Abstract
Lymphadenectomy is critical in the clinical prognosis of ovarian cancer patients. Therefore, we assessed whether lymph node ratio (LNR) has predictive value on overall survival (OS) of patients with serous epithelial ovarian cancer (SEOC). A total of 7,815 eligible SEOC patients were identified from the Surveillance, Epidemiology, and End Results (SEER) database, who underwent surgical resection between 1973 and 2013. We used the time-dependent receiver operating characteristic (ROC) curve and the area under curve to determine the optimal cut-off value of LNR. The predictive role of LNR was analyzed by Cox proportional hazards regression model. The effects of LNR and positive lymph nodes (PLN) on OS were evaluated by comparing the time-dependent ROC curves. The time-dependent ROC curves showed that the optimal LNR cut-off value was 42.0% for nodal-positive SEOC. As shown in Kaplan-Meier survival curves, survival was significantly poorer for all patients with LNR≥42.0% (log-rank test: P<0.0001), regardless of the stage. In the multivariate Cox analysis, LNR≥42.0% remained a significant and independent predictor of mortality risk for all patients [hazards ratio: 1.526, 95% confidence interval: 1.415-1.647; P<0.0001], compared with those LNR<42.0%. These results suggest that LNR, rather than the number of PLN or stage, could be regarded as a promising predictor of mortality risk, particularly in stage-III SEOC patients.
Highlights
According to GLOBOCAN 2012, the incidence of global ovarian cancer was 3.6% and the mortality rate reached up to 4.3% [5]
Under the hypothesis that lymph node (LN) metastasis varies by different histological types of epithelial ovarian cancer (EOC), we focused the prognostic value of lymph node ratio (LNR) on overall survival (OS) among Serous epithelial ovarian cancer (SEOC) patients using a population-based Surveillance, Epidemiology and End Results (SEER) database
Previous studies have identified the function of LNR on EOC, our study focused on the prognostic value of LNR in advanced LN-positive SEOC patients
Summary
According to GLOBOCAN 2012, the incidence of global ovarian cancer was 3.6% and the mortality rate reached up to 4.3% [5]. Previous studies have demonstrated that different histological subtypes of ovarian cancer lead to distinct clinical characteristics and prognosis [5]. LN status is regarded as an important factor for ovarian cancer staging in FIGO staging system. Previous studies have revealed that the LN status significantly affects the prognosis of patients with ovarian cancer [10 ,8]. The patients included in previous EOC studies were mostly staged as FIGO IIIC or/and IV, containing different histological types. Under the hypothesis that LN metastasis varies by different histological types of EOC, we focused the prognostic value of LNR on overall survival (OS) among SEOC patients using a population-based Surveillance, Epidemiology and End Results (SEER) database
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