologic confirm whether tumor involvement one by one according to the remarks during the operation. So if the patient has preoperative neoadjuvant chemotherapy or has had incomplete staging surgery in the past, the positive rate of the medical examination results will also be affected, which poses a challenge to whether there is uterine metastasis in advanced ovarian cancer.\u003c/p\u003e\u003cp\u003eAmong the 104 patients of stage II included in our study, there were 24 patients in stage IIA, including 14 patients in stage IIA due to uterine metastasis, 10 patients in stage IIA due to intraoperative uterine adhesions, and 4 patients (2 in muscular layer, 2 in a full layer) confirmed by pathology, which could not be statistically analyzed due to the small number of patients, and were not listed in the results. More stage II staging was due to the involvement of organs outside the pelvic uterus, such as intestines, bladder, and other organs. Some scholars believe that the disease of stage II intestinal metastasis that invades intestinal mucosa through the intestinal wall should be upgraded to stage IVB (Javadi et al. \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAccording to the analysis of the involved parts of the uterus, the involvement of the serous surface is consistent with the biological behavior of the direct spread of ovarian cancer. According to the purpose of tumor cell reduction, as long as the operation achieves no residual lesions with the naked eye, it is not necessarily necessary to remove and change the involved organs. For patients with endometrial invasion indicated by preoperative imaging, the presence of tumor involvement can be confirmed by hysteroscopy before surgery, and the occurrence of ovarian cancer combined with endometrial cancer can be ruled out. Therefore, in the case of uterine substantial metastasis, the uterus needs to be removed for myometrial metastasis, which is conducive to the reduction of tumor focus. This retrospective analysis found that 4.96% of patients with myometrial metastasis were confirmed after surgery, which is a small probability event.\u003c/p\u003e\u003cp\u003e3.3 possible effects for the treatment of epithelial ovarian cancer:\u003c/p\u003e\u003cp\u003eThe age of patients with fertility preservation brings hope. Early epithelial ovarian cancer and low malignant potential tumors can be operated on with fertility preservation (Nasioudis et al. \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), that is, unilateral adnexectomy or bilateral adnexectomy can be performed to preserve the uterus (Goeckenjan et al. \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). For young patients who hope to retain their reproductive function, the affected side can be resected + fully staged surgery in IA stage; In stage IB, bilateral adnexectomy (uterus preservation) and comprehensive staged operation are feasible (Baek et al. \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHowever, in the actual clinical work, patients diagnosed with stage II during the operation only removed bilateral fallopian tubes and ovaries, while there were few cases of reserving the uterus. Ovarian cancer occurred at a slightly older age, and patients often had a child. It was rare for patients to insist on reserving the uterus because of the requirement of reproduction. Patients removed bilateral ovaries, and there was no consensus on the preservation of eggs in ovarian cancer. These factors will reduce the possibility of reserving the uterus. At the same time, based on the patient's fear of being located in a malignant tumor, they hope to be resected to the maximum extent. Even young patients may give up childbearing and choose simultaneous hysterectomy of double appendages. It may also be that as a routine gynecological operation, hysterectomy does not increase the difficulty of the operator. Therefore, in the choice of cutting or not cutting, simultaneous resection is selected to a large extent. And whether the retention of the uterus will affect the five-year survival of patients, there is no definite answer.