Prognostic Significance of Systematic Lymphadenectomy in Patients With Optimally Debulked Advanced Ovarian Cancer: A Meta-Analysis

Abstract

Background: The effect of systematic lymphadenectomy (SL) on survival in patients with optimally debulked advanced ovarian cancer remains unclear. We evaluated the therapeutic value of SL in advanced ovarian cancer patients who underwent primary optimal debulking surgery. Methods: A meta-analysis was carried out using articles retrieved from the PubMed, Embase, and Cochrane databases. Overall survival (OS) and progression-free survival (PFS) were compared between patients who underwent SL and those who underwent unsystematic lymphadenectomy (USL). Results: Seven studies that included 2,425 patients with advanced ovarian cancer were included in the meta-analysis. The overall analyses indicated significantly improved OS [hazard ratio (HR) = 0.64, 95% confidence interval (CI): 0.49-0.84, P < 0.01] but not PFS (HR = 0.89, 95% CI: 0.69-1.15, P = 0.38) in patients who underwent SL compared to those who underwent USL. Subgroup analyses based on study type, study quality, total numbers of patients, and International Federation of Gynecology and Obstetrics (FIGO) stage provided similar results. However, subgroup analysis of patients with no residual tumor revealed that SL was not associated with improved OS (HR = 0.81, 95% CI: 0.66-1.00, P = 0.05) or PFS (HR = 1.09, 95% CI: 0.91-1.30, P = 0.33). Conclusions: In patients with optimally debulked advanced ovarian cancer, SL may improve OS but not PFS. However, SL does not provide a survival advantage when macroscopically complete resection of all visible tumors is achieved.

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

“…Results were similar in two other meta-analyses [ 35 , 36 ]. Latest meta-analysis showed greater overall survival, but not PFS, in patients with optimally debulked advanced ovarian cancer [ 37 ]. Nevertheless, these results must be cautiously interpreted due to the few included randomized trials, which were against systematic LND [ 36 ].…”

The insolvable problem; survival effect of lymphadenectomy in advanced stage ovarian cancer

“…While lymphadenectomy led to a significant improvement in OS [hazard ratio (HR) = 0.64; 95% confidence interval (CI): 0.49-0.84, p < 0.01], this effect was not seen in PFS (HR = 0.89, 95% CI: 0.69-1.15, p = 0.38). In the subgroup analysis, it was reported that it did not affect the PFS (HR = 1.09, 95% CI: 0.91-1.30, p = 0.33) and OS (HR = 0.81, 95% CI: 0.66-1.00, p = 0.05) [24]. In the uni-variate analysis in our study, although the mortality risk decreased in patients who had undergone SLND, there was no statistically significant difference (HR = 0.89; 95% CI: 0.65-1.22, p = 0.480).…”

Management of nodal disease in advanced-stage ovarian cancer: porta hepatis, celiac, pelvic and paraaortic lymphadenectomy

“…They showed that patients who underwent systematic lymphadenectomy had a marginally significantly improved PFS (p = 0.059) and significantly improved OS (p < 0.001) compared with those who underwent lymph node sampling. In the meta-analysis of 2425 patients with ovarian cancer, Wang et al [25] reported significantly improved OS (Hazard ratios (HR): 0.64, 95% Confidence interval (CI): 0.49-0.84, p < 0.01) but not PFS (HR: 0.89, 95% CI: 0.69-1.15, p = 0.38) in patients who underwent systematic lymphadenectomy compared to those without systematic lymphadenectomy.…”