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Yu J, Li X, Zeng H, Yin H, Wang Y, Wang B, Qiu M, Wu B. Prediction of Chemotherapy Efficacy in Patients with Colorectal Cancer Ovarian Metastases: A Preliminary Study Using Contrast-Enhanced Computed-Tomography-Based Radiomics. Diagnostics (Basel) 2023; 14:6. [PMID: 38201315 PMCID: PMC10802853 DOI: 10.3390/diagnostics14010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/02/2023] [Accepted: 12/11/2023] [Indexed: 01/12/2024] Open
Abstract
Ovarian metastasis (OM) from colorectal cancer (CRC) is infrequent and has a poor prognosis. The purpose of this study is to investigate the value of a contrast-enhanced CT-based radiomics model in predicting ovarian metastasis from colorectal cancer outcomes after systemic chemotherapy. A total of 52 ovarian metastatic CRC patients who received first-line systemic chemotherapy were retrospectively included in this study and were categorized into chemo-benefit (C+) and no-chemo-benefit (C-) groups, using Response Criteria in Solid Tumors (RECIST v1.1) as the standard. A total of 1743 radiomics features were extracted from baseline CT, three methods were adopted during the feature selection, and five prediction models were constructed. Receiver operating characteristic (ROC) analysis, calibration analysis, and decision curve analysis (DCA) were used to evaluate the diagnostic performance and clinical utility of each model. Among those machine-learning-based radiomics models, the SVM model showed the best performance on the validation dataset, with AUC, accuracy, sensitivity, and specificity of 0.903 (95% CI, 0.788-0.967), 88.5%, 95.7%, and 82.8%, respectively. All radiomics models exhibited good calibration, and the DCA demonstrated that the SVM model had a higher net benefit than other models across the majority of the range of threshold probabilities. Our findings showed that contrast-enhanced CT-based radiomics models have high discriminating power in predicting the outcome of colorectal cancer ovarian metastases patients receiving chemotherapy.
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Affiliation(s)
- Jinghan Yu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China; (J.Y.); (H.Z.); (Y.W.); (B.W.)
| | - Xiaofen Li
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China;
- Division of Abdominal Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Hanjiang Zeng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China; (J.Y.); (H.Z.); (Y.W.); (B.W.)
| | - Hongkun Yin
- Institute of Advanced Research, Infervision Medical Technology Co., Ltd., Beijing 100025, China;
| | - Ya Wang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China; (J.Y.); (H.Z.); (Y.W.); (B.W.)
| | - Bo Wang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China; (J.Y.); (H.Z.); (Y.W.); (B.W.)
| | - Meng Qiu
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China;
- Colorectal Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Bing Wu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China; (J.Y.); (H.Z.); (Y.W.); (B.W.)
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2
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Fields E, Chopra S, Ludwig M, Taunk N, Chino J. Pivotal Science From the 2022 International Gynecologic Cancer Society Meeting. Int J Radiat Oncol Biol Phys 2023; 116:473-478. [PMID: 37270241 DOI: 10.1016/j.ijrobp.2022.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/17/2022] [Indexed: 06/05/2023]
Affiliation(s)
- Emma Fields
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Supriya Chopra
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India
| | - Michelle Ludwig
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas
| | - Neil Taunk
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Junzo Chino
- Department of Radiation Oncology, Duke Cancer Center, Durham, North Carolina.
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Jiang W, Lin Y, Deng Y, Sun Y, Ye D, Zhong J, Huang Y, Chi P. The impact of prophylactic oophorectomy on the survival for postmenopausal patients with pT4a colorectal cancer. Asian J Surg 2023; 46:424-430. [PMID: 35667928 DOI: 10.1016/j.asjsur.2022.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/16/2022] [Accepted: 05/13/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE This study aimed to evaluate the prognostic effect of prophylactic oophorectomy (PO) in postmenopausal patients with pT4 colorectal cancers (CRC) in terms of overall survival (OS), disease-free survival (DFS), and peritoneal metastasis. METHODS The data of postmenopausal female patients with pT4 CRC undergoing surgical resection between 2000 and 2019 were analyzed. Kaplan-Meier analysis was used to evaluate survival outcomes between patients treated with and without PO. Risk factors for DFS and peritoneal metastasis were evaluated using Cox regression analysis. p-values <0.05 were considered statistically significant. RESULTS Totally, 176 (34.3%) patients received PO. There was no significant difference in estimated blood loss, rates of postoperative complications, and hospitalization between the PO and non-PO groups. The 5-year OS and DFS rates were similar in the two groups (47.9% vs. 54.1%, p = 0.278; 53.5% vs. 50.5%, p = 0.161, respectively). In the subgroup analysis of patients with peritoneal metastasis, the median survival was significantly longer for the PO group compared with the non-PO group (14 vs. 11 months, p < 0.001). CONCLUSION Undertaking PO in pT4 CRC female patients did not confer a survival benefit. Indication of PO even for advanced CRC patients should require caution. It has potential survival benefit only when the patients developed metachronous peritoneal metastases.
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Affiliation(s)
- Weizhong Jiang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, PR China
| | - Yu Lin
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, PR China
| | - Yu Deng
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, PR China
| | - Yanwu Sun
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, PR China
| | - Daoxiong Ye
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, PR China
| | - Jingming Zhong
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, PR China
| | - Ying Huang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, PR China.
| | - Pan Chi
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, PR China.
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van der Meer R, Jeuken JWM, Bosch SL, van Erning FN, Simkens LHJ, de Hingh IHJT, Roumen RMH. Biomarker concordance between primary colorectal cancer and ovarian metastases: a Dutch cohort study. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04502-3. [PMID: 36539535 DOI: 10.1007/s00432-022-04502-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE The genetic characteristics and mismatch repair (MMR) status of the primary tumor and corresponding metastases in colorectal cancer (CRC) are generally considered to be highly concordant. This implies that either the primary or metastatic tumor can be used for testing gene mutation and MMR status. However, whether this is also true for CRC and their ovarian metastases is currently unknown. Ovarian metastases generally show a poorer response to systemic therapy compared to other metastatic sites. Differences in biomarker status between primary CRC and ovarian metastases could possibly explain this difference in therapy response. METHODS The study cohort was selected from CRC patients treated in two Dutch hospitals. Eligible patients with CRC and ovarian metastasis who were surgically treated between 2011 and 2018 were included. CRC and corresponding ovarian metastatic tissues were paired. Gene mutation status was established using next-generation sequencing, while the MMR status was established using either immunohistochemistry or microsatellite instability analysis. RESULTS Matched samples of CRC and ovarian metastasis from 26 patients were available for analysis. A biomarker concordance of 100% was detected. CONCLUSION Complete biomarker concordance was found between MMR proficient CRC and their matching ovarian metastasis. Biomarker testing of MMR proficient CRC tissue appears to be sufficient, and additional testing of metastatic ovarian tissue is not necessary. Differences in therapy response between ovarian metastases and other metastases from CRC are thus unlikely to be caused by differences in the genetic status.
