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Review
. 2024 Feb 27;16(5):955.
doi: 10.3390/cancers16050955.

The Role of Systematic Lymphadenectomy in Low-Grade Serous Ovarian Cancer: A Systematic Review and Meta-Analysis

Rosa Montero-Macías  1 , Juan José Segura-Sampedro  2   3   4 , Pascal Rigolet  5 , Fabrice Lecuru  6   7 , Andrea Craus-Miguel  4   8 , Juan Manuel Castillo-Tuñón  9
Affiliations
Review

The Role of Systematic Lymphadenectomy in Low-Grade Serous Ovarian Cancer: A Systematic Review and Meta-Analysis

Rosa Montero-Macías et al. Cancers (Basel). .

Abstract

Objective: To evaluate the role of systematic lymphadenectomy in low-grade serous ovarian cancer (LGSOC) and determine its impact on clinical outcomes in overall survival (OS) and disease-free survival (DFS) terms.

Methods: A comprehensive, systematic computer literature search on PubMed was performed using the following Medical Subject Headings (MeSH) terms: "low grade serous ovarian cancer" AND/OR "lymphadenectomy" AND/OR "staging" AND/OR "ovarian cancer" AND/OR "cytoreduction". Separate searches were performed with MeSH terms on MEDLINE and EMBASE to extract all the relevant literature available. We included only patients with histologically confirmed LGSOC.

Results: Three studies were considered in the quantitative analysis. Systematic lymphadenectomy in LGSOC failed to provide a significant OS or PFS benefit in LGSOC when compared to no lymphadenectomy in the entire (all the stages) population (for OS: HR = 1.15, 95% CI [0.42, 3.18] I2 = 84% and for PFS: HR = 1.46, 95% CI [0.63, 3.41], I2 = 71%), nor did it in the subtype analysis regarding FIGO stages. For FIGO early-stage I-II LGSOC, the DFS data were pooled (HR = 1.48, 95% CI [0.58, 3.78], I2 = 75%). In patients with advanced-stage (FIGO II-IV), we also failed to prove survival benefit for lymphadenectomy in OS (HR = 1.74, 95% CI [0.87, 3.48], I2 = 11%) or DFS (HR = 1.48, 95% CI [0.58, 3.78], I2 = 75%) compared to no lymphadenectomy.

Conclusion: More extensive prospective research is mandatory to understand the real impact of lymphadenectomy on survival in LGSOC. The existing literature does not provide strong evidence.

Keywords: low-grade ovarian cancer; lymphadenectomy; overall survival; period-free disease.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA [18] flow diagram.
Figure 2
Figure 2
Meta–analysis for (a) OS in whole LGSOC population regarding systematic lymphadenectomy, (b) DFS in whole LGSOC population regarding systematic lymphadenectomy, (c) DFS in early-stage FIGO I–II LGSOC regarding systematic lymphadenectomy, (d) OS in advanced-stage FIGO III–IV LGSOC regarding systematic lymphadenectomy, and (e) for DFS in advanced-stage FIGO III–IV LGSOC regarding systematic lymphadenectomy. References: [19,20,21].
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