Incidence, risk factors, and outcomes of ovarian metastasis in early-stage cervical cancer: a population-based analysis of 983 patients

PURPOSE: To assess the incidence, risk factors, and prognostic impact of ovarian metastasis in early-stage cervical cancer using a large population-based registry. METHODS: We retrospectively analyzed 983 patients with cervical cancer classified as pT1a1-pT2b according to the TNM system treated with primary surgery and bilateral oophorectomy. The association between clinicopathological variables and ovarian metastasis was evaluated using Chi-square tests and binary logistic regression. Survival outcomes were assessed with Kaplan-Meier curves and Cox regression. RESULTS: Ovarian metastases were identified in 0.8% of cases (n = 8). Histologic subtype was significantly associated with ovarian metastasis (p = 0.010). In multivariate logistic regression, adenocarcinoma histology was an independent predictor of metastasis (OR 9.94, 95% CI 1.99-49.6, p = 0.005). Patients with ovarian metastases had significantly worse disease-free and overall survival (p < 0.001). Due to the rarity of events, multivariable survival analysis incorporating treatment parameters was limited. CONCLUSION: Ovarian metastasis is rare in early-stage cervical cancer but associated with significantly impaired prognosis. Adenocarcinoma histology was independently associated with ovarian metastasis and may be considered when discussing ovarian preservation, although validation in larger cohorts is warranted. These findings support the individualized selection of patients for ovary-sparing surgery.