Ovarian metastasis in women with cervical carcinoma in stages IA to IIB: A systematic review and meta-analysis

BACKGROUND: Cervical cancer is one of the common malignancies that afflict women worldwide. In rare cases, cervical cancer leads to ovarian metastasis (OM), resulting in poor outcomes. We conducted a systematic review and meta-analysis to evaluate the incidence and risk factors of OM in patients with adenocarcinoma (ADC) or squamous cell carcinoma (SCC) of the cervix. METHODS: We searched articles focused on OM in cervical carcinoma in PubMed, Embase, and the Cochrane Central Register of Controlled Trials. A meta-analysis was performed including selected publications. Pooled odds ratio (OR) and 95% confidence interval (95% CI) were calculated using random-effects models. The heterogeneity was evaluated by the I(2) test. I(2) > 50% was considered high heterogeneity. RESULTS: A total of 12 studies with 18,389 patients with cervical cancer in International Federation of Gynecology and Obstetrics stages IA to IIB were included in the meta-analysis. The overall incidence of OM was 3.61% among patients with ADC and 1.46% among patients with SCC (ADC vs SCC: OR 3.89, 95% CI 2.62–5.78; P < .001). Risk factors for OM were age >40 years (OR 1.79, 95% CI 1.02–3.13), bulky tumor (OR 2.65, 95% CI 1.77–3.95), pelvic lymph node involvement (PLNI; OR 9.33, 95% CI 6.34–13.73), lymphovascular space involvement (LVSI; OR 4.38, 95% CI 1.86–10.31), parametrial invasion (PMI; OR 7.87, 95% CI 5.01–12.36), and corpus uteri invasion (CUI; OR 7.64, 95% CI 2.51–23.24). PLNI, LVSI, and PMI were the leading risk factors, contributing to OM with respective population attributable fractions of 64.8%, 58.8%, and 51.5%. CONCLUSION: The incidence of OM is relatively low in ADC and SCC patients. Risk factors for OM include PLNI, LVSI, PMI, bulky tumor, CUI, or age over 40 years, with the first 3 contributing more to risk of OM.