\u003c/p\u003e\u003cp\u003eRetrospective analysis of 9017 patients (Bercow et al. \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) showed that the 5-year survival period of ovarian cancer patients aged 15–44 years was lower than that of the whole population group, and its influencing factors might be the way of fertility-preserving surgery, but more high-risk factors came from the period, so it was impossible to simply analyze the proportion of fertility-preserving surgery on the 5-year survival rate. Meta-analysis found that (Liu et al. \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2020\u003c/span\u003e): HR of patients undergoing fertility-preserving surgery in Phase I patients of 2223 patients in 8 centers decreased slightly, but there was no statistical significance, and also there was no statistical difference in the specific stage and pathological type, while there was no difference in the overall survival.\u003c/p\u003e\u003cp\u003eIn the true clinical events, there are still a few patients with ovarian epithelial malignant tumors who have undergone hysterectomy. For those patients who have retained fertility, the five-year survival time of most patients with borderline tumors and germ cell tumors is lower than that of those who have undergone radical surgery (Canlorbe et al. \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The follow-up study on the fertility and prognosis of 25 cases of borderline epithelial ovarian tumors found that (Kim et al. 2021): the risk of premature ovarian failure in fertility-preserving patients was higher than that in the control group, and the number of people who needed assisted reproductive technology increased. There was no significant impact on fertility, but there was no confirmed data for the long-term five-year survival. The report on the re-pregnancy rate of 153 patients with fertility preservation can be seen (Nitecki et al. \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), of which epithelial ovarian cancer accounts for 55%. There is no difference in the postoperative pregnancy outcome, delivery mode, newborn, and non-tumor patients.\u003c/p\u003e\u003cp\u003eAccording to this retrospective analysis, the rate of uterine parenchyma metastasis of ovarian cancer is low. After improving the preoperative examination when necessary, including curettage under hysteroscope and other methods to further exclude uterine lesions, for patients with fertility requirements, young patients, patients who have the desire to retain the uterus, or patients who are difficulty removing the uterus during surgery, or patients who are confirmed to be ovarian cancer patients who have not been fully staged after surgery, the uterus should be retained when making the next operation plan, Whether it will affect the five-year survival period of patients.\u003c/p\u003e\u003cp\u003e3.4 The influence of hysterectomy on patients' quality of life:\u003c/p\u003e\u003cp\u003eTake hysterectomy for benign diseases such as uterine leiomyoma as an example, the impact of hysterectomy on the quality of life, exercise ability, and sexual function of patients has also attracted attention. Compared to women with no hysterectomy, women with hysterectomy-bilateral oophorectomy were at increased risk of substantial PF limitations versus minimal PF limitations over 18 years of follow-up (Wilson et al. \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). At the 17-year follow-up, the route of hysterectomy is not associated with a difference in recurrence, grade, or subsequent treatment of prolapse when the indication for hysterectomy is considered. Prolapse, as an indication of hysterectomy, increases the risk for recurrence. Women planning a hysterectomy should be counseled appropriately about the risk of subsequent prolapse (Wilson et al. \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The prevalence of hysterectomy is disproportionately higher among women with self-reported disabilities compared with women without disabilities, with these differences most pronounced in women of childbearing age (Scime et al. \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe incidence of uterine myometrial metastasis of ovarian cancer is 4.96%, ovarian lesions location, oviduct metastasis and pelvic metastasis are the main independent risk factors for uterine metastasis of ovarian cancer. The Ca125, HE4, lesion location, diameter, stage, pathological type, degree of differentiation and ascites/ peritoneal washout evidence are secondary risk factors. The history of endometriosis may be the low risk factors of uterine metastasis. Whether the diagnosis and surgical scope of ovarian cancer need to be adjusted individually or not needs to be confirmed by subsequent clinical experiments.