Is there any therapeutic role of pelvic and para-aortic lymphadenectomy in apparent early stage epithelial ovarian cancer?

Bizzarri, Nicolò; Bois, Andreas du; Fruscio, Robert; Felice, Francesca De; Iaco, Pierandrea De; Casarin, Jvan; Vizza, Enrico; Chiàntera, Vito; Corrado, Giacomo; Cianci, Stefano; Magni, Sonia; Ferrari, Debora; Giuliani, Daniela; Harter, Philipp; Ataseven, Beyhan; Bommert, Mareike; Perrone, Anna Myriam; Scambia, Giovanni; Fagotti, Anna

doi:10.1016/j.ygyno.2020.10.028

Cited by 39 publications

(43 citation statements)

References 34 publications

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“…Based on these results, it has been suggested that micro-metastasis in the lymph nodes in epithelial ESOC can be eliminated either via complete lymphadenectomy or adjuvant chemotherapy, and patients undergoing lymphadenectomy can avoid adjuvant chemotherapy ( 25 , 33 ). Contrastingly, in the study of Bizzarri et al ( 41 ) all patients in the lymphadenectomy and control group received adjuvant chemotherapy and lymphadenectomy was still associated with better DFS but not in OS as compared to no lymphadenectomy. Thus, given the significant heterogeneity in the studies for adjuvant therapy, strong conclusions cannot be derived and there is a need for large-scale RCTs to confirm the benefits of lymphadenectomy for epithelial ESOC.…”

Section: Discussionmentioning

confidence: 75%

“…After reviewing them by the titles and abstracts, we excluded 3,504 studies due to nonrelevance with the review topic. Of the 38 studies selected for full-text analysis, 24 were excluded with reasons and a total of 12 studies were included in the review (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41). Details of included studies are presented in Table 1.…”

Section: Search Results and Details Of Included Studiesmentioning

confidence: 99%

“…Only one study was an RCT while all others were retrospective observational studies. Six studies ( 30 , 31 , 33 , 34 , 36 , 41 ) were conducted on epithelial tumors, three on malignant germ-cell tumors ( 32 , 39 , 40 ), two on sex cord-stromal tumors ( 35 , 38 ) and one was only on ovarian carcinosarcoma ( 37 ). The sample size in the lymphadenectomy arm varied from 40 to 8,489 patients while in the control arm it varied from 22 to 4,628 patients.…”

Section: Resultsmentioning

confidence: 99%

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Impact of Lymphadenectomy on Outcomes of Early-Stage Ovarian Cancer: A Systematic Review and Meta-Analysis

Yao

Jin

2021

Front. Surg.

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Objective: The study aimed to assess if additional lymphadenectomy with primary staging surgery improves overall survival (OS) and disease-free survival (DFS) of early-stage ovarian cancer (ESOC).Methods: PubMed and Embase databases were searched for any type of study comparing OS or DFS between lymphadenectomy and control groups for any type of ESOC. Adjusted hazard ratios (HR) were pooled in a random-effects model.Results: Twelve studies were included. Meta-analysis indicated that lymphadenectomy is associated with significantly improved OS only for epithelial tumors (HR 0.75 95% CI 0.68, 0.82 I2 = 0% p < 0.00001) but not for malignant germ cell tumors (HR 1.31 95% CI 0.88, 1.94 I2 = 0% p = 0.18). Single studies indicated a tendency of improved OS with lymphadenectomy which was significant for ovarian carcinosarcoma but not for sex cord-stromal tumors. On meta-regression of all histological types, the percentage of patients with lymph node metastasis in the lymphadenectomy group was not found to influence the effect size. Meta-analysis also indicated that lymphadenectomy is associated with significantly improved DFS for epithelial tumors (HR 0.59 95% CI 0.45, 0.77 I2 = 0% p < 0.0001). Single studies on malignant germ cell and sex cord-stromal tumors failed to demonstrate any significant beneficial effect of lymphadenectomy on DFS.Conclusions: Within the limitations of the review, lymphadenectomy may improve OS and DFS for epithelial ESOC. Scarce data suggest that lymphadenectomy is not associated with improved outcomes for malignant germ cell and sex cord-stromal tumors but may benefit ovarian carcinosarcoma. Large-scale RCTs and robust observational studies shall improve current evidence.

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Section: Discussionmentioning

confidence: 75%

Section: Search Results and Details Of Included Studiesmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Impact of Lymphadenectomy on Outcomes of Early-Stage Ovarian Cancer: A Systematic Review and Meta-Analysis

Yao

Jin

2021

Front. Surg.

