Ovarian Metastasis Is Associated with Retroperitoneal Lymph Node Relapses in Women Treated for Colorectal Peritoneal Car
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ORIGINAL ARTICLE – COLORECTAL CANCER
Ovarian Metastasis Is Associated with Retroperitoneal Lymph Node Relapses in Women Treated for Colorectal Peritoneal Carcinomatosis Clarisse Eveno, MD1, Diane Goe´re´, MD1, Peggy Dartigues, MD2, Charles Honore´, MD1, Fre´de´ric Dumont, MD1, Dimitri Tzanis, MD1, Le´onor Benhaim, MD1, David Malka, MD, PhD3, and Dominique Elias, MD, PhD1 Department of Surgical Oncology, Institut Gustave Roussy, Villejuif Cedex, France; 2Department of Biopathology, Institut Gustave Roussy, Villejuif Cedex, France; 3Department of Medical Oncology, Institut Gustave Roussy, Villejuif Cedex, France 1
ABSTRACT Purpose. To analyze the patterns of recurrence and the prognostic impact of ovarian metastases (OM) in a population of women with colorectal peritoneal carcinomatosis (CRPC) treated with curative intent. Methods. Data from all consecutive women with CRPC who underwent curatively intended complete cytoreductive surgery (CRS) plus intraperitoneal chemotherapy at our institution were retrieved from a prospective database. A bilateral oophorectomy or a complementary unilateral oophorectomy was systematically performed during CRS. Results. From 1994 to 2009, among 105 women who underwent CRS plus intraperitoneal chemotherapy for CRPC, 62 (60 %) had OM. Women with and without OM had comparable peritoneal cancer index (PCI) scores (10 vs. 12, respectively, p = 0.09). After a median follow-up of 60 (range 5–145) months, median overall survival of women with OM did not differ statistically from that of women without OM (respectively, 36 and 40 months; p = 0.75). Relapses occurred in 82 % of the patients, distributed similarly between the two groups except for retroperitoneal lymph node recurrence, which occurred in 19 patients (18 %), including 18 with OM. The only predictive factor for a retroperitoneal relapse was a history of OM (p = 0.0012). Conclusions. Retroperitoneal lymph node recurrence seems to be linked to OM originating from colorectal cancer and could worsen the prognosis. A systematic
Ó Society of Surgical Oncology 2012 First Received: 16 May 2012; Published Online: 7 September 2012 D. Goe´re´, MD e-mail: [email protected]
lymphadenectomy could be evaluated in women with isolated OM or very limited peritoneal carcinomatosis to analyze the incidence of invaded lymph nodes and study its potential benefit on survival.
Approximately 20 % of patients with colorectal cancer (CRC) have metastatic disease at diagnosis, and 25 % will develop metastases during follow-up. These metastases have a predilection for the liver (50 %) and lung (20 %) but rarely affect the ovaries, adrenal gland, and brain.1 Ovarian metastases (OM) differ from lesions at other metastatic sites because they are frequently associated with peritoneal carcinomatosis. Indeed, synchronous OM are reported in 1–9 % of the women undergoing surgical resection of a primary CRC, and metachronous OM occur in only 1–7 %.2–5 In cases of peritoneal carcinomatosis, more than half of the women have OM diagnosed either before or synchronously.6 In
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