Abstract
ObjectiveThe role of lymphadenectomy in interval debulking surgery (IDS) performed after neoadjuvant chemotherapy (NACT) in advanced ovarian cancer remains unclear. We aimed to investigate the clinical significance of lymphadenectomy in IDS.MethodsWe retrospectively reviewed and analyzed the data of patients with advanced ovarian cancer who underwent NACT followed by IDS.ResultsIn 303 patients receiving NACT-IDS, lymphadenectomy was performed in 127 (41.9%) patients. One hundred and sixty-three (53.8%) patients achieved no gross residual disease (NGRD), and 69 (22.8%) had residual disease < 1 cm, whereas 71 (23.4%) had residual disease ≥ 1cm. No significant difference in progression-free survival (PFS) and overall survival (OS) was observed between the lymphadenectomy group and the no lymphadenectomy group in patients with NGRD, residual disease < 1 cm, and residual disease ≥ 1 cm, respectively. The proportions of pelvic, para-aortic and distant lymph node recurrence were 7.9% (10/127), 4.7% (6/127) and 5.5% (7/127) in the lymphadenectomy group, compared with 5.7% (10/176, P = 0.448), 4.5% (8/176, P = 0.942) and 5.1% (9/176, P = 0.878), respectively, in no lymphadenectomy group. Multivariate analysis identified residual disease ≥ 1 cm [hazard ratios (HR), 4.094; P = 0.008] and elevated CA125 levels after 3 cycles of adjuvant chemotherapy (HR, 2.883; P = 0.004) were negative predictors for OS.ConclusionLymphadenectomy may have no therapeutic value in patients with advanced ovarian cancer underwent NACT-IDS. Our findings may help to better the therapeutic strategy for advanced ovarian cancer. More clinical trials are warranted to further clarify the real role of lymphadenectomy in IDS.
Highlights
Ovarian cancer ranks the second leading cause of cancer-related death in women with gynecologic malignancies, with an estimated 313,959 new cases and 207,252 deaths in 2020 worldwide [1]
NACT with a regimen of paclitaxel/docetaxel plus carboplatin/cisplatin was administered to 71.6% of the patients, and a regimen of cyclophosphamide and bleomycin plus carboplatin was administered to 20.5% of patients
Eoh et al [17] demonstrated that progression-free survival (PFS) was significantly better in the patients with lymphadenectomy during IDS who were preoperatively negative lymphadenopathy, comparing with those undergone lymph node sampling. These findings suggested that systematic lymphadenectomy might have therapeutic value in patients with advanced ovarian cancer during IDS
Summary
Ovarian cancer ranks the second leading cause of cancer-related death in women with gynecologic malignancies, with an estimated 313,959 new cases and 207,252 deaths in 2020 worldwide [1]. 75% of patients with advanced ovarian cancer will eventually relapse with the 5-year overall survival (OS) rate less than 25% [2]. The traditional treatment for advanced ovarian cancer is primary debulking surgery (PDS) followed by adjuvant chemotherapy. PDS typically includes the performance of a total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO), a complete omentectomy (OM) and resection of any metastatic disease from the peritoneal surfaces, and an extensive resection of upper abdominal metastasis in some cases. Randomized controlled trials failed to demonstrate that systematic lymphadenectomy improved OS in women with optimally debulked ovarian cancer [6,7,8]
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