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. 2019 Mar;30(2):e21.
doi: 10.3802/jgo.2019.30.e21. Epub 2018 Dec 4.

How to evaluate the adequacy of staging for nodal-negative epithelial ovarian cancer? Use of nodal staging score

Yuan Xu #  1 , Haoran Li #  2   3 , Xiaoxia Tong  3 , Yangyang Pang  4 , Xiaojuan Tong  5 , Luhong Li  6 , Lei Cheng  3   7
Affiliations

How to evaluate the adequacy of staging for nodal-negative epithelial ovarian cancer? Use of nodal staging score

Yuan Xu et al. J Gynecol Oncol. 2019 Mar.

Abstract

Objective: No guideline has been provided to assess the minimal number of lymph nodes (LNs) that should be dissected for accurate staging in patients with epithelial ovarian cancer (EOC). The aim of the study was to develop a nodal staging score (NSS) as an index to assess whether a pathologic (p)N0 EOC patient is indeed free of a nodal disease.

Methods: A total of 16,361 EOC patients staged I-III between 2004 and 2013 were identified from the Surveillance, Epidemiology and End Result database. With a β-binomial model, NSS was calculated to assess the probability of true-negative findings of LN status.

Results: With an increased number of LNs examined, the probability of missing a nodal disease decreased and varied among different pT stages. Given 1 LN examined, an NSS of 93.76% calculated could ensure a high adequacy of nodal-negative classification for pT1N0 EOC patients. For pT2N0 patients, 5 LNs examined could guarantee an NSS of 90% for adequate staging. Likewise, 11 and 29 LNs examined in pT3N0 patients could maintain NSS at the level of 80% and 90%, respectively. Our study suggested the optimal number of LNs that could be examined and stratified by the pT stages for EOC patients based on this statistical model derived from large pathologic data of clinical surgery patients.

Conclusion: NSS, as an auxiliary tool, not only could assist the International Federation of Gynecology and Obstetrics staging more precisely, but also would provide a statistical basis for postoperative evaluation for further clinical decision-making.

Keywords: Cancer Staging; Epithelial Ovarian Cancer; Lymph Node Dissection; Prognosis.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. The flowchart of this study.
AJCC, American Joint Committee on Cancer; EOC, epithelial ovarian cancer; ICD-O-3, International Classification of Diseases for Oncology, 3rd edition; LN, lymph node; LNE, lymphadenectomy; NSS, nodal staging score; SEER, the Surveillance, Epidemiology and End Results.
Fig. 2
Fig. 2. Probability of false-negative LNE in EOC patients under β-binomial model (A). The NSS of nodal-negative diagnosis stratified by the pT stage (B).
LNE, lymphadenectomy; NSS, nodal staging score.
Fig. 3
Fig. 3. OS by quartiles of probability of false-negative LN in nodal-negative patients with T1 stage (A), T2 stage (B), and T3 stage (C) by Kaplan-Meier curves.
LN, lymph node; OS, overall survival; NSS, nodal staging score.
See this image and copyright information in PMC

References

    1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65:87–108. - PubMed
    1. Trimbos JB, Vergote I, Bolis G, Vermorken JB, Mangioni C, Madronal C, et al. Impact of adjuvant chemotherapy and surgical staging in early-stage ovarian carcinoma: European organisation for research and treatment of cancer-adjuvant chemotherapy in ovarian neoplasm trial. J Natl Cancer Inst. 2003;95:113–125. - PubMed
    1. Chan JK, Munro EG, Cheung MK, Husain A, Teng NN, Berek JS, et al. Association of lymphadenectomy and survival in stage I ovarian cancer patients. Obstet Gynecol. 2007;109:12–19. - PubMed
    1. Morgan RJ, Jr, Armstrong DK, Alvarez RD, Bakkum-Gamez JN, Behbakht K, Chen LM, et al. Ovarian cancer, version 1.2016, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2016;14:1134–1163. - PubMed
    1. Prat J FIGO Committee on Gynecologic Oncology. FIGO's staging classification for cancer of the ovary, fallopian tube, and peritoneum: abridged republication. J Gynecol Oncol. 2015;26:87–89. - PMC - PubMed

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