Clinical Impact of Lymphadenectomy after Neoadjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer: A Review of Available Data

Seidler, Stéphanie; Koual, Meriem; Achen, Guillaume; Bentivegna, Enrica; Fournier, Laure; Delanoy, Nicolas; Nguyen-Xuan, Huyên-Thu; Bats, Anne‐Sophie; Azaïs, Henri

doi:10.3390/jcm10020334

Cited by 6 publications

(4 citation statements)

References 14 publications

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“…In our meta-analysis, patients exposed to NAC no longer obtained an oncological benefit from more extensive lymphadenectomy. Comparable results were also observed in other solid tumors, including breast cancer and ovarian cancer, where exposure to NAC led to a significant reduction in the number of axillary lymph node dissections [28,29]. Considering that extended PLND might be associated with adverse outcomes, such as longer hospital stay, increased operating time, greater blood loss, and a higher rate of post-operative complications, limiting the extent of PLND might be a reasonable alternative in patients who received NAC [30].…”

Section: Discussionsupporting

confidence: 58%

Adequate Pelvic Lymph Node Dissection in Radical Cystectomy in the Era of Neoadjuvant Chemotherapy: A Meta-Analysis and Systematic Review

Kaczmarek

Małkiewicz

Lemiński

2023

Cancers

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Radical cystectomy (RC) with pelvic lymphadenectomy (PLND) serves as the gold-standard treatment for muscle-invasive bladder cancer (MIBC). Numerous studies have shown that the number of lymph nodes (LN) removed during RC could affect patient prognosis. However, these studies confirmed the association between PLND and survival outcomes prior to the widespread adoption of neoadjuvant chemotherapy (NAC). Consequently, this study aimed to investigate the prognostic role of PLND in patients previously pretreated with NAC. A systematic review and meta-analysis were performed using PubMed, Web of Knowledge, and Scopus databases. The selected studies contained a total of 17,421 participants. The meta-analysis indicated a significant correlation between adequate PLND and overall survival in the non-NAC group. However, a survival benefit was not observed in patients undergoing RC with preoperative systemic therapy, regardless of the LN cut-off thresholds. The pooled HR for ≥10 and ≥15 LN were 0.87 (95% CI 0.75–1.01) and 0.87 (95% CI 0.76–1.00), respectively. The study results suggest that NAC mitigates the therapeutic significance of PLND, as patients pre-treated with NAC no longer gain oncological benefits from more extensive lymphadenectomy. This highlights the analogous roles of NAC and PLND in eradication of micrometastases and in prevention of distal recurrence post-RC.

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Section: Discussionsupporting

confidence: 58%

Adequate Pelvic Lymph Node Dissection in Radical Cystectomy in the Era of Neoadjuvant Chemotherapy: A Meta-Analysis and Systematic Review

Kaczmarek

Małkiewicz

Lemiński

2023

Cancers

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“…In principle, NAC apart from local disease downstaging, may serve a similar purpose to lymph node dissection, eliminating potential micrometastatic spread of cancer [ 23 ]. This phenomenon, which may diminish the therapeutic role of lymphadenectomy, has been extensively studied in other solid tumors, including ovarian cancer and breast cancer, where administration of NAC has led to a significant decline in the number of axillary lymph node dissections [ 24 , 25 , 26 ]. The results of our study indicate that patients who received NAC may not benefit oncologically from more extensive LN dissection, as the number of retrieved LNs is no longer associated with survival in this cohort.…”

Section: Discussionmentioning

confidence: 99%

The Influence of Lymph Node Count on Oncological Outcome of Radical Cystectomy in Chemotherapy Pre-Treated and Chemotherapy-Naïve Patients with Muscle Invasive Bladder Cancer

