Staging Lymphadenectomy in Patients With Clear Cell Carcinoma of the Ovary

Abstract

Objective The purpose of this study was to assess the rate of lymph node (LN) metastasis in comprehensively staged ovarian clear cell carcinoma (OCCC) clinically confined to the ovary and determine factors associated with LN metastasis. Methods We identified all cases of OCCC treated at four institutions from January 1994 through December 2011. We included cases with disease grossly confined to the ovary that had surgical staging performed, including at least 10 LNs sampled. Clinical and pathologic data were abstracted from electronic medical records and a de-identified data set was compiled and processed at a single institution. Factors potentially associated with LN metastasis were tested. Appropriate statistical tests were performed. Results We identified 145 eligible cases that met the criteria for this analysis. Median age was 52.9 years (range, 30–81), and median total LN count was 19 (range, 10–74). Seven (4.8%) of 145 comprehensively staged cases had LN metastasis; 6 of these cases (4.1%) were isolated metastasis. Cytologic washings, peritoneal, omental and fallopian tube involvement were not associated with nodal metastasis. Cases with ovarian surface involvement and positive cytology had a 37.5% incidence of LN positivity, which was statistically meaningful when compared with all other cases (p=0.003). Conclusion Women who underwent comprehensive staging for clinical stage I OCCC had a LN metastasis rate of 4.8%. The subgroup of cases with both ovarian surface involvement and positive cytology had the highest incidence of LN metastasis. This may influence clinical decision making on whether to perform lymphadenectomy in patients with incidental OCCC found after salpingo-oophorectomy.

Therapeutic significance of full lymphadenectomy in early-stage ovarian clear cell carcinoma

“…Third, eligible subjects were OCCC grossly confined to the ovary in another negative study [ 15 ]; a major problem of this study might have been its low rate of LNM (7.1% [10/134]). LNM rate in stage I OCCC is 4%–10% [ 16 18 19 ], which is lower than that in ovarian serous adenocarcinoma [ 20 ], and might be too low to detect a survival benefit for lymphadenectomy statistically. We do not intend to raise an objection to results of previous negative study for therapeutic efficacy of lymphadenectomy.…”

“…It is likely to be found at an early-stage and its prognosis is relatively good, while advanced-stage disease has notoriously poor prognosis due to its chemo-resistant characteristics. Opinions vary regarding the therapeutic significance of systematic lymphadenectomy in OCCC [ 14 15 16 17 18 19 20 ]. Despite some negative reports on its therapeutic significance [ 14 15 ], recent retrospective studies showed a potential survival benefit of more extensive lymphadenectomy in OCCC [ 16 17 ].…”

Clear cell carcinoma of the ovary

“…This was in line with a previous study, showing that 4.4% to 7.4% of all clinically apparent stage I diseases had metastasis to lymph nodes; with positive cytology or ovarian surface involvement, this rate was as high as 37.5%. [30] This may influence clinical decision-making on whether to perform lymphadenectomy in patients with incidental OCCC found after salpingo-oophorectomy. The question remains as to whether a nodal metastasis rate of approximately 5% is clinically relevant given that adjuvant chemotherapy is recommended even for stage IA OCCC by current treatment guidelines for EOC.…”

Updates of Pathogenesis, Diagnostic and Therapeutic Perspectives for Ovarian Clear Cell Carcinoma

“…In Mueller's study, 4.4% to 20% of clinically apparent stage I OCCC had lymph node involved. And this rate will be higher with positive cytology or ovarian surface involvement, accounting for as much as 37.5% of metastases 108 . Patients with localized relapse of OCCC tended to have a favorable prognosis (PFS=19 months, PRS=43 months).…”

“…Parenchymal organ metastases were occasional in the liver (4% to 5%), lungs (3.3% to 9.5%) and spleen (1.6%), respectively 15 , 105 , 108 , 109 . The liver and lung are commonly affected organs, similar to HGSC.…”