Prognostic significance of ovarian metastases (macroscopic or microscopic) in patients with colorectal cancer undergoing
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LETTER TO THE EDITOR
Prognostic significance of ovarian metastases (macroscopic or microscopic) in patients with colorectal cancer undergoing cytoreduction followed by HIPEC Christos Iavazzo 1
&
John Spiliotis 2,3
Accepted: 23 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Editor: With great deal of interest, we read the article entitled “Incidence, risk factors, treatment, and survival of ovarian metastases of colorectal origin: a Dutch population-based study” by Bakkers et al. [1]. In the study, 471 (4.2%) of patients with colorectal cancer had ovarian metastases. Around one quarter of them (27.2%) underwent CRS-HIPEC. The median overall survival of the patients with ovarian metastases who had CRS-HIPEC was 34.1 months with a 5-year overall survival reaching 28.5%. The group identified that the main risk factors included young age, T4/N+ tumor, and histology of signet ring cell carcinoma. The aim of our letter is to highlight the prognostic significance of ovarian metastases (macroscopic or microscopic) in patients with colorectal cancer undergoing cytoreduction followed by HIPEC. For this reason, we would like to present the preliminary clinical results of our retrospective study evaluating a smaller but similar cohort of patients. More specifically, in our cohort (study period 2005–2014), 70 out of 150 patients (46.6%) with colorectal cancer were women. Eighteen of them (25.7%) had ovarian metastases of which 13/18 (72.2%) were macroscopic and 5/18 microscopic (27.8%). All of them underwent cytoreductive surgery followed by HIPEC with mitomycin or oxaliplatin. The median overall survival was 14.3 months and 18.5 months in the group with macroscopic and microscopic disease,
* Christos Iavazzo [email protected] 1
Department of Gynecological Oncology, Metaxa Cancer Hospital, Piraeus, Greece
2
Department of Surgical Oncology and HIPEC, Athens Medical Centre, Athens, Greece
3
Department of Surgical Oncology and HIPEC, European Interbalkan Medical Centre, Thessaloniki, Greece
respectively. No statistical significance (p = 0.44) was revealed between the two groups. However, the group of colorectal patients without ovarian metastases had a median overall survival of 28.9 months (p = 0.01). The 5-year survival in those groups was 14%, 17%, and 26% for patients with macroscopic disease in the ovaries, microscopic ovarian metastases, or without ovarian metastases, respectively. The risk factors included age < 45 years, T4, N2 tumor, and histology of signet ring cell carcinoma. Previously reported incidence numbers of synchronous ovarian metastases ranged from 3 to 14%. In the Dutch study, it was 4% of all metastatic colorectal cancer patients. In a previously published, Greek single-center study, the incidence was 15.46% [2], while in our preliminary results, it reaches 25.7%. However, it should be highlighted that our center is a tertiary hospital subspecialized in HIPEC which might explain the difference. Comparing the two studies, Bakkers et al. present the first nati
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