Ovarian metastasis risk factors in endometrial carcinoma: A systematic review and meta-analysis

Eur J Obstet Gynecol Reprod Biol. 2021 Dec:267:245-255. doi: 10.1016/j.ejogrb.2021.11.016. Epub 2021 Nov 13.


Objective: To investigate the incidence of ovarian metastasis in endometrial carcinoma (EC) and analyze its risk factors and provide a theoretical basis for whether retention of the ovary in patients with EC.

Methods: A systematic search using synonyms of 'ovarian cancer' and 'metastasis' was conducted in PubMed, Cochrane database, Embase, Google Scholar, and WOS database. Meta-analysis was performed on 7 included studies, comprising 4281 clinical-stage I-IV EC patients. Studies were assessed using the Newcastle-Ottawa Scale (NOS) criteria. Odds risks (OR) and 95% confidence intervals (CI) were calculated using an inverse variance weighted random-effects model.

Results: The ovarian metastasis risk of EC was significantly higher for patients with myometrial invasion >1/2 (OR = 18.19, 95% CI 5.34 to 61.96 compared to myometrial invasion ≤1/2), any pelvic lymph node invasion (PLNI) (OR = 5.41, 95% CI 2.60-10.97 compared to without PLNI), G3 pathological grade (OR = 2.66, 95%CI 1.35-5.24 compared to G1-G2), non-endometrioid pathological type (OR = 6.46, 95% CI 3.25 to 12.83 compared to endometrioid), lymphatic vascular space invasion (LVSI) (OR = 6.46, 95% CI 3.25 to 12.83 compare to without LVSI), age >45 (OR = 2.01, 95% CI 0.29 to 14.11 compared to age ≤45), and cervical invasion (OR = 4.12, 95% CI 1.87 to 9.08 compared to without cervical invasion).

Conclusion: About 4.95% of EC patients develop ovarian metastasis. Age >45, myometrial invasion >1/2, cervical invasion, PLNI, pathological type, G3 pathological grade, and LVSI were the high-risk factors for ovarian metastasis of EC. Ovarian preservation should be carefully selected for patients with EC, and preoperative and intraoperative evaluations should be entirely performed.

Keywords: Endometrial carcinoma; High-risk factors; Meta-analysis; Ovarian metastasis.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Endometrial Neoplasms* / epidemiology
  • Endometrial Neoplasms* / pathology
  • Female
  • Humans
  • Lymph Nodes / pathology
  • Lymphatic Metastasis
  • Neoplasm Invasiveness
  • Neoplasm Staging
  • Ovarian Neoplasms* / epidemiology
  • Retrospective Studies
  • Risk Factors