Treatment of Liver Metastases in Patients with Epithelial Ovarian Cancer

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Treatment of Liver Metastases in Patients with Epithelial Ovarian Cancer

Ovarian cancer is one of the deadliest gynecologic cancers, with around 50,000 new cases diagnosed in China each year and a 40% annual mortality rate. For many patients, the disease spreads to the liver—a common site of metastasis that’s 18 to 40 times more likely than a primary liver tumor. How do doctors best treat these liver metastases, and what affects a patient’s survival? A study from Peking University People’s Hospital sheds light on these critical questions.

Hao Deng, Hong-Lan Zhu, Yi Li, and colleagues from the Department of Obstetrics and Gynecology at Peking University People’s Hospital analyzed data from 43 patients with epithelial ovarian cancer (EOC) who developed liver metastases between January 2013 and July 2018. All patients received systemic chemotherapy, and the team followed them until June 2019 or until they were lost to follow-up. The study was approved by the hospital’s medical ethics committee (No. 2019-105).

To ensure clarity, the researchers used standard definitions:

  • Oligometastasis: 5 or fewer liver tumors (per ESMO consensus guidelines).
  • Simultaneous metastases: Found at or before the initial EOC diagnosis.
  • Metachronous metastases: Found after surgery for EOC.
  • Optimal cytoreduction: Removing all visible tumor or leaving lesions smaller than 1 cm (a known predictor of better survival in advanced EOC).

What the Study Found

Here’s the key data on survival and treatment impact:

  • Median survival: Patients lived a median of 24.6 months after diagnosis of liver metastases, with a 36.5% 5-year survival rate.
  • Oligometastasis wins: Patients with 5 or fewer liver tumors lived longer (26.6 months) than those with more than 5 (12.2 months, P=0.033).
  • Size matters: Tumors smaller than 3 cm were linked to longer survival (27.3 months vs. 18.8 months for larger tumors, P=0.038).
  • Surgery is best: Patients who had hepatectomy (surgical removal of liver metastases) lived the longest (28.6 months). Those who got radiofrequency ablation (RFA—a minimally invasive heat treatment) lived 19.3 months, and transarterial chemoembolization (TACE—chemotherapy delivered directly to the liver artery) gave 9.5 months. This difference was statistically significant (P=0.026).
  • Cytoreduction counts: Patients who had optimal cytoreduction (removing most or all tumor) via hepatectomy lived 25.5 months—twice as long as those with suboptimal cytoreduction (13.4 months).
  • Timing and location: Whether metastases were found at EOC diagnosis (simultaneous) or after surgery (metachronous) didn’t affect survival. Nor did the location of metastases (left lobe, right lobe, or both).
  • BRCA testing: Five patients had BRCA testing—3 who had surgery (2 with mutations) and 2 who had RFA (1 with a mutation). Mutation carriers lived slightly longer (29.4 vs. 23.4 months), but the group was too small for statistical analysis (Supplementary Figure 1, http://links.lww.com/CM9/A441).

What Predicts Worse Survival?

Three factors independently predicted shorter life expectancy:

  1. More than 5 liver tumors: Non-oligometastasis doubled the risk of early death.
  2. Tumors larger than 3 cm: Bigger tumors were harder to treat and linked to faster progression.
  3. Choosing TACE over surgery or RFA: TACE offered the shortest survival, likely because it’s reserved for unresectable cases.

A Patient-Centered Treatment Protocol

Based on their findings and existing research (including studies by Vogl et al. on TACE and Liu et al. on RFA), the team created a simple, actionable protocol:

  1. Resectable: If liver metastases can be completely removed (R0 resection), surgery is the first choice. This gives the best survival.
  2. Potentially resectable: If metastases are too big or too many now, use conversion therapy (chemotherapy, RFA, or TACE) to shrink them. Then try surgery—2 patients in the study did this and lived 19–23 months.
  3. Unresectable: If surgery isn’t possible, use RFA or TACE to slow growth and relieve symptoms. Systemic chemotherapy remains the foundation of care.

Limitations and Future Directions

No study is perfect. This one had three key limitations:

  • Retrospective design: Data was collected from past records, so some bias is possible.
  • Small BRCA group: Only 5 patients had BRCA testing—a gene critical to ovarian cancer prognosis.
  • Few TACE patients: Just 2 patients received TACE, making it hard to draw strong conclusions about this treatment.

Future research should include larger, prospective trials (where patients are followed in real time) and more BRCA-tested patients. More data on TACE will also help refine guidelines.

Conclusion

For patients with resectable liver metastases from EOC, surgery offers the best chance of long-term survival. Nonsurgical treatments like RFA or TACE help when surgery isn’t an option, but they don’t extend life as long. The key takeaway? Tailor treatment to the number, size, and resectability of liver tumors.

Optimal cytoreduction—removing as much tumor as possible—remains the gold standard for advanced EOC. For patients with potentially resectable metastases, conversion therapy can turn “unresectable” into “curable.”

Original study published in the Chinese Medical Journal (2021;134:1236–1238). doi: https://doi.org/10.1097/CM9.0000000000001332

References:

  1. Chen W, et al. CA Cancer J Clin. 2016;66:115–132.
  2. Van Cutsem E, et al. Ann Oncol. 2016;27:1386–1422.
  3. Merideth MA, et al. Gynecol Oncol. 2003;89:16–21.
  4. Prat J, et al. Cancer. 2015;121:3452–3454.
  5. Deng K, et al. Gynecol Oncol. 2018;150:460–465.
  6. Liu B, et al. Int J Gynecol Cancer. 2017;27:1261–1267.
  7. Vogl TJ, et al. Gynecol Oncol. 2012;124:225–229.

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