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003eFINANCIAL DISCLAIMER/CONFLICT OF INTEREST:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNONE\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting Interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthor Contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Data collection and analysis were performed by Tianmei Wang. The first draft of the manuscript was written by Tianmei Wang and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData Availability\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthics approval\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of First Affiliated Hospital of Chongqing Medical University (Date 2022-10-14/ NO.2020-636).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBaek MH, Park JY, Kim DY, et al (2020) Feasibility and safety of fertility-sparing surgery in epithelial ovarian cancer with dense adhesion: a long-term result from a single institution. J Gynecol Oncol 31(6):e85 https://doi.org/10.3802/jgo.2020.31.e85\u003c/li\u003e\n\u003cli\u003eBercow A, Nitecki R, Brady PC, et al (2021) Outcomes after Fertility-sparing Surgery for Women with Ovarian Cancer: A Systematic Review of the Literature. J Minim Invasive Gynecol 28(3):527-536.e1 https://doi.org/10.1016/j.jmig.2020.08.018\u003c/li\u003e\n\u003cli\u003eCanlorbe G, Chabbert-Buffet N, Uzan C (2021) Fertility-Sparing Surgery for Ovarian Cancer. J Clin Med 10(18):4235 https://doi.org/10.3390/jcm10184235\u003c/li\u003e\n\u003cli\u003eDoubeni CA, Doubeni AR, Myers AE (2016) Diagnosis and Management of Ovarian Cancer. Am Fam Physician 93(11):937-944\u003c/li\u003e\n\u003cli\u003eGoeckenjan M, Freis A, Gla\u0026szlig; K, et al (2020) Motherhood after cancer: fertility and utilisation of fertility-preservation methods. Arch Gynecol Obstet 301(6):1579-1588 https://doi.org/10.1007/s00404-020-05563-w\u003c/li\u003e\n\u003cli\u003eGabriel I, Kalousdian A, Brito LG, et al (2021) Pelvic organ prolapse after 3 modes of hysterectomy: long-term follow-up. Am J Obstet Gynecol 224(5):496.e1-496.e10 https://doi.org/10.1016/j.ajog.2020.11.008\u003c/li\u003e\n\u003cli\u003eJavadi S, Ganeshan DM, Qayyum A, et al (2016) Ovarian Cancer, the Revised FIGO Staging System, and the Role of Imaging. AJR Am J Roentgenol 206(6):1351-1360 https://doi.org/10.2214/AJR.15.15199\u003c/li\u003e\n\u003cli\u003eJanda M, McGrath S, Obermair A (2019) Challenges and controversies in the conservative management of uterine and ovarian cancer. Best Pract Res Clin Obstet Gynaecol 55:93-108 https://doi.org/10.1016/j.bpobgyn.2018.08.004\u003c/li\u003e\n\u003cli\u003eKim SS (2021) Fertility preservation for women with borderline ovarian tumors: fertility-sparing surgery. Fertil Steril 115(1):83-84 https://doi.org/10.1016/j.fertnstert.2020.09.129\u003c/li\u003e\n\u003cli\u003eLiu D, Cai J, Gao A, et al(2020) Fertility sparing surgery vs radical surgery for epithelial ovarian cancer: a meta-analysis of overall survival and disease-free survival. BMC Cancer 20(1):320 https://doi.org/10.1186/s12885-020-06828-y\u003c/li\u003e\n\u003cli\u003eMonterrosa-Castro A, Monterrosa-Blanco A, Beltr\u0026aacute;n-Barrios T (2018) Insomnia and sexual dysfunction associated with severe worsening of the quality of life in sexually active hysterectomized women. Sleep Sci 11(2):99-105 https://doi.org/10.5935/1984-0063.20180019\u003c/li\u003e\n\u003cli\u003eNasioudis D, Mastroyannis SA, Haggerty AF, et al (2020) Fertility preserving surgery for high-grade epithelial ovarian carcinoma confined to the ovary. Eur J Obstet Gynecol Reprod Biol 248:63-70 https://doi.org/10.1016/j.ejogrb.2020.01.039\u003c/li\u003e\n\u003cli\u003eNitecki R, Clapp MA, Fu S, et al (2021) Outcomes of the First Pregnancy After Fertility-Sparing Surgery for Early-Stage Ovarian Cancer. Obstet