Abstract
The prognostic significance of pelvic and para-aortic lymphadenectomy during primary debulking surgery for advanced-stage ovarian cancer remains unclear. This study aimed to evaluate the survival impact of lymph node dissection (LND) in patients treated with optimal cytoreduction for advanced ovarian cancer. Data from 158 consecutive patients with stage IIIC–IV disease who underwent optimal cytoreduction (<1 cm) were obtained via retrospective chart review. Patients were classified into two groups: (1) lymph node sampling (LNS), node count <20; and (2) LND, node count ≥20. Progression-free (PFS) and overall survival (OS) were analyzed using the Kaplan–Meier method. Among the included patients, 96 and 62 patients underwent LND and LNS as primary debulking surgery, respectively. There were no differences in the extent of debulking surgical procedures, including extensive upper abdominal surgery, between the groups. Patients who underwent LND had a marginally significantly improved PFS (P = 0.059) and significantly improved OS (P < 0.001) compared with those who underwent LNS. In a subgroup with negative lymphadenopathy on preoperative computed tomography scans, revealed LND correlated with a better PFS and OS (P = 0.042, 0.001, respectively). Follow-ups of subsequent recurrences observed a significantly lower nodal recurrence rate among patients who underwent LND. A multivariate analysis identified LND as an independent prognostic factor for PFS (hazard ratio [HR], 0.629; 95% confidence interval [CI], 0.400–0.989) and OS (HR, 0.250; 95% CI, 0.137–0.456). In conclusion, systematic LND might have therapeutic value and improve prognosis for patients with optimally cytoreduced advanced ovarian cancer.
Highlights
More than two-thirds of patients with epithelial ovarian cancer (EOC) have advanced disease at the time of diagnosis; EOC remains a major cause of gynecologic cancerrelated mortality [1]
This study aimed to evaluate the survival impact of lymph node dissection (LND) in patients treated with optimal cytoreduction for advanced ovarian cancer
The role of systematic lymph node dissection (LND) in the treatment of stage IIIC–IV ovarian cancer remains controversial because this procedure does not LQÀXHQFH WKH VXUJLFDO VWDJH DQG LWV WKHUDSHXWLF EHQH¿W is uncertain [5,6,7]
Summary
More than two-thirds of patients with epithelial ovarian cancer (EOC) have advanced disease at the time of diagnosis; EOC remains a major cause of gynecologic cancerrelated mortality [1]. The primary standard treatment for advanced-stage EOC comprises debulking surgery and adjuvant taxane- and platinum-based chemotherapies [2]. Radical debulking surgery is a critical treatment strategy for advanced ovarian cancer, and several studies have supported the importance of maximal cytoreductive surgical efforts to minimize residual disease [3, 4]. The role of systematic lymph node dissection (LND) in the treatment of stage IIIC–IV ovarian cancer remains controversial because this procedure does not LQÀXHQFH WKH VXUJLFDO VWDJH DQG LWV WKHUDSHXWLF EHQH¿W is uncertain [5,6,7]. Current National Comprehensive Cancer Network (NCCN) guidelines do not recommend systematic LND other than the removal of suspicious and/or enlarged nodes in patients with advanced disease. 2 previous randomized controlled trials 5&7V IDLOHGWRLGHQWLI\DVLJQL¿FDQWEHQH¿WRIV\VWHPDWLF LND for overall survival (OS) [5, 11], whereas retrospective studies have demonstrated the potential favorable impact of this procedure on OS [9, 10, 12, 13]]
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