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Affiliation(s)
- Richard van der Meer
- Department of Surgery, Máxima Medical Center, P.O. Box 7777, 5500 MB, Veldhoven, The Netherlands
| | | | - Steven L Bosch
- Department of Pathology, Eurofins-PAMM, Eindhoven, The Netherlands
| | - Felice N van Erning
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
- Department of Surgery, Catharina Cancer Institute, Eindhoven, The Netherlands
| | - Lieke H J Simkens
- Department of Medical Oncology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Ignace H J T de Hingh
- Department of Surgery, Catharina Cancer Institute, Eindhoven, The Netherlands
- GROW - School for Oncology and Development Biology, Maastricht University, Maastricht, The Netherlands
| | - Rudi M H Roumen
- Department of Surgery, Máxima Medical Center, P.O. Box 7777, 5500 MB, Veldhoven, The Netherlands.
- GROW - School for Oncology and Development Biology, Maastricht University, Maastricht, The Netherlands.
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Van der Meer R, de Hingh IHJT, Bloemen JG, Janssen L, Roumen RMH. Role Of Ovarian Metastases In Colorectal Cancer (ROMIC): a Dutch study protocol to evaluate the effect of prophylactic salpingo-oophorectomy in postmenopausal women. BMC Womens Health 2022; 22:441. [DOI: 10.1186/s12905-022-02040-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/28/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The mean incidence of ovarian metastases (OM) in patients with colorectal cancer (CRC) is 3.4%. The 5-year survival of these patients, even when operated with curative intent, is remarkably low. The lifetime risk of ovarian cancer is approximately 1.3%. Prophylactic salpingo-oophorectomy (PSO, or surgical removal of the ovaries and fallopian tubes) could reduce the number of CRC patients that develop OM after removal of the primary tumor, as well as preventing the occurrence of primary ovarian cancer. Recently, the care pathway for CRC has been changed in several hospitals in line with the updated Dutch guideline. The possibility of PSO is now discussed with postmenopausal CRC patients in these hospitals. The aims of the current study are firstly to estimate the incidence of OM and primary ovarian cancer in postmenopausal patients with CRC, and secondly to evaluate the effect of PSO in these patients.
Methods
An information bulletin and decision guide on this topic was implemented in several Dutch hospitals in 2020. Post-decision outcomes will be collected prospectively. The study population consists of postmenopausal (≥ 60 years of age) patients that are operated with curative intent for CRC. Based on their own preference, patients will be divided into two groups: those who choose to undergo PSO and those who do not. The main study parameters are the reduction in incidence of ovarian malignancies (metastatic or primary) following PSO, and the number needed to treat (NNT) by PSO to prevent one case of ovarian malignancy.
Discussion
This will be the first study to evaluate the effect of PSO in postmenopausal CRC patients that is facilitated by an altered CRC care pathway. The results of this study are expected to provide relevant information on whether PSO adds significant value to postmenopausal patients with CRC.
Trial registration
International Clinical Trials Registry Platform, NL7870. Registered on 2019 July 12. URL of trial registry record: https://trialsearch.who.int/Trial2.aspx?TrialID=NL7870.
Protocol version: 1.0, date 2021 June 8.
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Ovarian metastases in young women with colorectal cancer: a retrospective multicenter cohort study. Int J Colorectal Dis 2022; 37:1865-1873. [PMID: 35857105 DOI: 10.1007/s00384-022-04217-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE Previous studies indicated that approximately 3.4% of female colorectal cancer (CRC) patients are at increased risk of developing ovarian metastases (OM). It has been suggested that young women more frequently develop this form of metastatic disease. METHODS This study evaluated, in 6 Dutch hospitals, the proportion of young women with CRC who developed OM. RESULTS In a cohort of 200 young (age ≤ 55) women with CRC, the proportion of patients diagnosed with synchronous or metachronous OM was calculated. This study revealed that 5% (n = 10) of young female CRC patients developed ovarian metastases resulting in a 5-year overall survival rate of approximately 40%. Furthermore, six patients had concurrent peritoneal metastases, five patients had bilateral ovarian metastases, and five patients had synchronous metastases, while the median time of the occurrence of metachronous metastases (n = 5) was 19 months. CONCLUSION This retrospective multicenter cohort study indicates that 5% of young women with CRC either present with or develop OM. This result appears to be clinically relevant and demonstrates the need for improved surveillance for young women diagnosed with CRC.
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7
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Primary ovarian cancer after colorectal cancer: a Dutch nationwide population-based study. Int J Colorectal Dis 2022; 37:1593-1599. [PMID: 35697933 DOI: 10.1007/s00384-022-04184-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE Women with colorectal cancer (CRC) are at risk not only of developing ovarian metastases, but also of developing a primary ovarian malignancy. Several earlier studies have in fact shown a link between the development of primary ovarian cancer and CRC. The purpose of this study was therefore to determine the risk of developing a primary ovarian cancer in women with prior CRC compared to the general population. METHODS Data from the Netherlands Cancer Registry were used. All women diagnosed with invasive CRC between 1989 and 2017 were included. Standardized incidence ratios (SIRs) and absolute excess risks (AERs) per 10,000 person-years were calculated. RESULTS During the study period, 410 (0.3%) CRC patients were diagnosed with primary ovarian cancer. Women with CRC had a 20% increased risk of developing ovarian cancer compared to the general population (SIR = 1.2, 95% CI: 1.1-1.3). The AER of ovarian cancer was 0.9 per 10,000 person-years. The risk was especially increased within the first year of a CRC diagnosis (SIR = 3.3, 95% CI: 2.8-3.8) and in women aged ≤ 55 years (SIR = 2.0, 95% CI: 1.6-2.6). CONCLUSION This study found a slightly increased risk of primary ovarian cancer in women diagnosed with CRC compared to the general population. However, this may be partly attributable to surveillance or detection bias. Nevertheless, our findings could be helpful for patient counseling, as CRC patients do not currently receive information concerning the increased risk of ovarian cancer.
