Clinical gynecological practice analysis of lymphadenectomy for primary advanced ovarian serous cystadenocarcinoma based on the SEER database

Abstract

Purpose Given the large number of patients with primary advanced ovarian serous cystadenocarcinoma (OSC) undergoing lymphadenectomy, it is necessary to explore the intrinsic significance of this procedure to improve the quality of precision medicine. Methods SEER database, epidemiological analysis, continuous landmark analysis, principal component analysis, COX regression and matrix analysis were performed to explore the weight changes of treatment, long-term effects, specific risk factors, and the significance of lymph node examination, positive lymph node count and ratio (LNR) for patients. Results Of the total 8673 patients who underwent debulking surgery, approximately 46.5% underwent additional lymphadenectomy. Through PCA, we found that FIGO/M staging, residual tumor volume/size, T/N staging, age and grade were extremely important risk factors for patients. Furthermore, Cox regression analysis showed that N, histology, residual tumor volume, systemic/surgery sequence, laterality, and marital status influenced the prognostic impact of lymphadenectomy compared with self-control. The LOESS fitting curve showed that when the number of examinations > 40, the beneficial effect of lymph nodes examination on survival time began to diminish in the survivor group, while showed a downward trend in the death cases. Additionally, LNR was found to be significantly associated with survival time and vital status, while lymph node examination was only significantly associated with survival time. Finally, residual foci size was found to be significantly associated with LNR and lymph node examination, but not with positive lymph nodes. Conclusions A detailed assessment of lymphadenectomy may have implications for clinical gynecologic practices and precision medicine.