Stage- and Histologic Subtype-Dependent Frequency of Lymph Node Metastases in Patients with Epithelial Ovarian Cancer Undergoing Systematic Pelvic and Paraaortic Lymphadenectomy

Para-aortic lymphadenectomy is part of staging in early epithelial ovarian cancer (EOC) and could be part of therapy in advanced EOC. However, only a minority of patients receive therapy according to guidelines or have attendance to a specialized unit. We analyzed pattern of lymphatic spread of EOC and evaluated if clinical factors and intraoperative findings reliably could predict lymph node involvement, in order to evaluate if patients could be identified in whom lymphadenectomy could be omitted and who should not be referred to a center with capacity of performing extensive gynecological operations. Retrospective analysis was carried out of all patients with EOC who had systematic pelvic and para-aortic lymphadenectomy during primary cytoreductive surgery. One hundred ninety-five patients underwent systematic pelvic and para-aortic lymphadenectomy. Histologic lymph node metastases were found in 53%. The highest frequency was found in the upper left para-aortic region (32% of all patients) and between vena cava inferior and abdominal aorta (36%). Neither intraoperative clinical diagnosis nor frozen section of pelvic nodes could reliably predict para-aortic lymph node metastasis. The pathologic diagnosis of the pelvic nodes, if used as diagnostic tool for para-aortic lymph nodes, showed a sensitivity of only 50% in ovarian cancer confined to the pelvis and 73% in more advanced disease. We could not detect any intraoperative tool that could reliably predict pathologic status of para-aortic lymph nodes. Systematic pelvic and para-aortic lymphadenectomy remains part of staging in EOC. Patients with EOC should be offered the opportunity to receive state-of-the-art treatment including surgery

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The association between lymph node metastases and long-term survival in patients with epithelial ovarian cancer

Współczesna Onkologia ◽

10.5114/wo.2020.99029 ◽

2020 ◽

Vol 24 (3) ◽

pp. 163-171

Author(s):

Katarzyna Lepinay ◽

Sebastian Szubert ◽

Agnieszka Lewandowska ◽

Tomasz Rajs ◽

Krzysztof Koper ◽

...

Keyword(s):

Ovarian Cancer ◽

Lymph Node ◽

Epithelial Ovarian Cancer ◽

Lymph Node Metastases ◽

Term Survival ◽

Long Term Survival ◽

Node Metastases

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Patterns of Lymph Node Metastases in Apparent Stage I Low-Grade Epithelial Ovarian Cancer: A Multicenter Study

Annals of Surgical Oncology ◽

10.1245/s10434-017-5919-y ◽

2017 ◽

Vol 24 (9) ◽

pp. 2720-2726 ◽

Cited By ~ 20

Author(s):

Lucas Minig ◽

Florian Heitz ◽

David Cibula ◽

Jamie N. Bakkum-Gamez ◽

Anna Germanova ◽

...

Keyword(s):

Ovarian Cancer ◽

Lymph Node ◽

Epithelial Ovarian Cancer ◽

Multicenter Study ◽

Lymph Node Metastases ◽

Stage I ◽

Low Grade ◽

Node Metastases

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PATTERNS OF LYMPH NODE METASTASES IN APPARENT STAGE I LOW-GRADE EPITHELIAL OVARIAN CANCER: A MULTICENTER STUDY.

10.26226/morressier.599bdc79d462b80296ca1877 ◽

2017 ◽

Author(s):

Lucas Minig

Keyword(s):

Ovarian Cancer ◽

Lymph Node ◽

Epithelial Ovarian Cancer ◽

Multicenter Study ◽

Lymph Node Metastases ◽

Stage I ◽

Low Grade ◽

Node Metastases

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Intraoperative Clinical Examination for Assessing Pelvic and Para-Aortic Lymph Node Involvement in Advanced Epithelial Ovarian Cancer: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm9092793 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2793

Author(s):

Camille Mimoun ◽

Jean Louis Benifla ◽

Arnaud Fauconnier ◽

Cyrille Huchon

Keyword(s):

