Abstract
BackgroundThe purpose of this retrospective study was to determine the prognosis of non-serous epithelial ovarian cancer (EOC) patients with exclusively retroperitoneal lymph node (LN) metastases, and to compare the prognosis of these women to that of patients who had abdominal peritoneal involvement.MethodsA multicenter, retrospective department database review was performed to identify patients with stage III non-serous EOC at 7 gynecologic oncology centers in Turkey. Demographic, clinicopathological and survival data were collected. The patients were divided into three groups based on the initial sites of disease: 1) the retroperitoneal (RP) group included patients who had positive pelvic and /or para-aortic LNs only. 2) The intraperitoneal (IP) group included patients with > 2 cm IP dissemination outside of the pelvis. These patients all had a negative LN status, 3) The IP / RP group included patients with > 2 cm IP dissemination outside of the pelvis as well as positive LN status. Survival data were compared with regard to the groups.ResultsWe identified 179 women with stage III non-serous EOC who were treated at 7 participating centers during the study period. The median age of the patients was 53 years, and the median duration of follow-up was 39 months. There were 35 (19.6%) patients in the RP group, 72 (40.2%) in the IP group and 72 (40.2%) in the IP/RP group. The 5-year disease-free survival (DFS) rates for the RP, the IP, and IP/RP groups were 66.4%, 37.6%, and 25.5%, respectively (p = 0.002). The 5-year overall survival (OS) rate for the RP group was significantly longer when compared to those of the IP, and the IP/RP groups (74.4% vs. 54%, and 36%, respectively; p = 0.011). However, we were not able to define “RP only disease” as an independent prognostic factor for increased DFS or OS.ConclusionsPrimary non-serous EOC patients with node-positive-only disease seem to have better survival when compared to those with extra-pelvic peritoneal involvement.
Highlights
The purpose of this retrospective study was to determine the prognosis of non-serous epithelial ovarian cancer (EOC) patients with exclusively retroperitoneal lymph node (LN) metastases, and to compare the prognosis of these women to that of patients who had abdominal peritoneal involvement
The groups were balanced for prognostic factors including age, menopausal status, histopathological subtype, Federation of Gynecology and Obstetrics (FIGO) grade, tumor size, and the number of LNs retrieved
Our results indicate a significant improvement in disease-free survival (DFS) and overall survival (OS) for RP only involvement compared to IP only tumor or a combination of IP and RP disease in a cohort of 179 women with non-serous EOC
Summary
The purpose of this retrospective study was to determine the prognosis of non-serous epithelial ovarian cancer (EOC) patients with exclusively retroperitoneal lymph node (LN) metastases, and to compare the prognosis of these women to that of patients who had abdominal peritoneal involvement. Frequent use of cyclophosphamide in first-line chemotherapy regimens might have acted as a confounding factor in earlier studies [3, 4, 6, 7] Today, it is well-known that ovarian cancer is not a single disease but rather a group of diseases - each with different morphology and biologic behavior [11]. At least five main types are currently distinguished: high-grade serous carcinoma (HGSC [70%]), endometrioid carcinoma (10%), clear-cell carcinoma (10%), mucinous carcinoma (3%), and low-grade serous carcinoma (LGSC [< 5%]) [12] It is well-known that tumor histology influences the incidence of nodal disease [13, 14], chemo sensitivity [15], and prognosis [16]. Distinct histopathological features might characterize tumor cells metastasizing through the lymphatic route compared to the trans-coelomic route
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