Surgery, Chemotherapy Considered Protective Survival Factors in Patients With OC, Liver Metastases

Surgery and chemotherapy significantly improved both overall survival (OS) and cancer-specific survival (CSS) in patients with liver metastases originating from ovarian cancer (OC), who generally face a poor prognosis with a 5-year survival rate of less than 30%.

Only receiving surgery and chemotherapy as treatment were considered protective factors of overall survival (OS) and cancer-specific survival (CSS) for patients with liver metastases originating from ovarian cancer (OC), according to a study published in PLoS One.1

The researchers explained that approximately 70% of patients with OC present with distant metastases at diagnosis, resulting in an overall 5-year survival rate of less than 30%.2 A past epidemiological investigation found that the liver is the most frequent distant metastasis site in patients with OC,3 and another determined the median survival time among those with liver metastases to be 30 months; this indicates a poor prognosis for those with OC and liver metastases.4

The investigators also noted that other past studies indicated that patients with advanced OC who undergo debulking surgery have a more favorable prognosis.1 Another study associated a prolonged delay in initiating adjuvant chemotherapy with a decrease in OS rates for patients with advanced OC.5

However, the researchers explained that the prognostic implications of therapies on patients with OC and liver metastases remain unknown.1 Therefore, they conducted a study to examine the morbidity and mortality trends among patients with OC and liver metastases, the primary end points being the OS and CSS among this population.

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

3D illustration of ovarian cancer (OC) | Image Credit: Lars Neumann -

3D illustration of ovarian cancer (OC) | Image Credit: Lars Neumann -

The researchers conducted the study using relevant data from the Surveillance, Epidemiology, and End Results (SEER) database, which compiles information on demographics, tumor characteristics, and details regarding mortality and survival rates among patients with cancer in the US.

They used SEER*Stat software to identify patients in the database aged 18 or older who were diagnosed with primary OC between 2010 and 2019 based on International Classification of Diseases for Oncology codes; eligible patients also had liver metastases at diagnosis. Conversely, the researchers excluded those with 2 or more primary cancers and those missing information on surgery and follow-up.

The study population consisted of 2925 patients, with a mean (SD) age of 65.16 (13.49) years. Most patients were white (78.46%), and the median follow-up duration was 8.0 months (range, 1.0-25.50). After the follow-up period, 689 remained alive, meaning the overall OS and CSS rates were 76.44% and 72.99%, respectively.

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

Additionally, after adjusting for all covariates, including age, race/ethnicity, and tumor size, OS was associated with patients with OC and liver metastases who only received surgery (HR, 0.39; 95% CI, 0.31-0.48; P < .001). They also found chemotherapy to be a significant protective factor for OS among patients with OC and liver metastases after adjusting for all variables (HR, 0.33; 95% CI, 0.30-0.37; P < .001).

Similarly, after adjusting for all covariates, the researchers found only receiving surgery (HR, 0.37; 95% CI, 0.30-0.47; P < .001) and chemotherapy (HR, 0.44; 95% CI, 0.39-0.50; P < .001) to be significant protective factors against CSS. Conversely, not receiving surgery (HR, 2.68; 95% CI, 2.10-3.43; P < .001) remained a risk factor for CSS.

Lastly, the researchers performed subgroup analyses on different distant metastasis types. These showed that only receiving chemotherapy and surgery were significant protective factors of CSS and OS for those with distant bone metastasis, with lung metastasis, without other distant metastases, and with distant metastases to the bone, lung, brain, or other organs.

The researchers acknowledged their limitations, one being that the SEER database only documented metastases of the liver, lung, brain, bone, and distant lymph nodes; therefore, specific metastases of other sites remain unknown. Also, the study population was limited to the US population, meaning further validation of these findings is necessary for generalization to international populations. Despite these limitations, the researchers expressed confidence in 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 OC,” the authors concluded.


  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. Gardner AB, Charo LM, Mann AK, Kapp DS, Eskander RN, Chan JK. Ovarian, uterine, and cervical cancer patients with distant metastases at diagnosis: most common locations and outcomes. Clin Exp Metastasis. 2020;37(1):107-113. doi:10.1007/s10585-019-10007-0
  4. Deng K, Yang C, Tan Q, et al. Sites of distant metastases and overall survival in ovarian cancer: A study of 1481 patients. Gynecol Oncol. 2018;150(3):460-465. doi:10.1016/j.ygyno.2018.06.022
  5. Liu Y, Zhang T, Wu Q, et al. Relationship between initiation time of adjuvant chemotherapy and survival in ovarian cancer patients: a dose-response meta-analysis of cohort studies. Sci Rep. 2017;7(1):9461. doi:10.1038/s41598-017-10197-1
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