Metastatic patterns at autopsy in patients with ovarian carcinoma

BACKGROUND. Previously published studies concerning autopsy findings in ovarian cancer failed to consider the broad differences in factors that influence the course of disease. Furthermore, those studies were conducted when the currently accepted standards in diagnostics and therapy had not been fully established. The objective of the current study was to determine the frequency and sites of metastases in patients with ovarian cancer with particular attention to the clinical course and therapy. METHODS. Autopsy reports, histologic slides, and clinical files from 197 patients who died of ovarian carcinoma between 1975 and 2005 were studied. The distribution of metastatic sites (19 different organ sites) and metastatic patterns, with particular attention to clinical course (age, length of survival) and therapy (surgical treatment with curative intention, different chemotherapy regimens), were analyzed. RESULTS. Overall, 66.3% of patients had metastases to sites outside the abdominopelvic cavity. Patients who were aged >70 years, who had a disease duration <= 6 months, or who had received either no treatment or treatment without curative intention more often had metastases limited to the abdominopelvic cavity. This pattern of spread was observed most frequently in patients who had received current chemotherapy regimens (odds ratio, 3.5; P = .002). Compared with patients who had received chemotherapy according to previous standards, these patients showed a significantly increased incidence of liver metastases (P < .001). CONCLUSIONS. Autopsy data may yield important information concerning the metastatic potential of a malignancy and may assist physicians in making clinical management decisions. The results from the current indicated that declining autopsy rates during the last decades have limited the ability of physicians to evaluate the impact of new therapy regimens on the frequency and distribution of metastases through postmortem examination.