Survival benefit from ovarian metastatectomy in colorectal cancer patients with ovarian metastasis: a retrospective analysis.
OBJECTIVE
A recent study demonstrated that colorectal cancer (CRC) with ovarian metastases was less responsive to chemotherapy compared with extraovarian metastases. Hence, the ovary may actually represent a "sanctuary" for metastatic cells from CRC. The aim of the study was to investigate the impact of ovarian metastatectomy on survival of CRC patients with ovarian metastasis.


METHODS
Between 1996 and 2008, 83 CRC patients underwent an oophorectomy. For the historical control, 47 CRC patients with ovarian metastasis without resection were included in the analysis.


RESULTS
The median age was younger (48 years) in the oophorectomy group compared with the historical control (54 years; P = 0.012). The proportion of synchronous metastasis was higher in the oophorectomy group than in the control group (57 vs. 30%; P = 0.003). After a median follow-up duration of 60.8 months (range of 7.4-169.7 months), the median OS was significantly longer in the oophorectomy group (28.1 vs. 21.2 months, oophorectomy vs. non-oophorectomy; P = 0.038). For ovary-specific survival (date of ovarian metastasis diagnosis to death), CRC patients with an oophorectomy showed a significantly more favorable survival rate than the control group (20.8 vs. 10.9 months; P < 0.001). In univariate analyses, oophorectomy (P = 0.038), unilaterality of ovarian metastasis (P = 0.032), metastasis confined to ovaries (P < 0.001), normal CEA level (P < 0.001), good performance status (P = 0.001), palliative chemotherapy (P = 0.001), and primary disease resection (P = 0.005) were identified as significantly good prognostic factors for overall survival. The oophorectomy, chemotherapy, metastasis confined to ovaries, normal CEA level, and good performance status retained statistical significance at the multivariate level (P = 0.003, P = 0.004, P = 0.005, P = 0.015, and P = 0.029, respectively).


CONCLUSIONS
Based on this retrospective analysis, the ovarian metastatectomy significantly prolonged survival in CRC patients with ovarian metastases. The potential role of an ovarian metastatectomy in the management of CRC should be prospectively studied.
Lee
Su Jin
SJ
Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong Kangnam-gu, Seoul, 135-710, Korea.
Lee
Jeeyun
J
Lim
Ho Yeong
HY
Kang
Won Ki
WK
Choi
Chel Hun
CH
Lee
Jeong-Won
JW
Kim
Tae-Joong
TJ
Kim
Byoung-Gie
BG
Bae
Duk-Soo
DS
Cho
Yong Beom
YB
Kim
Hee Cheol
HC
Yun
Seong Hyeon
SH
Lee
Woo Yong
WY
Chun
Ho-Kyung
HK
Park
Young Suk
YS
D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000556:secondary* / Q000601:surgery*; D010052:Ovariectomy; D010053:Ovary / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome