The value of surgical staging in patients with apparent early stage epithelial ovarian carcinoma

Hengeveld, Ellen M; Zusterzeel, Petra L.M.; Lajer, Henrik; Høgdall, Claus; Rosendahl, Mikkel

doi:10.1016/j.ygyno.2019.06.006

Cited by 24 publications

(47 citation statements)

References 22 publications

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“…28,29 Complete staging procedures are critical, as up to 16-35% of patients are upstaged due to occult metastatic disease, and patients who undergo complete staging have improved recurrence-free and overall survival. 20,[32][33][34][35] Many patients with stage I disease are under-staged, with estimates ranging from 33-67%. 36 This is usually due to lack of lymphadenectomy, blind peritoneal biopsies, or a diagnosis of a benign or borderline tumor on intraoperative frozen pathology with invasive cancer on final pathology.…”

Section: Prognosis Of Early-stage Eocmentioning

confidence: 99%

“…Microscopic metastases are also reported in the omentum in 2-7% and on peritoneal surfaces in 1-9% of stage I cases. 34,39 Careful inspection of the contralateral ovary is necessary; if the contralateral ovary appears completely normal, the risk of occult malignancy is estimated at only 0.8-2.5% in stage I disease. 34,40 If any abnormalities are seen, some authors suggest wedge biopsy, surface biopsy or bivalving to ensure there is no malignancy.…”

Section: Prognosis Of Early-stage Eocmentioning

confidence: 99%

“…34,39 Careful inspection of the contralateral ovary is necessary; if the contralateral ovary appears completely normal, the risk of occult malignancy is estimated at only 0.8-2.5% in stage I disease. 34,40 If any abnormalities are seen, some authors suggest wedge biopsy, surface biopsy or bivalving to ensure there is no malignancy. 41 Given endometriosis can contribute to carcinogenesis, especially with clear cell histology, endometriotic implants or lesions should be excised or fulgurated at the time of surgery.…”

Section: Prognosis Of Early-stage Eocmentioning

confidence: 99%

See 2 more Smart Citations

Fertility‐sparing treatment for early‐stage epithelial ovarian cancer: Contemporary oncologic, reproductive and endocrinologic perspectives

Mandelbaum

Klar

Takiuchi

et al. 2020

J of Obstet and Gynaecol

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Aim Epithelial ovarian cancer (EOC) can be a devastating diagnosis in women of reproductive age who desire future fertility. However, in early‐stage disease, fertility‐sparing surgery (FSS) can be considered in appropriately selected patients. Methods This is a narrative descriptive review of the recent literature on FSS for EOC from oncologic, reproductive and endocrinologic perspectives. Results The recurrence rate following FSS performed for stage I EOC in published retrospective studies collectively is 13% but ranges from 5 to 29%, while mortality ranges from 0 to 18%. Five‐year disease‐free survival following FSS is over 90% but decreases with higher stage and grade. Recurrences following FSS are more likely to be localized with a more favorable prognosis compared to recurrences following radical surgery. Adjuvant chemotherapy is recommended in women with high‐risk disease, and strategies to minimize gonadotoxicity during chemotherapy such as gonadotropin‐releasing hormone (GnRH) agonists may be considered. Oocyte, embryo and/or ovarian cryopreservation can also be offered to patients desiring future biologic children. Reproductive outcomes following FSS, including pregnancy and miscarriage rates, resemble those of the general population, with a chance of successful pregnancy of nearly 80%. Conclusion In retrospective data, FSS appears to be oncologically safe in stage IA and IC grade 1–2 non‐clear cell EOC. In patients with grade 3 tumors or clear cell histology, treatment can be individualized, weighing a slightly higher risk of recurrence with fertility goals. A multidisciplinary approach with oncology and reproductive endocrinology may be of utility to help these patients achieve their fertility goals.

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Section: Prognosis Of Early-stage Eocmentioning

confidence: 99%

Section: Prognosis Of Early-stage Eocmentioning

confidence: 99%

Section: Prognosis Of Early-stage Eocmentioning

confidence: 99%

See 1 more Smart Citation

Fertility‐sparing treatment for early‐stage epithelial ovarian cancer: Contemporary oncologic, reproductive and endocrinologic perspectives

Mandelbaum

Klar

Takiuchi

et al. 2020

J of Obstet and Gynaecol

View full text Add to dashboard Cite

show abstract

“…An interesting study which investigated the effectiveness of surgical staging in cases with apparent early stage ovarian cancer has been recently published by Hengeveld in 2019. The study included all patients submitted to surgery with presumed early stage disease between 2005 and 2017 in Danish and Dutch hospitals [20]. Finally, there were 1234 cases that had been preoperatively presumed to be classified as FIGO stage I disease; in all cases, omentectomy, pelvic and para-aortic lymph node sampling or lymph node dissection, as well as multiple peritoneal biopsies, were retrieved.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the authors underlined the fact that upstaging was responsible for changing the plan of treatment in 35.1% of cases. Therefore, the importance of an adequate staging was underlined once again; in the meantime, the study came to demonstrate that a significant proportion of cases that were finally upstaged originated from cases with serous or endometrial histology in association with a lower degree of differentiation [20].…”

Section: Discussionmentioning

confidence: 99%

The Risk of Para-Aortic Lymph Node Metastases in Apparent Early Stage Ovarian Cancer

et al. 2020

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Background and objectives: To identify the risk factors for para-aortic lymph node metastases in cases with presumed early stage ovarian cancer. Materials and methods: Between 2014 and 2019, 48 patients with apparent early stage ovarian cancer were submitted to surgery. In all cases, pelvic and para-aortic lymph node dissection was performed for staging purposes. Results: Among the 48 cases we identified nine cases with positive pelvic lymph nodes and 11 cases with positive para-aortic lymph nodes. The positivity of the retrieved lymph nodes was significantly correlated with the histopathological subtype represented by serous histology (p = 0.02), as well as with the degree of differentiation (p = 0.004). Conclusions: Patients with serous ovarian carcinomas in association with a poorer degree of differentiation are at risk of associated lymph node metastases even in presumed early stages of the disease. Therefore, lymph node dissection should be performed in such cases in order to provide adequate staging and tailoring of further treatment.

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The impact of lymph node dissection on apparent Stage I epithelial ovarian carcinoma: A population‐based study

Chen

Wang

Lang

2021

Intl J Gynecology & Obste

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Objective To explore the impact of lymphadenectomy on the prognosis of women of reproductive age with clinically apparent Stage I epithelial ovarian cancer (EOC). Methods Data of women of reproductive age with Stage I EOC, diagnosed between 2010 and 2016, were extracted from the Surveillance, Epidemiology, and End Results database. Five‐year cancer‐specific survival (CSS) was evaluated using the Kaplan–Meier method. Multivariate Cox analysis was performed to evaluate the effect of lymph node dissection on survival. Propensity score (PS) matching was conducted to balance various clinicopathologic factors. Results Of 2222 patients included, 1609 (72.4%) received lymph node dissection. The rate of histopathologically confirmed lymph node metastasis was highest in serous subtype (10.2%) and lowest in mucinous subtype (2.2%). No significant difference between the lymphadenectomy and non‐lymphadenectomy groups in 5‐year CSS was observed in the original cohort (P = 0.364) or in the PS matching cohort (P = 0.248). Nevertheless, there was a significant difference between the lymphadenectomy and non‐lymphadenectomy groups for patients with Stage IC EOC (92.4% vs. 88.1%, P = 0.027). According to the multivariate analysis, performance of the lymphadenectomy was not significantly associated with CSS in the original cohort (P = 0.163) or the PS matching cohort (P = 0.101). Conclusion Dissection of lymph nodes was not significantly associated with improved prognosis for most Stage I EOC, but, lymphadenectomy may be necessary for women of reproductive age with Stage IC subtype.

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The value of surgical staging in patients with apparent early stage epithelial ovarian carcinoma

Cited by 24 publications

References 22 publications

Fertility‐sparing treatment for early‐stage epithelial ovarian cancer: Contemporary oncologic, reproductive and endocrinologic perspectives

Fertility‐sparing treatment for early‐stage epithelial ovarian cancer: Contemporary oncologic, reproductive and endocrinologic perspectives

The Risk of Para-Aortic Lymph Node Metastases in Apparent Early Stage Ovarian Cancer

The impact of lymph node dissection on apparent Stage I epithelial ovarian carcinoma: A population‐based study

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