An Analysis On Omentum Metastasis And Related Factors In Epithelial Ovarian Carcinoma

Objective:The omentum macroscopic metastasis and occult metastasis in patients with epithelial ovarian carcinoma were evaluated,and the clinical and pathological factors affecting the omentum metastasis were analyzed by univariate and multivariate analysis.The aim of our study is to explore a more reasonable initial surgery scope to improve the prognosis and quality of life of patients with epethelial ovarian carcinoma.Methods:This is a retrospective study.All patients with ovarian carcinoma admitted to Women’s Hospital School of Medicine Zhejiang University from March 2008 to February 2018 were collected.All enrolled patients were treated by initial surgery and pathologically confirmed as epithelial ovarian carcinoma.The surgical approach is either comprehensive staging surgery or cytoreductive surgery.After evaluating,a total of 495 patients were included.The information of intraoperation and postoperative pathology were recorded.The omentum macroscopic metastasis and occult metastasis rates were accesed,and the relationship between occult metastasis and the metastasis in abdominal organs was analyzed.All clinical basic data and pathological data were recorded.Statistical analysis was used to analyze the clinical and pathological factors affecting omentum macroscopic metastasis and occult metastasis.Related factors of metastasis were analyzed by multivariate logistic regression analysis to screen for independent factors affecting omentum macroscopic metastasis and occult metastasis.Results:Among the 495 patients,141(28.5%)had omentum metastasis.Macroscopic omentum metastasis was observed in 106 cases(21.4%)and occult metastasis was seen in 35 cases(7.1%).When no extra ovarian metastases were visible during operation,the probability of omentum microscopic metastasis was 1.4%(3 cases/215 cases).The probability of isolated omentum metastasis was 1.5%(3 cases/201 cases).Univariate analysis showed that the number of involved ovary(unilateral or bilateral),ascites,metastasis outside the omentum,CA125 levels,serum albumin levels,tumor pathological type are the factors influencing omentum macroscopic metastasis(all p<0.05);Age,the number of involved ovary,ascites,metastasis outside the omentum,CA125 levels,serum albumin levels,tumor pathology were the factors influencing omentum occult metastasis(all p<0.05).Multivariate analysis showed that ascites(OR=3.175,95%CI:1.224-8.238,p<0.05),bilateral ovarian involvement(OR=4.233,95%CI:2.113-8.478,p<0.001),CA125 level≥100 U/ml(OR=4.108,95%CI:1.617-10.434,p<0.01),metastasis outside the omentum(OR=16.499,95%CI:2.149-126.692,p<0.01)and serous carcinoma(OR=2.838,95%CI:1.147-7.012,p<0.05)independently affected omentum macroscopic metastasis.CA125 levels>100 U/ml(OR=6.766,95%CI:1.539-29.739,p<0.05)and metastasis outside the omentum(OR=5.536,95%CI:1.256-24.399,p<0.05)are independent risk factors for omentum occult metastasis.Conclusion:The occurrence of omentum metastasis in epithelial ovarian carcinoma is closely related to the metastasis of other organs in the abdominal cavity.When there is no metastasis in other organs in the abdominal cavity,the isolated omentum occult metastasis rate is about 1.5%,suggesting that when operating the initial surgery of early ovarian carcinoma patients with no visible ovarian carcinoma metastasis lesions,it is worthy to consider retaining the omentum.The level of serum CA125 and metastasis to other parts of the obdomen are independent influencing factors for metastasis of ovarian carcinoma to omentum.These two factors can be used as a reference for deciding whether to remove the omentum during the initial surgery.