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8
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Fish R. Ovarian transposition in rectal cancer: uncertain benefit at a high price. Colorectal Dis 2022; 24:706-707. [PMID: 35249247 PMCID: PMC9314095 DOI: 10.1111/codi.16086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Rebecca Fish
- Colorectal and Peritoneal Oncology CentreThe Christie NHS FTManchesterUK,Division of Cancer SciencesUniversity of ManchesterManchesterUK
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9
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van der Meer R, Bakkers C, Rostamkhan E, de Hingh I, Roumen R. Ovarian metastases from colorectal cancer in young women: a systematic review of the literature. Int J Colorectal Dis 2021; 36:2567-2575. [PMID: 34432125 DOI: 10.1007/s00384-021-04012-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE In female colorectal cancer patients, a mean proportion of synchronous and/or metachronous ovarian metastases of 3.4% was described. Previous literature showed that young or premenopausal women (≤ 55 years of age) may be more frequently affected. Once ovarian metastases are diagnosed, the prognosis of the patient is generally dismal, with 5-year survival varying from 12 to 27%. The present study is aimed at determining the proportion of young or premenopausal women diagnosed with colorectal cancer who presented with or developed ovarian metastases by reviewing the current literature on this topic. METHODS This review was performed by querying MEDLINE and EMBASE databases using a combination of terms: "colorectal neoplasms, colorectal cancer, ovarian neoplasms, Krukenberg tumor, young adult, young age, premenopause." Studies that indicated ovarian metastases, either synchronous or metachronous (or a combination of the two), in young women were retrieved and analyzed. RESULTS The review identified 14 studies encompassing 3379 young or premenopausal female colorectal cancer patients. In this selected group of patients, a mean proportion of ovarian metastases of 4.6% [95% CI: 4.0;5.4] was found. CONCLUSIONS This review showed that approximately one in twenty young female colorectal cancer patients will present with or develop ovarian metastases. Since outcome of this specific oncological pathology is often dismal, this finding is clinically relevant. It demonstrates the need to develop strategies to lower the incidence of ovarian metastases with adequate treatment and counseling of these patients.
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Affiliation(s)
- Richard van der Meer
- Department of Surgery, Máxima Medical Center, PO BOX 7777, 5500 MB, Veldhoven, Netherlands.
| | - Checca Bakkers
- Department of Surgery, Catharina Cancer Institute, Eindhoven, Netherlands
| | - Elysa Rostamkhan
- Department of Surgery, Máxima Medical Center, PO BOX 7777, 5500 MB, Veldhoven, Netherlands
| | - Ignace de Hingh
- Department of Surgery, Catharina Cancer Institute, Eindhoven, Netherlands.,GROW - School for Oncology and Development Biology, Maastricht University, Maastricht, Netherlands
| | - Rudi Roumen
- Department of Surgery, Máxima Medical Center, PO BOX 7777, 5500 MB, Veldhoven, Netherlands.,GROW - School for Oncology and Development Biology, Maastricht University, Maastricht, Netherlands
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Madonia D, Graf W, Ghanipour L. The incidence and prognostic importance of ovarian involvement in patients with peritoneal metastasis undergoing CRS-HIPEC. Eur J Surg Oncol 2021; 48:666-671. [PMID: 34799231 DOI: 10.1016/j.ejso.2021.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/28/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Oophorectomy is a common procedure in women with peritoneal metastasis (PM) undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), which has unique consequences on hormonal balance and fertility before menopause. The objective of this study was to analyze histopathological results and the prognostic influence of ovarian involvement. MATERIAL AND METHODS A prospective HIPEC database was used to identify 442 patients with PM from colorectal cancer, pseudomyxoma peritonei and appendix cancer scheduled for CRS-HIPEC between 2012 and 2019 at the University Hospital, Uppsala, Sweden. Statistical analyses were performed using the Chi-square test and Cox regression analysis. RESULTS In all, 103 of 180 females underwent oophorectomy. Unilateral oophorectomy was performed in 19% (n = 20) and bilateral oophorectomy in 81% (n = 83). The median age was 61 (range 20-80). Benign ovarian histopathology was seen in 23% (n = 24). Of these, two patients were ≤35 years and 8 patients ≤50 years. The median peritoneal cancer index (PCI) was 16 in women undergoing oophorectomy, and 7 in those with no oophorectomy. Bilateral oophorectomy was associated with negative impact on overall survival (HR 4.84; 95% CI; 1.14-20.61). Malignant ovarian histopathology was also associated with a negative impact on overall survival (p = 0.043). CONCLUSION Almost a quarter of the patients had benign histopathology after oophorectomy. This is crucial information for females with childbearing potential when planning for extensive surgery. Extensive pelvic peritoneal cancer growth resulted more often in bilateral oophorectomy which influenced survival negatively.
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Affiliation(s)
- D Madonia
- Department of Surgical Sciences, Uppsala University, Sweden.
| | - W Graf
- Department of Surgical Sciences, Uppsala University, Sweden
| | - L Ghanipour
- Department of Surgical Sciences, Uppsala University, Sweden
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Zhou F, Ding J. Prognosis and factors affecting colorectal cancer with ovarian metastasis. Updates Surg 2021; 73:391-398. [PMID: 33523414 DOI: 10.1007/s13304-021-00978-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/12/2021] [Indexed: 12/27/2022]
Abstract
Colorectal cancer is one of the most common malignant tumors. Its incidence has been increasing in recent years, as has the number of cases of ovarian metastasis of colorectal cancer. The prognosis of colorectal cancer with ovarian metastasis is poor, and it is an important cause of death in female patients. A variety of clinicopathological factors were found to be related to the prognosis of patients with colorectal cancer with ovarian metastasis, such as menopausal status, metastasis limited to the pelvis, and tumor differentiation. Tumor genetic characteristics also provide a new perspective for the prognostic evaluation of colorectal cancer with ovarian metastasis. The prognosis of ovarian metastasis is also closely associated with treatment. The major treatment methods are prophylactic oophorectomy, surgical resection of the primary and metastatic lesions, cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy and systematic therapy. If feasible, complete surgical resection of the primary and ovarian metastatic macroscopic lesions combined with postoperative chemotherapy might currently be the most effective treatment for improving the prognosis of patients with colorectal cancer with ovarian metastasis. Genetic analysis also provides a theoretical basis for potential targeted therapy and immunotherapy.
