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

Zhou, Juan; He, Zhen-Yu; Li, Fengyan; Sun, Jiayuan; Lin, Huan‐Xin; Wu, San‐Gang; Chen, Qionghua

doi:10.18632/oncotarget.6911

Cited by 20 publications

(26 citation statements)

References 29 publications

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“…LNR, combining positive lymph nodes and resected number, should be utilized to reduce the potential bias. 18 In stage IIIC ovarian cancer patients with lymphadenectomy, increasing LNR leads to significantly decreased OS, 18,35 which was similar to the results of our study. In our study, we demonstrated that, in FIGO stage III patients, LNR within 0 to ≤40% group had survival advantage over LNR more than 40% group.…”

Section: Discussionsupporting

confidence: 89%

“…In FIGO stage I, a large number of resected lymph nodes did not represent a better outcome. The patients with [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] RLNs have the best prognosis. When RLNs numbered more than 30, the survival rate decreased.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, increasing attention has been paid to lymph node status, which can be evaluated by the number of resected lymph nodes (RLNs), 15 lymph node ratio (LNR), [16][17][18] and the log odds of positive lymph nodes (LODDS). [19][20][21][22][23][24] Compared to a single parameter, LNR exhibits its advantage in breast, [25][26][27][28] pancreatic, 19 colon, [29][30][31][32] and ovarian 16,18 cancers. Another parameter, LODDS, showed superiority in predicting outcomes in breast, 20 pancreatic, 19,21 colorectal, 22,23 and ovarian 24 cancers.…”

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confidence: 99%

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Survival effect of different lymph node staging methods on ovarian cancer: An analysis of 10 878 patients

Wang

Chen

et al. 2018

Cancer Medicine

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BackgroundTo compare the survival impact of several lymph node staging methods and therapeutic role of lymphadenectomy in patients with epithelial ovarian cancer who had undergone lymphadenectomy.MethodsData were retrospectively collected from the Surveillance, Epidemiology, and End Results program between 1988 and 2013.ResultsAn increasing number of resected lymph nodes (RLNs) was associated with a significant improvement in survival of FIGO stage II and III disease. However, for FIGO stage IV patients, better survival was not significantly associated with a more extensive lymphadenectomy. A higher lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) were associated with poorer survival regardless of stage. Nevertheless, four‐category classification of LODDS was more suitable for stage IV patients when three‐category classification was compatible with stage I‐III disease. Multivariate analysis demonstrated that LODDS and LNR were significant independent prognostic factors, but not RLN classification.ConclusionSixteen to thirty RLNs are recommended for stage I disease. For stages II and III patients, the more lymph node excision, the better the prognosis. However, lymphadenectomy was nonessential for stage IV patients. Considering staging methods, for stages II and III patients, three‐category classification of LODDS was recommended to evaluate the prognosis. For stage I and IV, three‐category classification of positive LNR was idoneous.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Survival effect of different lymph node staging methods on ovarian cancer: An analysis of 10 878 patients

Wang

Chen

et al. 2018

Cancer Medicine

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“…As the theoretical aim of LND in surgery is at detecting positive lymph nodes to remove microscopic metastasis, we furtherly explored the survival impact of removing pathological lymphatic metastasis in patients with no gross residual disease. Published studies evaluated the lymph metastasis status with the number of positive nodes, LNR, or log odds of positive lymph nodes (LODDS) and reported that the extent of lymph node involvement was a prognostic factor in OC (26)(27)(28)(29). In RCT (20), the researchers did not further analysis the patients who was found pathologic positive lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

Survival Analysis of Lymph Node Resection in Ovarian Cancer: A Population-Based Study

Cheng

Lang

2020

Front. Oncol.

