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Impact of Abdominal Wall Metastases on Prognosis in Epithelial Ovarian Cancer
  1. Beyhan Ataseven, MD,
  2. Andreas du Bois, PhD, MD,
  3. Philipp Harter, MD,
  4. Sonia Prader, MD,
  5. Christoph Grimm, MD,
  6. Christian Kurzeder, MD,
  7. Stephanie Schneider, MD,
  8. Sebastian Heikaus, MD,
  9. Anett Kahl, MD,
  10. Alexander Traut, MD and
  11. Florian Heitz, MD
  1. * Department of Gynecology and Gynecologic Oncology, Evangelische Huyssens-Stiftung, Kliniken Essen-Mitte, Essen, Germany;
  2. Department of Gynecology and Gynecologic Oncology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria; and
  3. Center for Pathology, Kliniken Essen-Mitte, Essen, Germany.
  1. Address correspondence and reprint requests to Beyhan Ataseven, MD, Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Henricistrasse, 92 45136 Essen, Germany. E-mail: b.ataseven{at}kliniken-essen-mitte.de.

Abstract

Objective Epithelial ovarian cancer (EOC) patients with the presence of abdominal wall metastasis (AWM) are categorized as stage International Federation of Gynecology and Obstetrics (FIGO) IVB, irrespective of other biologic factors or preceding invasive intervention before final surgery. We evaluated the impact of AWM on patients’ overall survival (OS).

Patients and Methods In this exploratory study, 634 consecutive patients with advanced EOC treated in our center from 2000 to 2014 were included. Patients were categorized into FIGO IIIC (n = 308), FIGO IVB AWM only (n = 86), and FIGO IV others (metastases other than AWM, n = 240). Clinicopathological parameters and survival data were extracted from our prospectively maintained tumor registry. Survival analyses were calculated using Kaplan-Meier method and Cox regression models.

Results In 75 (87.2%) of 86 cases, AWM was seen after a preceding intervention, and only in 12.7%, the deposits were spontaneously established. The median OS in patients with stage FIGO IIIC, FIGO IVB AWM only, and FIGO IV others was 37, 58, and 25 months (P < 0.001), respectively. Patients with FIGO IVB AWM only had a significantly better OS than patients with FIGO IV others (P < 0.001). The numeric longer OS of patients with FIGO IVB AWM only compared with patients with FIGO IIIC was not statistically significant (P = 0.151). In multivariate analysis considering all confounding factors including residual disease, OS of patients with FIGO IIIC did not differ from patients with FIGO AWM only (hazard ratio, 0.84; 95% confidence interval, 0.56–12.26; P = 0.398).

Conclusions Most AWM are acquired after preceding intervention (puncture or laparoscopy). Prognosis of patients with AWM as the only site of distant metastasis is superior compared with other stage FIGO IV patients. Therefore, up-staging of patients only because of AWM to FIGO IVB may be questioned. A revision/clarification of the FIGO classification system should be considered to avoid unnecessary stigmatization of patients and to classify these patients more appropriately according to prognosis.

  • Abdominal wall metastasis
  • Epithelial ovarian cancer
  • Overall survival

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Footnotes

  • The authors declare no conflicts of interest.

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