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. 2020 Sep;31(5):e58.
doi: 10.3802/jgo.2020.31.e58.

Incidence and predictors of peritoneal metastases of gynecological origin: a population-based study in the Netherlands

Lara Burg  1 , Maite Timmermans  2   3   4 , Maaike van der Aa  2 , Dorry Boll  5 , Koen Rovers  6 , Ignace de Hingh  6 , Anne van Altena  7
Affiliations

Incidence and predictors of peritoneal metastases of gynecological origin: a population-based study in the Netherlands

Lara Burg et al. J Gynecol Oncol. 2020 Sep.

Abstract

Objective: Peritoneal metastases (PM) are a challenge in gynecological cancers, but its appearance has never been described in a population-based study. Therefore, we describe the incidence of PM and identify predictors that increase the probability of peritoneal spread.

Methods: All ovarian, endometrial and cervical cancer patients diagnosed in the Netherlands between 1989 and 2015 were identified from the Netherlands Cancer Registry and stratified for PM. Crude and age-adjusted incidence over time was calculated. Independent predictors for PM were identified using uni- and multivariable analyses.

Results: The 94,981 patients were diagnosed with ovarian, endometrial or cervical cancer and respectively 61%, 2% and 1% presented with PM. Predictors for PM in ovarian cancer were: age between 50 and 74 years (odds ratio [OR]=1.19; 95% confidence interval [CI]=1.08-1.32), other distant metastases (OR=1.25; 95% CI=1.10-1.41), poor differentiation grade (OR=2.00; 95% CI=1.73-2.32) and serous histology. Predictors in endometrial cancer were lymph node metastases (OR=2.32; 95% CI=1.65-3.26), other distant metastases (OR=1.38; 95% CI=1.08-1.77), high-grade tumors (OR=1.95; 95% CI=1.38-2.76) and clear cell (OR=1.49; 95% CI=1.04-2.13) or serous histology (OR=2.71; 95% CI=2.15-3.42). In cervical cancer, the risk is higher in adenocarcinoma than in squamous cell carcinoma (OR=4.92; 95% CI=3.11-7.79).

Conclusion: PM are frequently seen in patients with ovarian cancer. In endometrial and cervical cancer PM are rare. Histological subtype was the strongest predictive factor for PM in all 3 cancers. Better understanding of predictive factors for PM and thus the biological behavior is of paramount importance.

Keywords: Endometrial Neoplasms; Epidemiology; Incidence; Ovarian Neoplasms; Peritoneal Neoplasms; Uterine Cervical Neoplasms.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. Flowchart of patients diagnosed with gynecological cancer between 1995 and 2015 in the Netherlands, according to NCR data.
FIGO, International Federation of Gynecology and Obstetrics; NCR, Netherlands Cancer Registry. *Patients with an unknown FIGO stage are excluded.
Fig. 2
Fig. 2. Crude and European standardized incidence rates for peritoneal metastases in patients with ovarian (A, B), endometrial (C, D) and cervical cancer (E, F) between 1989 and 2015 in the Netherlands.
See this image and copyright information in PMC

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