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Affiliation(s)
- Fangyue Zhou
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, 419 Fang-xie Road, Shanghai, 200011, People's Republic of China
| | - Jingxin Ding
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, 419 Fang-xie Road, Shanghai, 200011, People's Republic of China.
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12
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Incidence, risk factors, treatment, and survival of ovarian metastases of colorectal origin: a Dutch population-based study. Int J Colorectal Dis 2020; 35:1035-1044. [PMID: 32157379 DOI: 10.1007/s00384-020-03555-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this nationwide study was to provide insight in the incidence, risk factors, treatment, and survival of patients with ovarian metastases from colorectal cancer (CRC). METHODS Data from the Netherlands Cancer Registry were used. All newly diagnosed female CRC patients between 2008 and 2016 were included. Treatment was categorized as follows: cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (CRS-HIPEC); resection of the primary tumor; palliative treatment; and no treatment. Overall survival (OS) was investigated using Kaplan-Meier and multivariable Cox regression analyses. RESULTS Of 53,883 female CRC patients, 11,343 (21.1%) had metastases at time of diagnosis. Among them, 471 (4.2%) had ovarian metastases. Within latter group, 27.2% received CRS-HIPEC; 38.4% underwent resection of the primary tumor; 25.3% received palliative treatment; and 9.1% received no treatment. Median OS of all patients with ovarian metastases was 17.5 months. In patients receiving CRS-HIPEC, OS was significantly longer than in patients undergoing resection only (median OS 34.1 vs. 17.5 months, adjusted HR 0.44 [0.33-0.66]). Five-year OS was 28.5% for patients having underwent CRS-HIPEC, 11.0% for patients having underwent resection of the primary tumor, 1.2% for patients having underwent palliative treatment, and 0.0% for patients without treatment. CONCLUSIONS Synchronous ovarian metastases are diagnosed in 4.2% of female colorectal patients presenting with metastatic disease. Risk factors are young age, T4/N+ tumor and histology of signet ring cell carcinoma. Median OS of the entire cohort was 17.5 months, ranging from 3.1 months in patients without treatment to 34.1 months in patients undergoing CRS-HIPEC.
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Govaerts K, Lurvink RJ, De Hingh IHJT, Van der Speeten K, Villeneuve L, Kusamura S, Kepenekian V, Deraco M, Glehen O, Moran BJ. Appendiceal tumours and pseudomyxoma peritonei: Literature review with PSOGI/EURACAN clinical practice guidelines for diagnosis and treatment. Eur J Surg Oncol 2020; 47:11-35. [PMID: 32199769 DOI: 10.1016/j.ejso.2020.02.012] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/12/2020] [Indexed: 12/20/2022] Open
Abstract
Pseudomyxoma Peritonei (PMP) is a rare peritoneal malignancy, most commonly originating from a perforated epithelial tumour of the appendix. Given its rarity, randomized controlled trials on treatment strategies are lacking, nor likely to be performed in the foreseeable future. However, many questions regarding the management of appendiceal tumours, especially when accompanied by PMP, remain unanswered. This consensus statement was initiated by members of the Peritoneal Surface Oncology Group International (PSOGI) Executive Committee as part of a global advisory role in the management of uncommon peritoneal malignancies. The manuscript concerns an overview and analysis of the literature on mucinous appendiceal tumours with, or without, PMP. Recommendations are provided based on three Delphi voting rounds with GRADE-based questions amongst a panel of 80 worldwide PMP experts.
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Affiliation(s)
- K Govaerts
- Department of Surgical Oncology, Hospital Oost-Limburg, Genk, Belgium.
| | - R J Lurvink
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - I H J T De Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - K Van der Speeten
- Department of Surgical Oncology, Hospital Oost-Limburg, Genk, Belgium
| | - L Villeneuve
- Service de Recherche et Epidémiologie Cliniques, Pôle de Santé Publique, Hospices Civils de Lyon, Lyon, France, EMR 3738, Lyon 1 University, Lyon, France
| | - S Kusamura
- Department of Surgery, Peritoneal Surface Malignancy Unit, Fondazione IRCCS Instituto Nazionale Dei Tumori di Milano, Via Giacomo Venezian 1, Milano, Milan Cap, 20133, Italy
| | - V Kepenekian
- Service de Chirurgie Digestive et Endocrinienne, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France, EMR 3738, Lyon 1 University, Lyon, France
| | - M Deraco
- Department of Surgery, Peritoneal Surface Malignancy Unit, Fondazione IRCCS Instituto Nazionale Dei Tumori di Milano, Via Giacomo Venezian 1, Milano, Milan Cap, 20133, Italy
| | - O Glehen
- Department of Digestive Surgery, Centre Hospitalier Lyon Sud, Lyon, France
| | - B J Moran
- Peritoneal Malignancy Institute, North-Hampshire Hospital, Basingstoke, UK
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Biolchini F, Castro Ruiz C, Pavesi E, Musci G, Zizzo M, Ugoletti L, Annessi V. Diagnostic challenges in synchronous ovarian metastasis from rectal cancer: A case report. Medicine (Baltimore) 2019; 98:e17782. [PMID: 31689847 PMCID: PMC6946346 DOI: 10.1097/md.0000000000017782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 09/05/2019] [Accepted: 10/03/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Ovarian metastases from rectal cancer are infrequent; thus it might be hard to diagnose and treat them. Our study introduces a challenging case which highlights our method in addressing such an issue. PATIENTS CONCERNS A 74-year-old woman was admitted to our Unit showing abdominal pain, vomit, and a gross abdominal mass located in the right iliac fossa and mesogastrium. Oncological markers recorded following abnormalities: carbohydrate antigen 19.9 (Ca19.9) = 453.40 U/mL, carbohydrate antigen 125 (Ca125) = 88.3 U/mL. DIAGNOSIS Such a metastatic tumor being difficult to diagnose, we could not achieve a precise preoperative diagnosis. We entered the operating room with a histologic diagnosis that was highly suspicious of colon adenocarcinoma. During surgery, frozen section analysis was positive for primary ovarian cancer. Thanks to the immunohistochemistry test on the histologic specimen, which might be very helpful in diagnosing such metastatic tumor, final pathology report documented ovarian metastasis from rectal cancer. INTERVENTIONS We performed total hysterectomy with bilateral salpingo-oophorectomy and low anterior resection of the rectum with a terminal colostomy. Adjuvant chemotherapy was administered for 6 months using FOLFOX plus panitumumab in first-line therapy. OUTCOME At 8 months from surgery, during follow-up, a local pelvic progression of disease was detected, leading to second-line chemotherapy treatment. CONCLUSION Correct differential diagnosis between primary and metastatic ovarian tumors is paramount in choosing the best treatment which leads to the best possible outcome. In ovarian metastatic tumors, immunohistochemistry could represent an optimal diagnostic tool.
