title: Advanced High-Grade Serous Ovarian Cancer: Frequency and Timing of Thoracic Metastases and the Implications for Chest Imaging Follow-up.
abstract: OBJECTIVE
  To study the frequency, timing, and associations of thoracic metastases in advanced (stage III and IV) high-grade serous ovarian cancer (HGSC) to help optimize the use of cross-sectional chest imaging.
  
  
  METHODS
  This institutional review board-approved retrospective study with waived informed consent included 186 consecutive patients with pathologically proven advanced HGSC after primary cytoreduction (mean age ± standard deviation, 60 years ± 9.7) who underwent imaging at our tertiary cancer institution from January 2012 to December 2012 with at least 1 year of follow-up, unless there was thoracic metastasis or death. Electronic medical records and all available imaging studies were reviewed to record patient and tumor characteristics, frequency and timing of abdominal and thoracic metastases, and visibility of the first thoracoabdominal metastasis on abdominal images. Patient and tumor characteristics associated with thoracic metastases were studied by using univariate and multivariate Cox proportional analysis.
  
  
  RESULTS
  After median follow-up of 57 months (interquartile range [IQR], 38-93), 175 patients (94%) developed metastatic disease; each had abdominal disease, and 76 (41%) had thoracic metastases. The first thoracoabdominal metastasis was visible on abdominal images in all 175 patients. The thoracic metastasis-free interval was longer than the abdominal disease-free interval (median, 85 months [IQR, 28-131] vs 14 months [IQR, 7-27], respectively; P < .0001). Presence of disease on abdominal images (hazard ratio, 2.56; 95% confidence interval: 1.35, 4.76) was the only factor independently associated with thoracic metastases.
  
  
  CONCLUSIONS
  Thoracic metastases in advanced HGSC rarely occur before abdominal disease, and first thoracoabdominal metastases are invariably visible on abdominal images. Therefore, cross-sectional chest imaging may be deferred until development of abdominal disease, with minimal risk of missing thoracic metastases.
authors.affiliation: From the Department of Radiology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02115 (A.B.S., A.C.O., B.S., S.H.T., M.N., A.D.V.d.A., N.H.R.); and Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Mass (S.C.).
authors.forename: Atul B
authors.initials: AB
authors.lastname: Shinagare
authors.affiliation: From the Department of Radiology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02115 (A.B.S., A.C.O., B.S., S.H.T., M.N., A.D.V.d.A., N.H.R.); and Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Mass (S.C.).
authors.forename: Ailbhe C
authors.initials: AC
authors.lastname: O'Neill
authors.affiliation: From the Department of Radiology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02115 (A.B.S., A.C.O., B.S., S.H.T., M.N., A.D.V.d.A., N.H.R.); and Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Mass (S.C.).
authors.forename: SuChun
authors.initials: S
authors.lastname: Cheng
authors.affiliation: From the Department of Radiology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02115 (A.B.S., A.C.O., B.S., S.H.T., M.N., A.D.V.d.A., N.H.R.); and Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Mass (S.C.).
authors.forename: Bhanusupriya
authors.initials: B
authors.lastname: Somarouthu
authors.affiliation: From the Department of Radiology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02115 (A.B.S., A.C.O., B.S., S.H.T., M.N., A.D.V.d.A., N.H.R.); and Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Mass (S.C.).
authors.forename: Sree H
authors.initials: SH
authors.lastname: Tirumani
authors.affiliation: From the Department of Radiology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02115 (A.B.S., A.C.O., B.S., S.H.T., M.N., A.D.V.d.A., N.H.R.); and Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Mass (S.C.).
authors.forename: Mizuki
authors.initials: M
authors.lastname: Nishino
authors.affiliation: From the Department of Radiology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02115 (A.B.S., A.C.O., B.S., S.H.T., M.N., A.D.V.d.A., N.H.R.); and Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Mass (S.C.).
authors.forename: Annick D
authors.initials: AD
authors.lastname: Van den Abbeele
authors.affiliation: From the Department of Radiology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02115 (A.B.S., A.C.O., B.S., S.H.T., M.N., A.D.V.d.A., N.H.R.); and Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Mass (S.C.).
authors.forename: Nikhil H
authors.initials: NH
authors.lastname: Ramaiya
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D009626:Terminology as Topic; D013899:Thoracic Neoplasms / Q000556:secondary*; D014057:Tomography, X-Ray Computed