Lemiński

Kaczmarek

Michalski

et al. 2021

JCM

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Radical cystectomy (RC) with pelvic lymph node dissection (PLND) remains the mainstay of treatment for muscle-invasive bladder cancer (MIBC). The extent of PLND and number of removed lymph nodes (LNs) have been associated with improved staging and survival outcomes in several series of RC patients. Neoadjuvant chemotherapy (NAC) has become standard of care for cisplatin-eligible patients qualified to RC, yet few studies on PLND stratified cases according to the receipt of NAC. We aimed to address this issue and reevaluate the prognostic value of PLND nodal yields in series of patients who underwent RC on the verge of the NAC era. This single-center, retrospective, clinical follow-up study enrolled 439 consecutive patients, out of whom 83 received NAC. We analyzed survival outcome of RC according to the number of removed nodes between NAC and non-NAC subgroups. We found PLND thresholds of 10 and 15 LNs prognostically meaningful in our study cohort, and this association was particularly pronounced in the non-NAC subgroup. Higher numbers of LNs provided a 25% reduction in risk of all-cause mortality and correspondingly correlated with up to a 14% increase in 3-year overall survival. The receipt of NAC diminished the benefit of adequate PLND, as the number of retrieved LNs was not associated with survival in the NAC-RC cohort. Given the limitations of our study, additional research is needed to verify these findings.

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“…In addition to advanced ovarian cancer patients undergoing primary debulking surgery, several recent studies have evaluated the role of lymphadenectomy in patients who underwent interval debulking surgery. A systematic literature review from Seidler et al, that included 1094 patients from six retrospective series, suggested no benefit of systematic lymphadenectomy during interval debulking surgery procedure on survival in node-negative, advanced-stage ovarian cancer patients (15). He et al retrospectively analyzed the role of lymphadenectomy in advanced-stage ovarian cancer patients who underwent interval debulking surgery.…”

Section: Univariate and Multivariate Analysis Of The Predictors Of Re...mentioning

confidence: 99%

Therapeutic Role of Retroperitoneal Lymphadenectomy in 170 Patients With Ovarian Clear Cell Cancer

et al. 2022

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IntroductionWe evaluated the therapeutic role of retroperitoneal lymphadenectomy in patients with ovarian clear cell cancer (OCCC).Materials and MethodsWe retrospectively reviewed 170 OCCC patients diagnosed at two hospitals in China between April 2010 and August 2020. Clinical data were abstracted, and patients were followed until February 2021. Patients were divided into retroperitoneal lymphadenectomy and no lymphadenectomy groups. The Kaplan–Meier method was used to compare progression-free (PFS) and overall survival (OS) between the two groups. Statistical differences were determined by the log-rank test. The COX proportional hazards regression model was applied to identify predictors of tumor recurrence.ResultsThe median age was 52 years; 90 (52.9%) and 80 (47.1%) patients were diagnosed as early and advanced stage, respectively. Clinically positive and negative nodes was found in 40 (23.5%) and 119 (70.0%) patients, respectively. Of all the 170 patients, 124 (72.9%) patients underwent retroperitoneal lymphadenectomy, while 46 (27.1%) did not. The estimated 2-year PFS and 5-year OS rates were 71.4% and 65.9% in the lymphadenectomy group, and 72.0% and 73.7% in no lymphadenectomy group (p = 0.566 and 0.669, respectively). There was also no difference in survival between the two groups when subgroup analysis was performed stratified by early and advanced stage, or in patients with clinically negative nodes. Multivariate analysis showed that retroperitoneal lymphadenectomy were not an independent predictor of tumor recurrence.ConclusionRetroperitoneal lymphadenectomy provided no survival benefit in patients diagnosed with OCCC. A prospective clinical trial is needed to confirm the present results.

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Clinical Impact of Lymphadenectomy after Neoadjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer: A Review of Available Data

Cited by 6 publications

References 14 publications

Adequate Pelvic Lymph Node Dissection in Radical Cystectomy in the Era of Neoadjuvant Chemotherapy: A Meta-Analysis and Systematic Review

Adequate Pelvic Lymph Node Dissection in Radical Cystectomy in the Era of Neoadjuvant Chemotherapy: A Meta-Analysis and Systematic Review

The Influence of Lymph Node Count on Oncological Outcome of Radical Cystectomy in Chemotherapy Pre-Treated and Chemotherapy-Naïve Patients with Muscle Invasive Bladder Cancer

Therapeutic Role of Retroperitoneal Lymphadenectomy in 170 Patients With Ovarian Clear Cell Cancer

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