Risk factors for ovarian metastasis following curative resection of gastric adenocarcinoma

BACKGROUND Ovarian metastases from gastric carcinoma usually present as large, symptomatic masses and sometimes represent the sole metastatic site. Accordingly, prophylactic oophorectomy may be useful in the overall management of gastric carcinoma. This retrospective study was undertaken to determine the risk factors for ovarian metastasis following curative resection of gastric adenocarcinoma. METHODS The clinicopathologic profiles of 690 female patients who underwent curative gastrectomy at Seoul National University Hospital between July 1987 and June 1996 were reviewed, and their first relapse sites were identified. The prognostic factors at the time of gastrectomy influencing ovarian metastasis were analyzed using the Cox proportional hazards model. RESULTS The overall 3-year ovarian relapse rate was estimated to be 6.7% (95% confidence interval [CI], 4.2–9.2%). Multiple regression analysis indicated that the number of lymph nodes with metastases and patient age were significant independent risk factors for ovarian metastasis after curative resection of gastric adenocarcinoma. The number of lymph nodes with metastases (>6) was associated with the highest risk of ovarian metastasis, with an adjusted relative risk (aRR) of 38.0 (95% CI, 3.0–480.6). The age of the patient (<50 years) also predicted the risk of ovarian metastasis, with an aRR of 3.1 (95% CI, 1.4–7.0). Lauren diffuse type tended to predict for ovarian metastasis with borderline significance (aRR, 5.9; 95% CI, 0.8–44.3). The 3-year ovarian relapse rate for patients younger than 50 years with more than 6 lymph nodes with metastases was estimated to be 39.5% (95% CI, 23.8–55.7%). CONCLUSIONS This study suggests that the risk of ovarian metastasis after curative gastrectomy is strongly associated with the number of metastatic lymph nodes (>6) and patient age (<50 years). Prospective studies are needed to evaluate further the role of prophylactic oophorectomy in young female gastric carcinoma patients who have multiple regional lymph nodes with metastases. Cancer 1999;85:1490–9. © 1999 American Cancer Society.