Risk factors associated with adverse outcomes in patients with metastatic ovary tumors: multi-center study

Objective. The purpose of this study was to investigate the clinical risk factors associated with adverse outcomes in cases of metastatic ovary tumors during a recent 20-year periods. Patients and methods. One hundred sixty-four patients with metastatic ovary tumors who was confirmed on pathologic diagnosis after surgery in three centers between January 1996 and December 2015. Clinical variables were collected from the patient’s medical records, laboratory results and radiologic data. The patients with metastatic ovary tumors were divided into four subgroups according to original primary tumor sites: gynecologic (n=27), colorectal (n=75), stomach (n=49), and hepatobiliary cancer group (n=13). Cox proportional hazards model was used to investigate risk factors with adverse results in cases of metastatic ovary tumors. Results. The hepatobiliary tract as primary tumor sites were found to be the most significant risk factor in patients with metastatic ovary tumors. (p=0.001). The 2-year survival rate of hepatobiliary cancer group was 23% which was significantly shorter than gynecologic cancer group (p=0.002). In multivariate analysis, ovarian metastases from non-gynecologic cancer group and preoperative lymph node positivity in imaging modality were significant unfavorable prognostic factors, respectively (HR=5.420/p<0.001, HR=1.675/p=0.013). Interestingly, the level of CA19-9 in hepatobiliary cancer group was much higher than the other groups (gynecologic, colorectal, stomach cancer groups). Median value of CA19-9 in hepatobiliary cancer group was 830.5 and 88% of those increased more than 35U/mL. Multiloculation of ovary mass was more frequently observed in non-gynecologic cancer group than gynecologic cancer group and there was a significant difference of ovarian tumor size between non-gynecologic cancer group and gynecologic cancer group (10.4±5.5cm vs 3.4±3.5 cm, p<0.001). Conclusion. Hepatobiliary cancer group is the most significant risk factor related with poor outcomes in metastatic ovary tumors. Furthermore, CA19-9 may be used to detect hepatobiliary cancer group as an original tumor site among metastatic ovary tumors.