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Objective: This study aimed at comprehensively investigating the survival impact of lymphadenectomy during primary surgery in ovarian cancer. Methods: Based on the surveillance, epidemiology, and end results registry (SEER) database, we included ovarian cancer patients with detailed information between 2010 and 2016. Cox regression was performed to select prognostic factors. We conducted propensity score-weighted survival analysis to balance baseline variables, and series of stratified analyses to control main confounding factors. Results: A total of 8,652 patients were ultimately identified. Among 4,360 patients with advanced disease, lymphadenectomy did not show significant survival benefit in general (median overall survival 44 months in non-lymphadenectomy vs. 49 months in lymphadenectomy group, P = 0.055). In subgroup analysis on patients received optimal debulking, lymphadenectomy did not significantly benefit the survival outcome (median overall survival 51, 47, 60, and 58 months in the non-lymphadenectomy, 1-9 lymph nodes, 10-19 lymph nodes, ≥20 lymph nodes groups, respectively, P = 0.287). Consistent results were observed in further stratification analyses. In optimal debulking subgroup, lymph node metastasis indicated worse survival. However, when limited the number of removed lymph nodes to more than 15, there was a marginal statistical difference in overall survival (P = 0.0498) while no significant difference presented in cause-specific survival (P = 0.129) between non-lymphadenectomy, pathological negative lymph node group and positive lymph node group. And the regions of lymph metastasis were also not significantly associate with survival (P = 0.123). Among 3,266 (75%) patients with apparent early-stage disease received lymphadenectomy, 7.75% of whom were reported isolated lymph nodes metastasis and have a poorer survival (P < 0.05). Conclusions: In primary debulking for patients with advanced ovarian cancer, lymphadenectomy was not associated with more favorable outcomes when compared to no lymphadenectomy. The value of lymphadenectomy lies more in staging for apparent early disease rather than therapeutic benefit.

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“…Approximately 41,000 cases and a estimated 27,000 women die from this disease every year in China [4]. The peak incidence of EOC is over 70 years of age, and these elderly patients account for approximately two-thirds of cancer-related deaths [5][6][7][8][9]. With the improvement in population age and life expectancy, the increasing number of patients has altered the demographics of EOC.…”

Section: Introductionmentioning

confidence: 99%

Prognostic factors for types I and II epithelial ovarian cancer in the elderly

Cheng¹,

Zhou²,

Yang³

et al. 2020

EJGO

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No consensus exists on whether age is independently associated with poor prognosis in epithelial ovarian cancer (EOC). This study aimed to examine the prognostic factors of EOC in elderly patients. Materials and Methods: A total of 665 EOC patients from Jiangsu Institute of Cancer Research (JICR, People's Republic of China) were retrospectively analyzed between 1996 and 2015. For validation, 990 cases who consulted at MD Anderson Cancer Center (MDACC, USA) from 1990 to 2011 were recruited. The associations between survival durations and covariates were assessed by Cox proportional hazards model and log-rank test. Results: Histological type II (p = 0.01) and suboptimal surgery outcome (p = 0.00) were more common in the elderly (age ≥ 70 years) patients with EOC than in younger patients from JICR. The International Federation of Gynecology and Obstetrics (FIGO) stage, histological type, and optimal surgery were independently associated with overall survival (OS; p = 0.00, p = 0.03, and p = 0.00, respectively) and progression-free survival (PFS; p = 0.00, p = 0.02, and p = 0.00, respectively) in the EOC patients. Both OS and PFS were lower in the elderly patients with type I EOC than in the younger cases (136.5 months vs. 191.8 months at p = 0.00 and 35.5 months vs. 75.1 months at p = 0.01, respectively). The OS and PFS of the elderly patients were poorer than those of the younger cases with type II EOC (38.4 months vs. 42.3 months at p = 0.00 and 14.9 months vs. 16.8 months, p = 0.04, respectively). In type II ovarian cancer patients who achieved optimal debulking, the median OS and PFS durations of younger patients remained longer than those of elderly patients (50.2 months vs. 68.0 months, p = 0.00 and 14.9 months vs. 19.2 months, p = 0.01, respectively). Conclusions: Compared with young patients, elderly EOC more commonly presented with an aggressive histological type and poor performance status and was more frequently undertreated. Advanced age was independently associated with poor prognosis in EOC, even after the influence of histological type and surgical outcome was eliminated.

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

Cited by 20 publications

References 29 publications

Survival effect of different lymph node staging methods on ovarian cancer: An analysis of 10 878 patients

Survival effect of different lymph node staging methods on ovarian cancer: An analysis of 10 878 patients

Survival Analysis of Lymph Node Resection in Ovarian Cancer: A Population-Based Study

Prognostic factors for types I and II epithelial ovarian cancer in the elderly

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