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Affiliation(s)
| | | | - Erica Pavesi
- Department of General Surgery, Chirurgia Area Nord
| | | | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Mariani S, Chiloiro G, Villa P, Meldolesi E, Barbaro B, Di Giorgio A, Corrado G, Corvari B, Giraffa M, Scambia G, Valentini V, Gambacorta MA. Fertility preservation in chemo-radiotherapy for rectal cancer: A combined approach. Clin Transl Radiat Oncol 2019; 19:77-79. [PMID: 31650042 PMCID: PMC6804737 DOI: 10.1016/j.ctro.2019.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/06/2019] [Accepted: 09/06/2019] [Indexed: 11/28/2022] Open
Abstract
Young females affected by rectal cancer need counselling on fertility preservation. Ovarian transposition and cryopreservation are feasible. Advances in radiation therapy techniques can help reducing fertility impairment. A multidisciplinar approach is recommended.
Introduction Colorectal cancer is a very common form of cancer worldwide, affecting an increasing number of young women. Standard treatment for locally advanced rectal cancer (LARC) can pose a threat to fertility in these patients. Case presentation We present the case of a young woman affected by LARC who expressed a desire for child-bearing. The treatment she was proposed, according to guidelines, was neoadjuvant chemo-radiotherapy (CRT) followed by delayed surgery, carrying with it a high risk for amenorrhea. Counselling was performed before the initiation of treatment, with the aim of preserving fertility by the proposal of GnRH agonist administration, ovarian transposition and ovarian tissue cryopreservation, which the patient accepted. Treatment was then successfully completed. The patient presented regular menstrual period from before the surgery. Discussion Ovarian tissue is very sensitive to radiations. Transposition of the organ can prevent ovarian insufficiency by placing it outside the radiation field, while ovarian tissue cryopreservation and orthotopic transplantation offers the possibility to restore fertility in the case of organ failure. We performed both of the techniques. GnRH analogs administration allowed to diminish the risk of ovarian cytotoxicity. Radiation treatment plan was optimized in order to minimize the dose to organs at risk (ovary and vagina in particular); position of the uterus, which is quite radiosensitive too, was monitored with daily cone-beam CT (CBCT). Conclusion The strategy proposed seemed safe and effective, resulting in radical treatment and persistence of regular menstrual period. Further studies are needed.
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Affiliation(s)
- S Mariani
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - G Chiloiro
- Università Cattolica del Sacro Cuore, Roma, Italy.,Department of Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - P Villa
- Università Cattolica del Sacro Cuore, Roma, Italy.,Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - E Meldolesi
- Università Cattolica del Sacro Cuore, Roma, Italy.,Department of Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - B Barbaro
- Università Cattolica del Sacro Cuore, Roma, Italy.,Department of Bioimaging and Radiological Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - A Di Giorgio
- Università Cattolica del Sacro Cuore, Roma, Italy.,Division of General Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - G Corrado
- Università Cattolica del Sacro Cuore, Roma, Italy.,Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - B Corvari
- Università Cattolica del Sacro Cuore, Roma, Italy.,Department of Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - M Giraffa
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - G Scambia
- Università Cattolica del Sacro Cuore, Roma, Italy.,Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - V Valentini
- Università Cattolica del Sacro Cuore, Roma, Italy.,Department of Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - M A Gambacorta
- Università Cattolica del Sacro Cuore, Roma, Italy.,Department of Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
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Bignell MB, Mehta AM, Alves S, Chandrakumaran K, Dayal SP, Mohamed F, Cecil TD, Moran BJ. Impact of ovarian metastases on survival in patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal malignancy originating from appendiceal and colorectal cancer. Colorectal Dis 2018; 20:704-710. [PMID: 29502336 DOI: 10.1111/codi.14057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 02/20/2018] [Indexed: 12/24/2022]
Abstract
AIM Ovarian metastases from gastrointestinal tract malignancies have been considered an ominous finding with poor prognosis. The aim of this project was to determine the impact on survival, and potential cure, when cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are combined to treat peritoneal malignancy in women with Krukenberg tumours. METHOD A retrospective analysis of prospectively collected data between January 2010 and July 2015. Female patients undergoing complete CRS (macroscopic tumour removal) and HIPEC for pseudomyxoma peritonei (PMP) of appendiceal origin, or colorectal peritoneal metastases (CPM) were included. Survival was estimated using the Kaplan-Meier method and survival rates compared using the log-rank test. RESULTS In total, 889 patients underwent surgery for peritoneal malignancy, of whom 551 were female. Of these, 504/551 (91%) underwent complete CRS and HIPEC. Overall, 405/504 (80%) had at least one involved ovary removed either during CRS and HIPEC or at their index prereferral operation. Three hundred and fifty-two patients (87%) had an appendiceal tumour and 53 (13%) had CPM. At a median follow up of 40 months, overall survival (OS) did not differ significantly between patients with or without ovarian involvement in women with a primary low-grade appendiceal tumour or CPM. In women with high-grade primary appendiceal pathology, OS was significantly lower in patients with ovarian metastases compared with those without ovarian involvement. CONCLUSION Women with ovarian metastases from low-grade appendiceal tumours or colorectal cancer treated with CRS and HIPEC have similar survival rates to patients without ovarian metastases. Long-term survival and cure is feasible in patients amenable to complete tumour removal.