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“…Prior studies on lymphadenectomy in apparent early stage EOC have focused on the effect of absence or presence of lymphadenectomy [4] and the rate of upstaging in clinical early-stage disease [2]. The underlying reason of the bene t of lymphadenectomy was kept in background.…”

Section: Discussionmentioning

confidence: 99%

“…This spread pattern which occurs out of vision, constitutes the back-up "adequate lymphadenectomy" and "identifying the occult metastases" concepts in the management of apparent early-stage EOC. Moreover, the positive survival effect of lymphadenectomy in apparent early stage EOC was proven by multiple studies [4,5]. Matsuo et al showed that lymphadenectomy resulted in a reduction of cause speci c mortality in apparent early stage EOC [6].…”

Section: Introductionmentioning

confidence: 99%

Survival Impact of Number of Removed Para-Aortic Lymph Nodes in Stage I Epithelial Ovarian Cancer

Günakan

Akıllı

Kara

et al. 2021

Preprint

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Purpose: The survival effect of presence or absence of lymphadenectomy in early stage epithelial ovarian cancer (EOC) was priorly shown but the effect of number of removed lymph nodes kept in background. We aimed to evaluate the survival impact of number of removed lymph nodes and their localizations in stage I EOC.Methods: Study included 182 patients. Best cut-off levels for number of pelvic and para-aortic lymph nodes(PaLN) were 24 and 10, respectively. Univariate and multivariate survival analyses were performed for these cut-offs and other prognostic factors. Results: Median age of the patients was 49. Median number of removed pelvic and paraartic lymph nodes were 29 and 9, respectively. Median overall(OS) and Progression-free survival(PFS) were 67 and 50 months, respectively. The OS rate was 89.6%. Recurrence occured in 24 (19.5%) patients. In univariate analyses tumor grade(p:0.005), pelvic LN number(p:0.041) and PaLN number(p:0.004) were the factors that were significantly associated with PFS. Tumor grade and PaLN number were independently and significantly associated with PFS in multivariate analyses (p:0.015 and p:0.017, respectively). In OS analyses, age, tumor grade, presence of LVI, number of pelvic and PaLNs were the significantly associated factors (p<0.05 for all). In multivariate analyses age and PaLN number were independently and significantly associated with OS (p:0.011 and p:0.21, respectively). Conclusions: The number and localizations of removed lymph nodes may have a survival affect in stage I EOC. We also think that this study may constitute a kernel point for larger prospective series on lymph node number and lymphatic regions.

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Nomograms for predicting overall survival and cancer‐specific survival of endometrioid ovarian carcinoma: A retrospective cohort study from the SEER database

Wang,

Ran,

et al. 2023

Intl J Gynecology & Obste

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ObjectiveEndometrioid ovarian cancer (EnOC) accounts for approximately 10%–15% of epithelial ovarian cancer cases. There are no effective tools for predicting the prognosis of EnOC in clinical work. The aim of this study was to construct and validate a nomogram to predict overall survival and cancer‐specific survival (CSS) in patients with EnOC.MethodsData regarding patients diagnosed with primary EnOC between 2004 and 2019 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. LASSO Cox regression and Cox regression analyses were performed to screen for prognostic factors, which were used to construct nomograms. In addition, we performed subgroup analyses of the prognostic value of chemotherapy and lymph node surgery.ResultsIn total, 3957 patients with primary EnOC were included in the analysis: 2770 in a training cohort and 1187 in a validation cohort. Age, stage, grade, lymph node surgery, and race were significantly and independently correlated with overall survival and CSS. Nomograms were constructed to predict 3‐ and 5‐year overall survival and CSS. Nomograms have good predictive ability and clinical practicability. Subgroup analysis showed that lymph node surgery improved the prognosis of patients with EnOC (P < 0.05) except for patients with grade III–IV and Stage I disease (overall survival P = 0.272, CSS P = 0.624). Chemotherapy did not improve survival time in most patients (P > 0.05) except for patients with grade I–II and Stage II–IV disease (overall survival P = 0.008, CSS P = 0.046).ConclusionWe constructed predictive nomograms and a risk classification system to evaluate overall survival and CSS in EnOC patients. For most patients with EnOC, chemotherapy did not improve the prognosis. In contrast to chemotherapy, lymph node surgery improved prognosis in most patients with EnOC.

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Is there any therapeutic role of pelvic and para-aortic lymphadenectomy in apparent early stage epithelial ovarian cancer?

Cited by 39 publications

References 34 publications

Impact of Lymphadenectomy on Outcomes of Early-Stage Ovarian Cancer: A Systematic Review and Meta-Analysis

Impact of Lymphadenectomy on Outcomes of Early-Stage Ovarian Cancer: A Systematic Review and Meta-Analysis

Survival Impact of Number of Removed Para-Aortic Lymph Nodes in Stage I Epithelial Ovarian Cancer

Nomograms for predicting overall survival and cancer‐specific survival of endometrioid ovarian carcinoma: A retrospective cohort study from the SEER database

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