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Parenchymal liver metastasis in advanced ovarian cancer: Can bowel involvement influence the frequency and the related mortality rate?

Published:November 11, 2022DOI:https://doi.org/10.1016/j.ejogrb.2022.11.008

      Highlights

      • Parenchymal liver metastasis correlates with bowel involvement in Ovarian cancer.
      • Parenchymal liver metastasis amount relates to the depth of bowel involvement.
      • A reduction in OS is seen when muscular layer and deeper layers are involved.

      Abstract

      Objective

      This retrospective study estimates the frequency of parenchymal liver metastasis (PLM) and the overall survival (OS) rate of patients with FIGO Stage IIIC-IV Advanced Epithelial Ovarian Cancer (EOC) with bowel involvement.

      Study design

      Between November 2008 and July 2020, all consecutive patients with FIGO Stage IIIC-IV EOC who underwent Visceral Peritoneal Debulking and bowel resection(s) at the Gynaecological Oncology Unit of “Centro di Riferimento Oncologico (CRO)”, Aviano, Italy, without evidence of PLM at pre-operative imaging assessment, were included in the study. The presence and the time of the onset of PLM during the follow-up period were detected by diagnostic imaging (CT-scan, Ultrasound and PET). The OS of patients with and without PLM was compared. Considering the bowel’s layers, the association between depth of bowel involvement, number of PLM, and the relative OS rate was evaluated.

      Results

      The median follow-up period was 47.3 (12–138) months. PLM occurred in 24/72 (33.0%) cases; the average onset time of PLM was 13 months. PLM was associated with increased significant mortality risk and an average OS of 33.2 versus 56.8 months (p < 0.001). The risk of developing PLM correlated directly with the depth of bowel involvement. However, there was no statistical difference between the layers in terms of OS at the end of the observational period.

      Conclusions

      PLM occurred more frequently among patients with EOC and bowel involvement. The PLM arose within 15 months of follow-up and the frequency increased according to the depth of involvement. Particularly, the difference is remarkably higher starting from muscular layer where the total number of PLM arose significantly (p = 0.02). Although there was no significant difference among the infiltrated bowel layers in terms of OS, patients with bowel involvement up to muscular had a dramatic reduction in the OS rate during the first 30 months of follow-up.