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Affiliation(s)
- M B Bignell
- Peritoneal Malignancy Institute, Basingstoke amd North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - A M Mehta
- Peritoneal Malignancy Institute, Basingstoke amd North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - S Alves
- Peritoneal Malignancy Institute, Basingstoke amd North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - K Chandrakumaran
- Peritoneal Malignancy Institute, Basingstoke amd North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - S P Dayal
- Peritoneal Malignancy Institute, Basingstoke amd North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - F Mohamed
- Peritoneal Malignancy Institute, Basingstoke amd North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - T D Cecil
- Peritoneal Malignancy Institute, Basingstoke amd North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - B J Moran
- Peritoneal Malignancy Institute, Basingstoke amd North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
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Kammar PS, Engineer R, Patil PS, Ostwal V, Shylasree TS, Saklani AP. Ovarian Metastases of Colorectal Origin: Treatment Patterns and Factors Affecting Outcomes. Indian J Surg Oncol 2017; 8:519-526. [PMID: 29203984 PMCID: PMC5705507 DOI: 10.1007/s13193-017-0667-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 05/02/2017] [Indexed: 01/25/2023] Open
Abstract
The purpose of this study is to evaluate the patterns of treatment and factors affecting outcomes in ovarian metastases of colorectal origins treated at our institution and to assess the response of ovarian metastases to chemotherapy. Survival in R0 and R+ resections and patients receiving only chemotherapy is also analyzed. This is a retrospective study of 25 patients registered between January 2012 and December 2015. Patient's age, disease status, mode of presentation, disease spread, mode of treatment, response to chemotherapy, completeness of resection, histology, and outcomes were considered as variables for analysis. There were 21 synchronous presentations and 4 metachronous presentations. In synchronous presentations, only 2 had extra-abdominal disease. Of these patients, 15 underwent surgeries of various extents. The remaining 6 patients were treated with chemotherarpy initially. Only one of them could come up to surgery later. In R0 resections, disease recurred between 1 and 9 months (median 3.5 months). The recurrence was in peritoneum and ovaries. In operated cases, 12 of 15 patients received chemotherapy and 9 patients progressed on first line chemotherapy. In all 4 metachronous patients, the disease was in the peritoneum. No one underwent surgery for the recurrence due to the extensive nature of the disease. All received chemotherapy. Sixty-six percent ovarian metastases showed progression on chemotherapy. There was no significant difference in the median survival between patients treated with surgery plus chemotherapy (23 months) vs. those treated with chemotherapy alone (28 months). Age and presence of disease at other sites did not affect the outcomes. Non-signet ring cell histologies showed better outcomes compared to signet ring cell histology (p = 0.02). Synchronous presentation, R0 resections, and responsive disease showed better survival, however it was clinically not significant. Treatment of ovarian metastases of colorectal origins is varied but has consistently poor outcome. Non-signet histology was the only prognostic factor which showed better outcome. Survival was not different between patients treated with surgery+chemotherapy and chemotherapy alone but majority of ovarian metastases progressed on chemotherapy. Considering the poor response to chemotherapy and peritoneum being the most common site of disease, both in primary and recurrent setting, R0 resection should always be attempted after selecting the correct patients using PET scan, laparoscopy and standard exploratory protocols. Treatment should be tailored upon patient's status and disease burden with an aim to do complete cytoreduction whenever possible. CRS+HIPEC (cytoreductive surgery + hyperthermic intraperitoneal chemotherapy) can be considered on case to case basis as even R0 resections tend to recur.
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Affiliation(s)
- Praveen S. Kammar
- Department of Surgical Oncology, Tata Memorial Centre, Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India
| | - Prachi S. Patil
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Mumbai, India
| | - Vikas Ostwal
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - T. S. Shylasree
- Department of Gynaecologic Oncology, Tata Memorial Centre, Mumbai, India
| | - Avanish P. Saklani
- Department of Surgical Oncology, Tata Memorial Centre, Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
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Ribeiro R, Rebolho JC, Tsumanuma FK, Brandalize GG, Trippia CH, Saab KA. Uterine transposition: technique and a case report. Fertil Steril 2017; 108:320-324.e1. [DOI: 10.1016/j.fertnstert.2017.06.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 06/03/2017] [Accepted: 06/08/2017] [Indexed: 02/07/2023]
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Abstract
BACKGROUND Ovarian metastases of GI tumors grow rapidly and are relatively resistant to systemic chemotherapy. They may be unilateral or bilateral and macroscopic or occult. The risk of macroscopic ovarian involvement or occult involvement of macroscopically normal ovaries is unquantified. OBJECTIVE This study aims to quantify the risks of ovarian involvement in patients with peritoneal malignancy undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. DESIGN This was a retrospective analysis of a dedicated prospective malignancy database. SETTINGS This study was conducted at a high-volume tertiary referral center for peritoneal malignancy. PATIENTS Female patients with at least 1 remaining ovary, undergoing complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for appendiceal tumors or colorectal peritoneal metastases between January 2010 and March 2015 were included. OUTCOME MEASURES Data regarding ovarian involvement was extracted from surgical and histological records. RESULTS Two hundred fifty-eight female patients with at least 1 ovary underwent complete cytoreduction and hyperthermic intraperitoneal chemotherapy during the study period. In total, 141 of 258 (54.7%) patients had ovarian tumor involvement, and 80% with at least 1 macroscopically abnormal ovary had bilateral involvement. Of 40 patients with 1 macroscopic ovarian metastasis, microscopic involvement of the contralateral ovary was found in 18 of 40 (45.0%). Of 141 patients in whom both ovaries were macroscopically normal, 24 of 141 (17.0%) patients had microscopic ovarian involvement. LIMITATIONS The retrospective nature limits the interpretation of these results. CONCLUSIONS Occult malignancy was present in 17% when both ovaries looked macroscopically normal and in 45% of contralateral normal-looking ovaries if the other ovary was macroscopically involved. These results help to inform preoperative consent and intraoperative decision making in patients with advanced appendiceal and colorectal malignancy, and are of benefit in managing advanced lower GI tract malignancy.