Ovarian Cancer ◽

Lymph Node ◽

Diagnostic Accuracy ◽

Epithelial Ovarian Cancer ◽

Clinical Examination ◽

Cytoreductive Surgery ◽

Lymph Node Metastases ◽

Meta Analysis ◽

Node Metastases ◽

Advanced Epithelial Ovarian Cancer

After the publication of the Lymphadenectomy in Ovarian Neoplasms (LION) trial results, lymphadenectomy in advanced epithelial ovarian cancer with primary complete cytoreductive surgery is considered indicated only for women with suspicious lymph nodes. The aim of this meta-analysis was to evaluate the diagnostic accuracy of intraoperative clinical examination for detecting lymph node metastases in patients with advanced epithelial ovarian cancer during primary complete cytoreductive surgery. MEDLINE, EMBASE, Web of Science and the Cochrane Library were searched for January 1990 to May 2019 for studies evaluating the diagnostic accuracy of intraoperative clinical examination for detecting lymph node metastases in patients with advanced epithelial ovarian cancer during primary complete cytoreductive surgery, with histology as the gold standard. Methodological quality was assessed by using the QUADAS-2 tool. Pooled diagnostic accuracy was calculated, and hierarchical summary receiver operating curve was constructed. The potential sources of heterogeneity were analyzed by meta-regression analysis. Deek’s funnel plot test for publication bias and Fagan’s nomogram for clinical utility were also used. This meta-analysis included five studies involving 723 women. The pooled sensitivity of intraoperative clinical examination for detecting lymph node metastases was 0.79, 95% CI (0.67–0.87), and its specificity 0.85, 95% CI (0.67–0.94); the area under the hierarchical summary receiver operating curve was 0.86, 95% CI (0.83–0.89). In the meta-regression analysis, patient sample size, mean age, and type of cancer included were significant covariates explaining the potential sources of heterogeneity. Deek’s funnel plot test showed no evidence of publication bias (p = 0.25). Fagan’s nomogram indicated that intraoperative clinical examination increased the post-test probability of lymph node metastases to 79% when it was positive and reduced it to 16% when negative. This meta-analysis shows that the diagnostic accuracy of intraoperative clinical examination during primary complete cytoreductive surgery for detecting lymph node metastases in advanced epithelial ovarian cancer is good.

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Restaging and Survival Analysis of 4036 Ovarian Cancer Patients According to the 2013 FIGO Classification for Ovarian, Fallopian Tube, and Primary Peritoneal Cancer

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000675 ◽

2016 ◽

Vol 26 (4) ◽

pp. 680-687 ◽

Cited By ~ 21

Author(s):

Mikkel Rosendahl ◽

Claus Kim Høgdall ◽

Berit Jul Mosgaard

Keyword(s):

Ovarian Cancer ◽

Lymph Node ◽

Cancer Patients ◽

Lymph Node Metastases ◽

Stage Iiic ◽

Primary Peritoneal Cancer ◽

Peritoneal Cancer ◽

Figo Staging ◽

Node Metastases ◽

Similar Survival

ObjectiveWith the 2013 International Federation of Gynecology and Obstetrics (FIGO) staging for ovarian, fallopian tube, and primary peritoneal cancer, the number of substages changed from 10 to 14. Any classification of a malignancy should easily assign patients to prognostic groups, refer patients to individualized treatments, and allow benchmarking and comparison of patients and results between centers. The stage should reflect survival in particular. The objective of the study was to validate these requirements of the revised FIGO staging on a high number of ovarian cancer patients.Materials and MethodsDemographic, surgical, histological, and survival data from 4036 ovarian cancer patients were used in the analysis. Five-year survival rates (5YSR) and hazard ratios for the old and revised FIGO staging were calculated using Kaplan-Meier curves and Cox regression.ResultsA total of 1532 patients were assigned to new stages. Stages IA and IC1 had similar survival (5YSR, 87%); and stages IB, IC2, and IC3 had similar survival (5YSR, 75%–80%). Stage IIC was omitted, resulting in similar survival in stages IIA and IIB (5YSR, 61% and 65%). Of 1660 patients in stage IIIC, 79 were restaged: In 16 cases, IIIC was down-staged to IIIA1, as they had only been stage IIIC owing to lymph node metastases; and in 63 cases, IIIC was down-staged to IIIB, as they had lymph node metastases and abdominal tumor of less than 2 cm. The 5YSR in stage IIIC was unchanged (22%). Stage IV (5YSR, 14% ) was restaged as IVA (13%) and IVB (13%). Both were different from IIIC; P < 0.0001.ConclusionWith introduction of new substages, staging becomes more demanding. Second, as fewer patients are allocated to each substage, statistical power is diminished, resulting in uncertainty in the results. Despite this, and most importantly, the revised coding adequately reflects survival, as there was a clear graphical and statistical tendency for poorer survival with increasing stage.

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