title: Patterns and Prognostic Importance of Hepatic Involvement in Patients with Serous Ovarian Cancer: A Single-Institution Experience with 244 Patients.
abstract: Purpose To evaluate the frequency, patterns, and prognostic importance of metastatic hepatic involvement in serous ovarian cancer. Materials and Methods This institutional review board-approved retrospective study, with waived informed consent, included 244 patients with pathologically proven serous ovarian cancer (mean age ± standard deviation, 59 years ± 10.7; range 19-93 years). Electronic medical records and all available imaging studies over a median follow-up of 44 months (interquartile range [IQR], 27-70) were reviewed to identify the frequency of liver parenchymal invasion (LPI) from perihepatic peritoneal metastasis and hematogenous liver metastases. The associations and prognostic importance of LPI and hematogenous metastases were studied by using univariate and multivariate Cox proportional analysis. Results Eighty-four of 244 patients (34%) developed perihepatic metastases, of whom 55 (23%) developed LPI after median of 43 months (IQR, 25-63). Hematogenous hepatic metastases developed in 38 of 244 patients (16%) after median of 42 months (IQR, 26-64). At multivariate analysis, age (P = .008; hazard ratio [HR]: 1.03; 95% confidence interval [CI]: 1.009, 1.07) and suboptimal cytoreduction (P = .03; HR, 2.13; 95% CI: 1.12, 4.07) were associated with LPI. Increasing age (P = .01; HR, 1.04; 95% CI: 1.008, 1.08), high-grade tumor (P = .01; HR, 6.75; 95% CI: 1.44, 120.5), and advanced stage (P = .03; HR, 3.16; 95% CI: 1.94, 4.56) were associated with hematogenous metastases. Overall survival with and without LPI was similar (median, 80 months; IQR, 50-not reached vs 123 months; IQR, 49-279; P = .6). Hematogenous metastases were associated with significantly shorter survival at univariate (median 63 months, IQR 43-139 vs 145 months, IQR 50-not reached; P = .006) and multivariate analyses (P = .03; HR, 1.88; 95% CI: 1.14, 3.28). Conclusion Differentiating hematogenous metastases and LPI is important for radiologists; hematogenous metastases are associated with shorter survival, while LPI does not adversely affect survival and prognostically behaves like peritoneal disease.©RSNA, 2016.
authors.affiliation: From the Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115.
authors.forename: Ailbhe C
authors.initials: AC
authors.lastname: O'Neill
authors.affiliation: From the Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115.
authors.forename: Bhanusupriya
authors.initials: B
authors.lastname: Somarouthu
authors.affiliation: From the Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115.
authors.forename: Sree Harsha
authors.initials: SH
authors.lastname: Tirumani
authors.affiliation: From the Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115.
authors.forename: Marta
authors.initials: M
authors.lastname: Braschi-Amirfarzan
authors.affiliation: From the Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115.
authors.forename: Annick D
authors.initials: AD
authors.lastname: Van den Abbeele
authors.affiliation: From the Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115.
authors.forename: Nikhil H
authors.initials: NH
authors.lastname: Ramaiya
authors.affiliation: From the Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115.
authors.forename: Atul B
authors.initials: AB
authors.lastname: Shinagare
mesh_terms: D000368:Aged; D003287:Contrast Media; D005260:Female; D006801:Humans; D007472:Iohexol; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology*; D011379:Prognosis; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D007472:Iohexol