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20
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Xu KY, Gao H, Lian ZJ, Ding L, Li M, Gu J. Clinical analysis of Krukenberg tumours in patients with colorectal cancer-a review of 57 cases. World J Surg Oncol 2017; 15:25. [PMID: 28088224 PMCID: PMC5237542 DOI: 10.1186/s12957-016-1087-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 12/22/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A Krukenberg tumour (KT) is defined as an ovarian metastasis from a gastrointestinal adenocarcinoma and suggests a terminal condition. This study aimed to identify the prognostic factors affecting the survival of patients with KTs of colorectal origin who receive cytoreductive surgery. METHODS Medical records of patients who had received cytoreductive surgery and had been pathologically diagnosed with KT of colorectal origin in two centres were reviewed. Information about the patients' clinicopathological features and follow-up visit were collected. Factors influencing patient survival were analysed. RESULTS Fifty-seven patients were included in this study. The median survival time was 35 months. Five-year overall survival was 25%. Patients who had recurrence 2 years after resection of the primary tumour, achieved complete cytoreduction, had metastases confined to the pelvis, had no lymph node involvement, and received systemic chemotherapy had a significantly longer median survival than those who had recurrence at the same time as resection of the primary tumour (P = 0.027), received incomplete cytoreduction (P < 0.001), had metastases beyond the pelvis (P < 0.001), had lymph node involvement (P = 0.011), and did not receive systemic chemotherapy (P = 0.006) on log-rank test. Less extensive metastatic disease, achievement of complete cytoreduction, and use of systemic chemotherapy were significantly associated with improved prognosis on multivariate analysis. CONCLUSIONS Cytoreductive surgery may confer survival benefits in patients with KTs of colorectal origin who attain complete cytoreduction and whose metastases are confined to the pelvis and when combined with active systemic chemotherapy.
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Affiliation(s)
- K Y Xu
- Department of Surgical Oncology, Beijing Shijitan Hospital and Cancer Centre of Capital Medical University, Beijing, China
| | - H Gao
- Department of Surgical Oncology, Beijing Shijitan Hospital and Cancer Centre of Capital Medical University, Beijing, China
| | - Z J Lian
- Department of Surgical Oncology, Beijing Shijitan Hospital and Cancer Centre of Capital Medical University, Beijing, China
| | - L Ding
- Department of Surgical Oncology, Beijing Shijitan Hospital and Cancer Centre of Capital Medical University, Beijing, China
| | - M Li
- Department of Colorectal Surgery, Beijing Cancer Hospital, No. 52, Road Fu Shi, District Haidian, Beijing, China
| | - J Gu
- Department of Colorectal Surgery, Beijing Cancer Hospital, No. 52, Road Fu Shi, District Haidian, Beijing, China.
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Thompson CV, Naumann DN, Kelly M, Karandikar S, McArthur DR. Prophylactic oophorectomy during primary colorectal cancer resection: A systematic review and meta-analysis. World J Surg Proced 2015; 5:167-172. [DOI: 10.5412/wjsp.v5.i1.167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 09/13/2014] [Accepted: 02/11/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To appraise the current evidence for prophylactic oophorectomy in patients undergoing primary curative colorectal cancer resection.
METHODS: Occult ovarian metastases may lead to increased mortality, therefore prophylactic oophorectomy may be considered for women undergoing colorectal resection. A systematic review and meta-analysis was performed for English language studies from 1994 to 2014 (PROSPERO Registry number: CRD42014009340), comparing outcomes following prophylactic oophorectomy (no known ovarian or other metastatic disease at time of surgery) vs no ovarian surgery, synchronous with colorectal resection for malignancy. Outcomes assessed: local recurrence, 5-year mortality, immediate post-operative morbidity and mortality, and rate of distant metastases.
RESULTS: Final analysis included 4 studies from the United States, Europe and China, which included 627 patients (210 prophylactic oophorectomy and 417 non-oophorectomy). There was one randomized controlled trials, the remainder being non-randomised cohort studies. The studies were all at high risk of bias according to the Cochrane Collaboration’s assessment tool for randomised studies and the Newcastle-Ottawa Score for the cohort studies. The mean age of patients amongst the studies ranged from 56.5 to 67 years. There were no significant differences between the patients having prophylactic oophorectomy at time of primary colorectal resection compared with patients who did not with respect to local recurrence, 5-year survival and distant metastases. There was no difference in post-operative complications or immediate post-operative mortality between the groups.
CONCLUSION: Current evidence does not favour prophylactic oophorectomy for patients without known genetic predisposition. Prophylactic surgery is not associated with additional risk of post-operative complications or death.
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23
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24
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Tai DKC, Li WH, Cheung MT. Krukenberg tumours of colorectal origin: Experience of a tertiary referral centre and review of the literature. SURGICAL PRACTICE 2012. [DOI: 10.1111/j.1744-1633.2012.00592.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Ceccaroni M, Paglia A, Ruffo G, Scioscia M, Bruni F, Pesci A, Minelli L. Symptomatic vaginal bleeding in a postmenopausal woman revealing colon adenocarcinoma metastasizing exclusively to the vagina. J Minim Invasive Gynecol 2011; 17:779-81. [PMID: 20955988 DOI: 10.1016/j.jmig.2010.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Revised: 03/31/2010] [Accepted: 05/28/2010] [Indexed: 01/02/2023]
Abstract
Vaginal carcinomas are rare entities, accounting for 2% of all malignant cancers of the female genital tract, and the vast majority are metastatic. Adenocarcinoma of the colon metastasizing to the vagina is extremely rare, only 5 cases have been reported. We present the case of a woman who experienced vaginal bleeding as an isolated symptom of vaginal metastasis of colorectal adenocarcinoma. Vaginal localization of metastasis from colorectal cancer significantly worsens the survival prognosis, and a standard treatment has not yet been proposed. Potential mechanisms of spread of colorectal cancer to the vagina and therapeutic approaches are discussed. In this case, treatment included surgery and chemotherapy.
