Downward Morbidity, Mortality Trends Discovered Among Patients With Ovarian Cancer, Liver Metastases

A downward trend in morbidity and mortality rates was discovered among patients with liver metastases originating from ovarian cancer (OC), according to a study published by PLoS One.¹

The researchers explained that OC can spread through blood, tissue, and the lymph system. Consequently, 70% of patients with OC present with distant metastases at diagnosis, resulting in an overall 5-year survival rate of less than 30%.² They noted that the most frequent site of distant metastasis in OC is the liver, with the median survival time among patients with OC and liver metastases being 30 months, indicating a poor prognosis.¹

A previous study showed that patients with advanced OC who undergo debulking surgery have a more favorable prognosis.³ However, the researchers noted that the prognostic implications of other therapies, like chemotherapy, on patients with OC and liver metastases remain unknown.¹

Because of this, they conducted a study to examine the trends in morbidity and mortality among patients with OC and liver metastases. They also investigated the impact of different treatments on both the overall survival (OS) and cancer-specific survival (CSS) in this population; the researchers defined OS as the time from diagnosis to death, and they defined CSS as the time from the date of diagnosis to death from liver metastases of OC. Additionally, they conducted subgroup analyses on patients with metastases beyond the liver.

Patient with liver metastases | Image Credit: Rasi - stock.adobe.com

“It is imperative to investigate the optimal treatment for ovarian cancer patients with liver metastasis in order to enhance patient outcomes and alleviate disease burden,” the authors wrote.

To conduct their study, the researchers used data from the Surveillance, Epidemiology, and End Results (SEER) database, which encompasses demographics, tumor characteristics, mortality details, and survival rates of US patients with cancer. SEER*Stat software helped them to identify patients in the database diagnosed with primary OC between 2010 and 2019 at age 18 years or older with liver metastases present at diagnosis. Conversely, the researchers excluded those with 2 or more primary cancers or with missing information on surgery and follow-up.

Based on their criteria, the researchers included 2925 eligible patients in their study. Most patients were White (78.46%), with a mean (SD) age of 65.16 (13.49) years. Also, the median follow-up duration was 8.00 (95% CI, 1.00-25.50) months. After the follow-up period, 689 patients remained alive. Consequently, the OS and CSS rates among the study population were 76.44% and 72.99%, respectively.

The researchers found a significant decreasing trend in the incidence rate of liver metastases in patients with OC (average annual percent change [AAPC], –2.3; 95% CI, –3.9 to –0.7). They also found decreasing trends of all-cause mortality (AAPC, –12.8; 95% CI, –15.6 to –9.9) and specific mortality (AAPC, –13.0; 95% CI, –16.1 to –9.8) among patients with OC and liver metastases.

Additionally, regarding treatment methods, receiving surgery was associated with OS (HR, 0.39; 95% CI, 0.31-0.48) and CSS (HR, 0.37; 95% CI, 0.30-0.47) after adjusting for all confounding factors. Similarly, chemotherapy was a protective factor for OS (HR, 0.33; 95% CI, 0.30-0.37) and CSS (HR, 0.44; 95% CI, 0.39-0.50); however, not receiving surgery remained a risk factor for both OS and CSS.

Lastly, through the subgroup analyses, the researchers found that only receiving surgery and chemotherapy were still significant protective factors against OS and CSS for patients with bone metastasis, with lung metastasis, without other distant metastases, or with distant metastases to the bone, lung, brain, or other organs.

The researchers acknowledged their study’s limitations, one being that the SEER database only documented liver, brain, bone, lung, and distant lymph node metastases. Therefore, specific metastases of other sites remain unknown. Also, since they only analyzed US patients, further validation of these findings is necessary to generalize them to diverse populations worldwide. Despite these limitations, the researchers made treatment suggestions based on their findings.

“The findings of this study provide valuable guidance for clinicians and patients in selecting optimal treatment modalities to enhance the prognosis of individuals with liver metastases from ovarian cancer,” the authors concluded.

References

1. Li N, Jin S, Wu J, Ji H, Du C, Liu B. Effect of different treatment modalities on ovarian cancer patients with liver metastases: a retrospective cohort study based on SEER. PLoS One. 2024;19(4):e0299504. doi:10.1371/journal.pone.0299504

2. Zhao H, Xu F,Li J,Ni M,Wu X. A population-based study on liver metastases in women with newly diagnosed ovarian cancer. Front Oncol. 2020;10:571671. doi:10.3389/fonc.2020.571671

3. Dabi Y, Huchon C, Ouldamer L, et al. Patients with stage IV epithelial ovarian cancer: understanding the determinants of survival. J Transl Med. 2020;18(1):134. doi:10.1186/s12967-020-02295-y