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. 2021 May;26(5):995-1004.
doi: 10.1007/s10147-021-01866-3. Epub 2021 Jan 29.

Omental metastasis as a predictive risk factor for unfavorable prognosis in patients with stage III-IV epithelial ovarian cancer

Yutaka Iwagoi  1 , Takeshi Motohara  2 , Sangyoon Hwang  1 , Koichi Fujimoto  3 , Tokunori Ikeda  4   5 , Hidetaka Katabuchi  1
Affiliations

Omental metastasis as a predictive risk factor for unfavorable prognosis in patients with stage III-IV epithelial ovarian cancer

Yutaka Iwagoi et al. Int J Clin Oncol. 2021 May.

Abstract

Background: Epithelial ovarian cancer has a clear predilection for the omentum as the site of metastasis; however, its contribution to clinical outcomes remains unresolved. This study aimed to evaluate the prognostic significance and efficacy of chemotherapy in the presence of omental metastasis.

Methods: A retrospective cohort study was performed in 56 patients with stage III-IV ovarian cancer who underwent primary debulking surgery between 2004 and 2018 at Kumamoto University Hospital.

Results: Thirty-six (64.3%) patients were categorized into the omental metastasis-positive group, whereas 20 (35.7%) patients were in the omental metastasis-negative group. The 5-year overall survival rates were 43.4% in the omental metastasis-positive group and 93.8% in the omental metastasis-negative group. Statistically significant differences were observed in overall survival (p = 0.002) and progression-free survival (p = 0.036) between the omental metastasis-positive and metastasis-negative groups. Notably, multivariate analysis demonstrated that the existence of omental metastasis is an independent risk factor for overall survival in patients with stage III-IV ovarian cancer (hazard ratio 8.90, 95% confidence interval 1.16-69.77; p = 0.038). Furthermore, the omental metastasis-positive group had significantly lower overall response rates to chemotherapy for recurrent disease, compared to the omental metastasis-negative group (31.6% vs. 85.7%, p = 0.026).

Conclusion: Our present data demonstrated that omental metastasis is closely associated with an unfavorable prognosis due to increased chemoresistance in patients with stage III-IV ovarian cancer. Elucidating the biological mechanism of omental metastasis will shed light on novel therapeutic approaches for the management of advanced ovarian cancer patients.

Keywords: Chemoresistance; Omental metastasis; Ovarian cancer; Prognosis.

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Figures

Fig. 1
Fig. 1
Flowchart of the study design and inclusion of patients. Patients included in our analysis were evaluated for the effect of omental metastasis on clinicopathological characteristics and clinical outcomes. FIGO International Federation of Gynecology and Obstetrics, TAH total abdominal hysterectomy, BSO bilateral salpingo-oophorectomy
Fig. 2
Fig. 2
Kaplan–Meier analysis of overall survival (a), progression-free survival (b), and post-recurrence survival (c) of eligible patients with stage III–IV ovarian cancer, based on the existence of omental metastasis. HR hazard ratio, CI confidence interval
See this image and copyright information in PMC

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