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Affiliation(s)
- Marcello Ceccaroni
- Gynaecologic Oncology Division, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy
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Cai GX, Xu Y, Tang DF, Lian P, Peng JJ, Wang MH, Guan ZQ, Cai SJ. Interaction between synchronous bilateral prophylactic oophorectomy and adjuvant chemotherapy in female patients with locally advanced colorectal cancer. Colorectal Dis 2011; 13:414-9. [PMID: 20041916 DOI: 10.1111/j.1463-1318.2009.02179.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM In this study we explored the prognostic impact of synchronous bilateral prophylactic oophorectomy in female patients with primary colorectal cancer undergoing radical surgery. METHOD From 1991 to 2000, 267 female patients with stage II or stage III colorectal cancer, who had undergone curative resection, were retrospectively reviewed. In 224 patients, the ovaries were preserved. The other 43 patients underwent synchronous bilateral prophylactic oophorectomy. Univariate and multivariate analyses (Kaplan-Meier and Cox regression, respectively) were used to evaluate the effect of prophylactic oophorectomy and other clinical factors on the prognosis of patients. RESULTS Both univariate and multivariate analyses showed that tumor stage and adjuvant chemotherapy were the only two significant clinical factors that affected the 5-year overall survival of patients (P < 0.01). There was no significant difference in the 5-year overall survival between patients who had, or had not, undergone prophylactic oophorectomy (75%vs 73%, P > 0.05). In the subgroup analysis by adjuvant chemotherapy, the 5-year overall survival in patients receiving adjuvant chemotherapy was similar between nonoophorectomy and oophorectomy groups. However, in patients without adjuvant chemotherapy, the oophorectomy group was shown to have a significantly better 5-year overall survival than the nonoophorectomy group (76%vs 51%, P = 0.047). CONCLUSION Prophylactic oophorectomy may improve the overall survival of female patients with locally advanced colorectal cancer without adjuvant chemotherapy, but its survival benefit vanished in patients receiving adjuvant chemotherapy. The role of prophylactic oophorectomy may be substituted by adjuvant chemotherapy, which makes prophylactic oophorectomy unnecessary during surgery for locally advanced colorectal cancer.
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Affiliation(s)
- G X Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Centre, Shanghai, China
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Evers DJ, Verwaal VJ. Indication for oophorectomy during cytoreduction for intraperitoneal metastatic spread of colorectal or appendiceal origin. Br J Surg 2011; 98:287-92. [PMID: 21046680 DOI: 10.1002/bjs.7303] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND The incidence of ovarian metastases at the time of peritoneal carcinomatosis, and the influence of such metastases on survival after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), are unknown. METHODS This retrospective analysis included 194 women subjected to CRS and HIPEC since 2001. The incidence of ovarian metastases, disease-free survival and disease-specific survival were analysed. RESULTS The histological diagnosis was colorectal cancer carcinomatosis in 108 patients, peritoneal mucinous carcinomatosis (PMCA) in 23 and disseminated peritoneal adenomucinosis (DPAM) in 63. Ninety-nine patients underwent oophorectomy during the HIPEC procedure. Ovarian metastases were confirmed in at least 52 per cent of the patients. There was a significant difference in disease-free survival between women with or without ovarian metastases in both PMCA and DPAM groups (P = 0·044 and P = 0·010 respectively). No significant differences in survival were found in the group with colorectal cancer carcinomatosis. CONCLUSION When peritoneal carcinomatosis of colorectal or appendiceal origin is confirmed, at least 52 per cent of ovaries will have synchronous metastases. Disease-free survival after a HIPEC procedure for PMCA or DPAM is significantly lower in women with ovarian metastases. Oophorectomy during CRS for peritoneal carcinomatosis should be strongly considered.
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Affiliation(s)
- D J Evers
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam 1066 CX, The Netherlands.
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Abstract
Recurrence of colorectal carcinoma represents a significant challenge. As the majority of recurrences involve more than just the anastomosis, surgical resection is ordinarily a major undertaking. Curative resection may require resection of other organs and structures, resulting in complex reconstructive procedures and substantial morbidity. In addition, carefully selected patients with distant metastases to sites such as the liver and lungs may also undergo potentially curative resection. Long-term survival following curative surgery for recurrence, however, ranges from only 15 to 40%. In addition to resection for curative intent, some patients may benefit from palliative procedures designed to relieve symptoms. Surgery alone is not usually sufficient therapy in these patients. Chemotherapy and radiation therapy play a vital adjunctive role in the management of recurrent disease. This article strives to review the risk factors and patterns of recurrence, selection of individuals for resection of recurrent disease, and outcomes of surgical procedures.
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Affiliation(s)
- Michael D Hellinger
- Department of Surgery, Division of Colon and Rectal Surgery, University of Miami, Miller School of Medicine, Miami, FL 33136, USA.
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Kir G, Gurbuz A, Karateke A, Kir M. Clinicopathologic and immunohistochemical profile of ovarian metastases from colorectal carcinoma. World J Gastrointest Surg 2010; 2:109-16. [PMID: 21160859 PMCID: PMC2999225 DOI: 10.4240/wjgs.v2.i4.109] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 01/28/2010] [Accepted: 02/04/2010] [Indexed: 02/06/2023] Open
Abstract
Metastasis of colorectal adenocarcinoma of the ovary is not an uncommon occurrence and ovarian metastases from colorectal carcinoma frequently mimic endometrioid and mucinous primary ovarian carcinoma. The clinical and pathologic features of metastatic colorectal adenocarcinoma involving the ovary is reviewed with particular focus on the diagnostic challenge of distinguishing these secondary ovarian tumors from primary ovarian neoplasm. Immunohistochemical stains that may be useful in the differential diagnosis of metastatic colorectal tumors to the ovary and primary ovarian tumors are detailed.
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Affiliation(s)
- Gozde Kir
- Gozde Kir, Department of Pathology, Umraniye Education and Research Hospital, Umraniye, Istanbul 34766, Turkey
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Moparty B, Gomez G, Bhutani MS. Large solitary ovarian metastasis from colorectal cancer diagnosed by endoscopic ultrasound. World J Gastroenterol 2008; 14:5096-7. [PMID: 18763296 PMCID: PMC2742941 DOI: 10.3748/wjg.14.5096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A case is presented of rectal carcinoma in which during staging by endoscopic ultrasound (EUS) a second large extrarectal mass was seen not otherwise visualized on computer tomography (CT) that was a solitary ovarian metastasis. The surgeon was alerted to the EUS finding prior to the planned laparoscopic colectomy. On retrospective review of the CT pelvis after surgery, the radiologist could still not diagnose the ovarian lesion separated from the primary rectal tumor due to their close proximity. However, on EUS we were able to clearly see on real-time imaging that there was a distinct peri-rectal mass apart from the primary rectal tumor.
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Imaging of metastatic disease. COLORECTAL CANCER 2007. [DOI: 10.1017/cbo9780511902468.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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