      Keywords

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      References

        • Prat J.
        • FIGO Committee
        • on Gynecologic Oncology
        Staging classification for cancer of the ovary, fallopian tube, and peritoneum.
        Int J Gynaecol Obstet. 2014; 124: 1-5
        • Bristow R.E.
        • Tomacruz R.S.
        • Armstrong D.K.
        • et al.
        Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis.
        J Clin Oncol. 2002; 20: 1248-1259
        • Rafii A.
        • Stoeckle E.
        • Jean-Laurent M.
        • et al.
        Multi-center evaluation of post-operative morbidity and mortality after optimal cytoreductive surgery for advanced ovarian cancer.
        PLoS ONE. 2012; 7: e39415
        • Jaeger W.
        • Ackermann S.
        • Kessler H.
        • et al.
        The effect of bowel resection on survival in advanced epithelial ovarian cancer.
        Gynecol Oncol. 2001; 83: 286-291
        • Scarabelli C.
        • Gallo A.
        • Franceschi S.
        • et al.
        Primary cytoreductive surgery with rectosigmoid colon resection for patients with advanced epithelial ovarian carcinoma.
        Cancer. 2000; 88: 389-397
        • O'Hanlan K.A.
        • Kargas S.
        • Schreiber M.
        • et al.
        Ovarian carcinoma metastases to gastrointestinal tract appear to spread like colon carcinoma: implications for surgical resection.
        Gynecol Oncol. 1995; 59: 200-206
        • Baiocchi G.
        • Cestari L.A.
        • Macedo M.P.
        • et al.
        Surgical implications of mesenteric lymph node metastasis from advanced ovarian cancer after bowel resection.
        J Surg Oncol. 2011; 104: 250-254
        • Di Giorgio A.
        • Cardi M.
        • Biacchi D.
        • et al.
        Depth of colorectal-wall invasion and lymph-node involvement as major outcome factors influencing surgical strategy in patients with advanced and recurrent ovarian cancer with diffuse peritoneal metastases.
        World J Surg Oncol. 2013; 11: 64
        • Deng K.
        • Yang C.
        • Tan Q.
        • et al.
        Sites of distant metastases and overall survival in ovarian cancer: A study of 1481 patients.
        Gynecol Oncol. 2018; 150: 460-465
        • O'Neill A.C.
        • Somarouthu B.
        • Tirumani S.H.
        • et al.
        Patterns and Prognostic Importance of Hepatic Involvement in Patients with Serous Ovarian Cancer: A Single-Institution Experience with 244 Patients.
        Radiology. 2017; 282: 160-170
        • Wang M.
        • Zhou J.
        • Zhang L.
        • et al.
        Surgical treatment of ovarian cancer liver metastasis.
        Hepatobiliary Surg Nutr. 2019; 8: 129-137
        • Manfredi S.
        • Lepage C.
        • Hatem C.
        • et al.
        Epidemiology and management of liver metastases from colorectal cancer.
        Ann Surg. 2006; 244: 254-259
        • Tozzi R.
        • Hardern K.
        • Gubbala K.
        • et al.
        En-bloc resection of the pelvis (EnBRP) in patients with stage IIIC-IV ovarian cancer: A 10 steps standardised technique. Surgical and survival outcomes of primary vs. interval surgery.
        Gynecol Oncol. 2017; 144: 564-570
        • Winter 3rd, W.E.
        • Maxwell G.L.
        • Tian C.
        • et al.
        Tumor residual after surgical cytoreduction in prediction of clinical outcome in stage IV epithelial ovarian cancer: a Gynecologic Oncology Group Study.
        J Clin Oncol. 2008; 26: 83-89
        • Engstrand J.
        • Nilsson H.
        • Strömberg C.
        • et al.
        Colorectal cancer liver metastases - a population-based study on incidence, management and survival.
        BMC Cancer. 2018; 18: 78
        • Engstrand J.
        • Strömberg C.
        • Nilsson H.
        • et al.
        Synchronous and metachronous liver metastases in patients with colorectal cancer-towards a clinically relevant definition.
        World J Surg Oncol. 2019; 17: 228
        • Rosati A.
        • De Rose A.M.
        • Sala E.
        • et al.
        Ovarian cancer metastases in the liver area: proposal of a standardized anatomo-surgical classification.
        Int J Gynecol Cancer. 2022; 32: 955-956
        • Foote J.
        • Lopez-Acevedo M.
        • Samsa G.
        • et al.
        Predicting 6- and 12-Month Risk of Mortality in Patients With Platinum-Resistant Advanced-Stage Ovarian Cancer: Prognostic Model to Guide Palliative Care Referrals.
        Int J Gynecol Cancer. 2018; 28: 302-307
        • Gallotta V.
        • Ferrandina G.
        • Vizzielli G.
        • et al.
        Hepatoceliac Lymph Node Involvement in Advanced Ovarian Cancer Patients: Prognostic Role and Clinical Considerations.
        Ann Surg Oncol. 2017; 24: 3413-3421
        • Naxerova K.
        • Reiter J.G.
        • Brachtel E.
        • et al.
        Origins of lymphatic and distant metastases in human colorectal cancer.
        Science. 2017; 357: 55-60
        • Vogelstein B.
        • Kinzler K.W.
        The Path to Cancer –Three Strikes and You're Out.
        N Engl J Med. 2015; 373: 1895-1898
        • Gallotta V.
        • Fanfani F.
        • Fagotti A.
        • et al.
        Mesenteric lymph node involvement in advanced ovarian cancer patients undergoing rectosigmoid resection: prognostic role and clinical considerations.
        Ann Surg Oncol. 2014; 21: 2369-2375
        • Park J.Y.
        • Seo S.S.
        • Kang S.
        • et al.
        The benefits of low anterior en bloc resection as part of cytoreductive surgery for advanced primary and recurrent epithelial ovarian cancer patients outweigh morbidity concerns.
        Gynecol Oncol. 2006; 103: 977-984
        • Gallotta V.
        • Fanfani F.
        • Vizzielli G.
        • et al.
        Douglas peritonectomy compared to recto-sigmoid resection in optimally cytoreduced advanced ovarian cancer patients: analysis of morbidity and oncological outcome.
        Eur J Surg Oncol. 2011; 37: 1085-1092
        • Salani R.
        • Diaz-Montes T.
        • Giuntoli R.L.
        • et al.
        Surgical management of mesenteric lymph node metastasis in patients undergoing rectosigmoid colectomy for locally advanced ovarian carcinoma.
        Ann Surg Oncol. 2007; 14: 3552-3557
        • Hohenberger W.
        • Weber K.
        • Matzel K.
        • et al.
        Standardized surgery for colonic cancer: complete mesocolic excision and central ligation–technical notes and outcome.
        Colorectal Dis. 2009; 11: 354-364
        • Gallotta V.
        • Conte C.
        • D'Indinosante M.
        • et al.
        Prognostic factors value of germline and somatic brca in patients undergoing surgery for recurrent ovarian cancer with liver metastases.
        Eur J Surg Oncol. 2019; 45: 2096-2102
        • Hou G.M.
        • Jiang C.
        • Du J.P.
        • et al.
        Nomogram Models for Predicting Risk and Prognosis of Newly Diagnosed Ovarian Cancer Patients with Liver Metastases - A Large Population-Based Real-World Study.
        J Cancer. 2021; 12: 7255-7265
        • Del Basso C.
        • Usai S.
        • Levi Sandri G.B.
        Non-colorectal non-neuroendocrine liver metastasis: a narrative review of surgical treatment.
        Chin Clin Oncol. 2022; 11: 28
        • Bacalbaşa N.
        • Balescu I.
        • Dima S.
        • et al.
        Long-term Survivors After Liver Resection for Ovarian Cancer Liver Metastases.
        Anticancer Res. 2015; 35: 6919-6923
        • Neumann U.P.
        • Fotopoulou C.
        • Schmeding M.
        • et al.
        Clinical outcome of patients with advanced ovarian cancer after resection of liver metastases.
        Anticancer Res. 2012; 32: 4517-4521
        • Harries M.
        • Gore M.
        Part II: chemotherapy for epithelial ovarian cancer-treatment of recurrent disease.
        Lancet Oncol. 2002; 3: 537-545
        • Lim M.C.
        • Kang S.
        • Lee K.S.
        • et al.
        The clinical significance of hepatic parenchymal metastasis in patients with primary epithelial ovarian cancer.
        Gynecol Oncol. 2009; 112: 28-34