Defining the optimal lymphadenectomy cut-off value in epithelial ovarian cancer staging surgery utilizing a mathematical model of validation

Pereira, Augusto; Irishina, Natalia; Pérez-Medina, Tirso; Magrina, J.F.; Magtibay, Paul M.; Kovaleva, A; Rodríguez-Tapia, Ana; Iglesias, E.

doi:10.1016/j.ejso.2012.12.006

Cited by 10 publications

(7 citation statements)

References 24 publications

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“…Takei et al showed that patients with ≥35 LNs removed have an improved recurrence-free survival 21. Pereira et al study defined optimal lymphadenectomy cut-off value was at least obtain 15 pelvic LNs and 7 aortic LNs 27. However, the number of metastatic LNs is depended on many factors such as the surgeon and the pathologist's distinct experience in searching for positive LNs, the patients' anatomic variation, the extent of the tumor, and patients'age 16, 17.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of lymph nodes ratio in patients with stage III ovarian clear cell carcinoma: A retrospective study of patients in Southwest China

Nie

Mao

2019

J. Cancer

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Background: Ovarian clear cell carcinoma (OCCC) has a worse prognosis compared to other histological subtypes. Although the survival effect of lymph nodes ratio (LNR) on ovarian carcinoma have been elucidated in several studies, the prognostic effect of LNR in OCCC has not been separately studied. This study aimed to investigate the prognostic significance of LNR in FIGO stage III OCCC.Methods: Patients with FIGO stage III OCCC who underwent primary cytoreductive surgery and systematic lymphadenectomy from January 2008 to June 2014 in two independent hospitals were retrospectively reviewed. Two independent patients cohorts were used to investigate the survival impact of LNR by using Kaplan-Meier and Cox regression proportional hazard method.Results: In training cohort, the 5-year progression-free survival (PFS) rates was 32.4% for patients with LNR ≤ 25%, and 19.8% for patients with LNR > 25%, respectively (p = 0.017). The 5-year overall survival (OS) rates was 41.3% for patients with LNR ≤ 25%, and 25.8% for patients with LNR > 25%, respectively (p = 0.003). In multivariate analysis, increased LNR was correlated with a poorer DFS (HR = 2.12 ,95% CI 1.32-3.41, p = 0.002) and OS (HR = 2.29, 95% CI 1.37-5.12, p = 0.001). These results were verified in a validation cohort.Conclusions: LNR is an independent survival predictor in patients with FIGO stage III OCCC.

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Section: Discussionmentioning

confidence: 99%

Prognostic value of lymph nodes ratio in patients with stage III ovarian clear cell carcinoma: A retrospective study of patients in Southwest China

Nie

Mao

2019

J. Cancer

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“…Based on these findings, it seemed that the total number of RLNs was not a reliable prognostic factor for patients with EOC. However, Pereira et al used a mathematical model to predict the probability of a positive node in EOC surgical staging if at least 22 lymph nodes were removed between the pelvic and aortic lymphadenectomy [ 29 ]. Chan et al used the SEER database to examine the impact of lymph node dissection on the survival of 13,918 women with stage III-IV node-positive EOC.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of lymph node ratio in stage IIIC epithelial ovarian cancer with node-positive in a SEER population-based study

Zhou

et al. 2016

Oncotarget

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To assess the prognostic value of the lymph node ratio (LNR) in patients with stage IIIC epithelial ovarian cancer (EOC) with node-positive in a Surveillance, Epidemiology, and End Results (SEER) population-based study. Data of patients were obtained from the SEER database from 1990 to 2012, and analyzed using Kaplan-Meier survival methods and Cox regression proportional hazard model. The prognostic value of the LNR on cause-specific survival (CSS) and overall survival (OS) were calculated. A total of 5,926 patients were identified. Univariate analysis showed that the number of removed lymph nodes (RLNs), the number of positive lymph nodes, and the LNR were significantly associated with CSS and OS (P < 0.05 for all). Multivariate analysis indicated that a higher LNR was an independent prognostic factor for poorer CSS (hazard ratio [HR]: 1.896, 95% confidence interval [CI]: 1.709-2.104, P < 0.001) and OS (HR:1.679, 95% CI: 1.454-1.939, P < 0.001). Among patients with LNR ≤ 0.42 and those with LNR > 0.42, the 5-year CSS was 53.1% and 34.7%, respectively (P < 0.001), and the 5-year OS was 50.4% and 32.0%, respectively (P < 0.001). The prognostic value of the LNR persisted for patients after stratification by the numbers of RLNs, tumor histology, and tumor grade. LNR is a more accurate prognostic method for stage IIIC EOC patients. Patients with a higher LNR are associated with poorer survival in stage IIIC EOC.

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“…Pathologically explicit FIGO stages I to IIa were defined as early stage. The LN dissection methods were classified into three categories to control quality (5,7,(15)(16)(17)(18)(19)):…”

Section: Clinical Data Collection and Organizationmentioning

confidence: 99%

Systematic Lymph Node Dissection May Be Abolished in Patients With Apparent Early-Stage Low-Grade Mucinous and Endometrioid Epithelial Ovarian Cancer

Chen

Yin

et al. 2021

Front. Oncol.

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ObjectiveTo investigate whether systematic lymph node dissection can confer clinical benefits in patients with apparent early-stage low-grade epithelial ovarian cancer.MethodsPatients with apparent early-stage low-grade epithelial ovarian cancer seen at Peking Union Medical College Hospital from January 1, 2005, to December 31, 2015, were retrospectively enrolled. Patients with other histological types and those who did not receive necessary adjuvant chemotherapy were excluded. Data collection and long-term follow-up were performed. According to the removed lymph node number, three groups based on surgical methods were used: abnormal lymph node resection, pelvic lymphadenectomy, and systematic lymph node dissection to control surgical quality. Their effects on prognosis were analyzed in pathological subgroups.ResultsA total of 196 patients were enrolled; 30.1% of patients had serous, 42.3% of patients had mucinous, and 27.6% of patients had endometrioid carcinoma, of which 51 (26.0%), 96 (49.0), and 49 (25.0%) patients were treated with the above surgical methods, respectively. The occult lymph node metastasis rate was 14 (7.1%), and only five (2.6%) of apparent early-stage patients were upstaged due to lymph node metastasis alone. Systematic lymph node dissection did not benefit progression-free survival or disease-specific overall survival of apparent early-stage low-grade mucinous and endometrioid epithelial ovarian cancer but prolonged progression-free survival of apparent early-stage low-grade serous patients (OR, 0.231, 95% CI, 0.080, 0.668, p = 0.007).ConclusionsSystematic lymph node dissection may be abolished in patients with apparent early-stage low-grade mucinous and endometrioid epithelial ovarian cancer but may be considered for apparent early-stage low-grade serous patients.

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Defining the optimal lymphadenectomy cut-off value in epithelial ovarian cancer staging surgery utilizing a mathematical model of validation

Cited by 10 publications

References 24 publications

Prognostic value of lymph nodes ratio in patients with stage III ovarian clear cell carcinoma: A retrospective study of patients in Southwest China

Prognostic value of lymph nodes ratio in patients with stage III ovarian clear cell carcinoma: A retrospective study of patients in Southwest China

Prognostic value of lymph node ratio in stage IIIC epithelial ovarian cancer with node-positive in a SEER population-based study

Systematic Lymph Node Dissection May Be Abolished in Patients With Apparent Early-Stage Low-Grade Mucinous and Endometrioid Epithelial Ovarian Cancer

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