Impact of Lymphadenectomy on Survival of Patients with Serous Advanced Ovarian Cancer After Neoadjuvant Chemotherapy: A French National Multicenter Study (FRANCOGYN)

Abstract

Background: The population of interest to this study comprised individuals with advanced-stage ovarian carcinoma who were exposed to neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS). Those who had not received systematic lymphadenectomy (SL; Group 1) were compared to those who had received SL (Group 2). Outcome measures included progression-free survival (PFS), overall survival (OS), and surgical complications. Methods: This was a retrospective, multicenter cohort study in nine referral centers of France between January 2000 and June 2017. OS analysis using the multivariate Cox regression model was performed. PFS and surgery-related morbidity were analyzed. Results: Of the 255 patients included, 100 were in Group 1 and 155 in Group 2. Patient majority was, on average, younger and less comorbid, with predominant R0 surgery in Group 2. Dindo–Clavien score was similar between the two groups (p = 0.15). Median OS was 26.8 months in Group 2 and 27.6 months in Group 1. SL was not statistically significant on OS (p = 0.7). Median PFS was 18.3 months in Group 2 and 16.6 months in Group 1. SL had positive impact on PFS (p = 0.005). Conclusions: patients who had received SL (Group 2) had significantly higher PFS regardless of node-positivity status when compared to those who had not received SL (Group 1).

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

“…The difference was not statistically different after adjustment for age, grade and peritoneal carcinomatosis index, with HR =1.88, 95% CI 0.89–3.94; p = 0.088. The same trend is reported by Bund et al, with 26.8 months (SyLND) and 27.6 months (NoLND), ( p = 0.73) [ 6 , 9 ].…”

“…Half of them were multi-centric. The studies’ characteristics are described in Table 1 [ 4 , 5 , 6 , 7 , 8 , 9 ]. Altogether, this review summarizes the outcomes for 1094 patients.…”

“…Altogether, this review summarizes the outcomes for 1094 patients. Macroscopic complete CRS (classified CC-0) was achieved from 80% up to 100%, except for Eoh’s series [ 7 ] and the no lymphadenectomy group of Bund’s study [ 9 ], where the rate of complete CRS was respectively 35% and 50%.…”

“…All the studies had a survival analysis as primary endpoint to evaluate the impact of lymph node dissection. Four studies compared SyLND to NoLND [ 4 , 5 , 6 , 9 ], one study compared SyLND to SeLND [ 7 ] and one compared the three groups [ 8 ].…”

“…The difference remained not statistically significant after adjustment for age, grade and peritoneal carcinomatosis index with HR = 1.43, 95% CI = 0.86–2.39 and p = 0.17 [ 6 ]. For Bund et al, the median RFS was 18.3 months for SyLND and 16.6 months for NoLND, a difference not statistically significant in either case [ 9 ]. Iwase et al also showed similar two-year RFS in NoLND group SyLND subgroup with positive lymph nodes ( p = 0.895).…”