title: Impact of Abdominal Wall Metastases on Prognosis in Epithelial Ovarian Cancer.
abstract: Epithelial ovarian cancer (EOC) patients with the presence of abdominal wall metastasis (AWM) are categorized as stage International Federation of Gynecology and Obstetrics (FIGO) IVB, irrespective of other biologic factors or preceding invasive intervention before final surgery. We evaluated the impact of AWM on patients' overall survival (OS).
  
  
  
  In this exploratory study, 634 consecutive patients with advanced EOC treated in our center from 2000 to 2014 were included. Patients were categorized into FIGO IIIC (n = 308), FIGO IVB AWM only (n = 86), and FIGO IV others (metastases other than AWM, n = 240). Clinicopathological parameters and survival data were extracted from our prospectively maintained tumor registry. Survival analyses were calculated using Kaplan-Meier method and Cox regression models.
  
  
  
  In 75 (87.2%) of 86 cases, AWM was seen after a preceding intervention, and only in 12.7%, the deposits were spontaneously established. The median OS in patients with stage FIGO IIIC, FIGO IVB AWM only, and FIGO IV others was 37, 58, and 25 months (P < 0.001), respectively. Patients with FIGO IVB AWM only had a significantly better OS than patients with FIGO IV others (P < 0.001). The numeric longer OS of patients with FIGO IVB AWM only compared with patients with FIGO IIIC was not statistically significant (P = 0.151). In multivariate analysis considering all confounding factors including residual disease, OS of patients with FIGO IIIC did not differ from patients with FIGO AWM only (hazard ratio, 0.84; 95% confidence interval, 0.56-12.26; P = 0.398).
  
  
  
  Most AWM are acquired after preceding intervention (puncture or laparoscopy). Prognosis of patients with AWM as the only site of distant metastasis is superior compared with other stage FIGO IV patients. Therefore, up-staging of patients only because of AWM to FIGO IVB may be questioned. A revision/clarification of the FIGO classification system should be considered to avoid unnecessary stigmatization of patients and to classify these patients more appropriately according to prognosis.
authors.affiliation: *Department of Gynecology and Gynecologic Oncology, Evangelische Huyssens-Stiftung, Kliniken Essen-Mitte, Essen, Germany; †Department of Gynecology and Gynecologic Oncology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria; and ‡Center for Pathology, Kliniken Essen-Mitte, Essen, Germany.
authors.forename: Beyhan
authors.initials: B
authors.lastname: Ataseven
authors.forename: Andreas
authors.initials: A
authors.lastname: du Bois
authors.forename: Philipp
authors.initials: P
authors.lastname: Harter
authors.forename: Sonia
authors.initials: S
authors.lastname: Prader
authors.forename: Christoph
authors.initials: C
authors.lastname: Grimm
authors.forename: Christian
authors.initials: C
authors.lastname: Kurzeder
authors.forename: Stephanie
authors.initials: S
authors.lastname: Schneider
authors.forename: Sebastian
authors.initials: S
authors.lastname: Heikaus
authors.forename: Anett
authors.initials: A
authors.lastname: Kahl
authors.forename: Alexander
authors.initials: A
authors.lastname: Traut
authors.forename: Florian
authors.initials: F
authors.lastname: Heitz
mesh_terms: D034861:Abdominal Wall / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077216:Carcinoma, Ovarian Epithelial; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009375:Neoplasms, Glandular and Epithelial / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000556:secondary; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult