Comparison Clinicopathologic Characteristics of Primary and Secondary Ovarian Cancers

Abstract

Objective: Due to primary and secondary ovarian cancer have different management, preoperative assessment is important. We endeavor to identify the different preoperative clinical characteristics. Methods: We performed a retrospective case-control study that included 31 patients with secondary ovarian cancer (SOC) and 301 controls with primary ovarian cancer (POC) diagnosed between 2007 and 2018. The demographic parameters, signs, symptoms, preoperative tumor marker levels, and imaging findings were reviewed. Results: The incidence of SOC was 2.5% (66/2605) of all ovarian malignancies. The most common site of origin was the colon (58.1%). Thirty-five percent of the patients with SOC had a history of previous malignancy and 80.8% of them were multiparous. Abdominal mass and bladder symptoms were significantly higher in patients with POC than those with SOC (p < 0.001, p = 0.04, respectively). The preoperative imaging showed that SOC was more often bilateralism (p < 0.001) and more presence of ascites (p = 0.004). The consistency of SOC was cystic-solid (50%). From the multivariate analysis, the risk of SOC was significantly increased in patients who developed previous malignancy, CEA level (>5 ng/mL), and CA 125/CEA ratio (≤25) with the odds ratios (95%CI) of 5.07 (1.52, 16.96), 6.17 (1.68, 22.59) and 12.12 (3.91, 37.59), respectively. Conclusions: The preoperative distinction between POC and SOC is difficult. A history of malignancy, an elevated serum CEA, and CA 125/CEA ratio, can provide a useful clue for diagnosis and proper management in these patients.