Abstract
BACKGROUND: Late-stage distant metastasis is the primary cause of death and poor prognosis in patients with ovarian cancer. This study aims to evaluate the association between patterns of single distant metastases and survivals in advanced ovarian cancer, and to identify the prognostic factors for site-specific distant metastases. METHODS: Data collected between 2010 and 2016 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier survival curves and Cox regression were used to analyze overall survival (OS) and disease-specific survival (DSS). Subgroup and interaction analyses were performed to assess the effects on survival and prognosis. Floating absolute risk (FAR) methods and propensity score matching (PSM) analyses were used to reduce confounding bias. RESULTS: A total of 639 patients were included in this study. The most prevalent single distant metastatic site was the liver (n=338; 52.9%), followed by the lungs (n=267; 41.8%), bones (n=29; 4.5%), and brain (n=5; 0.8%), with median survival times of 31, 25, 25, and 19 months, respectively. Through univariate and multifactorial analyses, we found that serous cancer, surgery, chemotherapy, and liver metastasis were independent factors influencing the prognosis of ovarian cancer. Compared to other metastatic sites, patients with liver metastasis exhibited significantly better OS [hazard ratio (HR) =0.79, 95% confidence interval (CI): 0.64-0.98, P=0.03], which remained consistent even after the application of FAR (HR =0.79, 95% CI: 0.62-1.02, P=0.03) and PSM (HR =0.77, 95% CI: 0.62-0.96, P=0.02). Similar results were observed in the DSS. Additionally, subgroup analysis and interaction tests revealed a significant interaction between the serous histological type and liver metastasis (P=0.007). CONCLUSIONS: Among patients with single-site distant metastasis of advanced ovarian cancer, the prognosis varies significantly depending on the specific metastatic site. Liver metastasis is associated with better outcomes, providing new evidence for clinical diagnosis and individualized treatment strategies.