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. 2017 Jun 6;8(23):37807-37816.
doi: 10.18632/oncotarget.13696.

Role of systematic lymphadenectomy as part of primary debulking surgery for optimally cytoreduced advanced ovarian cancer: Reappraisal in the era of radical surgery

Kyung Jin Eoh  1 , Jung-Yun Lee  1 , Jung Won Yoon  1 , Eun Ji Nam  1 , Sunghoon Kim  1 , Sang-Wun Kim  1 , Young Tae Kim  1
Affiliations

Role of systematic lymphadenectomy as part of primary debulking surgery for optimally cytoreduced advanced ovarian cancer: Reappraisal in the era of radical surgery

Kyung Jin Eoh et al. Oncotarget. .

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.

Keywords: advanced epithelial ovarian cancer; lymph node dissection; lymphadenectomy; optimal cytoreductive surgery; primary debulking surgery.

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Conflict of interest statement

CONFLICTS OF INTEREST

None.

Figures

Figure 1
Figure 1. Comparison of PFS in patients who underwent LNS and LND
A. Overall analysis of PFS. Patients who underwent LND had a favorable PFS with marginal significance (P = 0.059). B. Subgroup analysis of PFS according to lymphadenopathy status on preoperative CT scan. In the Image(-) subgroup, LND group showed significantly longer PFS than the LNS groups [log-rank test: Image(+)/LND vs. Image(+)/LNS, P = 0.346; Image(-)/LND vs. Image(-)/LNS, P = 0.042]. PFS, progression-free survival; LNS, lymph node sampling; LND, lymph node dissection.
Figure 2
Figure 2. Comparison of OS in patients who underwent LNS and LND
A. Overall analysis of OS. Patients who underwent LND had a significantly favorable OS, compared to those treated with LNS (P < 0.001). B. Subgroup analysis of OS according to lymphadenopathy status on preoperative CT scan. Both LND groups had a significantly longer OS relative to the LNS groups, regardless of the preoperative suspected lymphadenopathy status [log-rank test: Image(+)/LND vs. Image(+)/LNS, P = 0.002; Image(-)/LND vs. Image(-)/LNS, P = 0.001]. OS, overall survival; LNS, lymph node sampling; LND, lymph node dissection.
Figure 3
Figure 3. Patient selection diagram
LNS, lymph node sampling; LND, lymph node dissection.
See this image and copyright information in PMC

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