Gynecol 137(6):1109-1118 https://doi.org/10.1097/AOG.0000000000004394\u003c/li\u003e\n\u003cli\u003ePereira N, Schattman GL (2017) Fertility Preservation and Sexual Health After Cancer Therapy. J Oncol Pract 13(10):643-651 https://doi.org/10.1200/JOP.2017.023705\u003c/li\u003e\n\u003cli\u003eSalvo G, Falconer H, Pareja R (2021) Beyond oncologic outcomes: fertility and ovarian preservation as key priorities. Int J Gynecol Cancer 31(3):313 https://doi.org/10.1136/ijgc-2021-002435\u003c/li\u003e\n\u003cli\u003eScime NV, Brown HK, Metcalfe A, et al (2021) Prevalence of Hysterectomy by Self-Reported Disability Among Canadian Women: Findings from a National Cross-Sectional Survey. Womens Health Rep (New Rochelle) 2(1):557-565 https://doi.org/10.1089/whr.2021.0069\u003c/li\u003e\n\u003cli\u003eWilson LF, Pandeya N, Byles J, et al (2018) Hysterectomy and perceived physical function in middle-aged Australian women: a 20-year population-based prospective cohort study. Qual Life Res 27(6):1501-1511 https://doi.org/10.1007/s11136-018-1812-9\u003c/li\u003e\n\u003cli\u003eWilson L, Pandeya N, Byles J, et al (2018) Hysterectomy and incidence of depressive symptoms in midlife women: the Australian Longitudinal Study on Women\u0026apos;s Health. Epidemiol Psychiatr Sci 27(4):381-392 https://doi.org/10.1017/S2045796016001220\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 1","content":"\u003cp\u003eTable 1 is available in Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"ovarian epithelial cancer, uterus, metastasis","lastPublishedDoi":"10.21203/rs.3.rs-2465403/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2465403/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\n\u003cp\u003eOvarian epithelial malignant tumor spreads directly and easily spreads to the serous surface of the uterus. However, whether invasion and metastasis occur in the uterine parenchyma is unknown. Its metastasis rate and its related clinical characteristics reveal that ovarian cancer surgery with uterus preservation provides objective data support.\u003c/p\u003e\n\u003ch2\u003eMethods\u003c/h2\u003e\n\u003cp\u003eThe data of patients with ovarian cancer who underwent hysterectomy from January 1, 2017, to March 31, 2022, were collected retrospectively, and the distribution of actual uterine metastasis and possible factors related to clinical characteristics were analyzed.\u003c/p\u003e\n\u003ch2\u003eResults\u003c/h2\u003e\n\u003cp\u003eA total of 464 patients were included, and the uterine metastasis rate was 38.58%, with 29.09% confirmed by pathology, including 4.96% of myometrial metastasis and 1.51% of endometrial metastasis. The occurrence of metastasis is positively related to the Ca125, HE4, unilateral or bilateral ovarian lesions, diameter of the ovarian tumor, clinical stage, whether the fallopian tube is metastatic, pathological type, pathological grade, degree of differentiation, ascites/ peritoneal washout evidence, the timing of surgery, and whether there is extrauterine organ metastasis in the pelvic cavity, and negatively related to whether there is endometriosis.\u003c/p\u003e\n\u003ch2\u003eConclusion\u003c/h2\u003e\n\u003cp\u003eThe incidence of uterine myometrial metastasis of ovarian cancer is 4.96%. The assessment of risk factors, such as unilateral or bilateral ovarian lesions, oviduct metastasis and pelvic metastasis may provide assistance to patients undergoing fertility-preserving surgical treatment.\u003c/p\u003e\n\u003cp\u003eTrial registration number:2020-636\u003c/p\u003e","manuscriptTitle":"Clinical characteristics of uterine metastasis in epithelial ovarian cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-01-12 21:32:49","doi":"10.21203/rs.3.rs-2465403/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0ebdaca5-4db3-4f5a-99f2-b49363a27e17","owner":[],"postedDate":"January 12th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-01-12T21:40:51+00:00","versionOfRecord":[],"versionCreatedAt":"2023-01-12 21:32:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2465403","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2465403","identity":"rs-2465403","version":["v1"]},"buildId":"uwybb5PU2iWlRI8EIam5Y","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}