Incidence and Impact of Lymph Node Metastases in Advanced Ovarian Cancer: Implications for Surgical Treatment

Abstract

Background: This study aimed to clarify the impact of node involvement (affected to resected nodes) in optimally cytoreduced (residual tumour ≤1cm) stage IIIC/IV ovarian cancer.Methods: 108 consecutive patients with primary stage IIIC/IV ovarian cancer underwent stage-related surgery and got adjuvant platinum-based chemotherapy. Median follow-up: 53.5 months. All patients got systematic para-aortic and pelvic lymphadenectomy. Clinical parameters were retrospectively evaluated. Patients were stratified into 3 groups to evaluate node affection: 1) no (0%), 2) minor (>0%, ≤50%) >0 and 3) major (>50% of affected nodes). Kaplan-Meier survival curve was used to evaluate the prognostic value.Results: On average, 21.3 pelvic and para-aortic nodes were removed per patient (range 1-60 nodes). Minor nodal involvement (node ratio >0-≤0.5: (59%) was most often detected. Increasing node ratio leads to significant decreased overall survival (p<0.001). Significant best overall survival was associated with minor node involvement (node ratio >0 to ≤0.5). Complete cytoreduction correlated with node affection shows significant best prognostic impact in minor node affection compared to incomplete resection (R>0-≤1cm) independent to nodal status (OS p<0.001).Conclusion: Radical surgery is the main factor of improved overall and tumor free survival. Paraaortal and iliacal lymphadenectomy seems to play an important role for prognostic and therapeutic reasons: Prognostic in accurate staging and therapeutic in case of achieved optimal cytoreduction including lymph nodes with histology proven minor node involvement.

Clinicopathological factors of pelvic lymph nodes involvement in advanced serous ovarian cancer

“…Fournier et al [14] presented similar observations, but the ratio of metastases in primary surgery was 50%. In other studies, metastases to retroperitoneal lymph nodes in early ovarian cancer were found in 13-25% [4,15], while in advanced stage were observed in 45-75% cases [4,7,16,17]. Elective pelvic and aortocaval lymphadenectomy in patients with clinical stage I and II results in final diagnosis of stage III in 20% [4].…”

“…In our study, we analysed only serous tumors regarding it was the histologic type associated with the most common pelvic and para-aortic lymph nodes involvement. Although Roger et al [18] found similar frequency for lymph nodes involvement in different histological types of epithelial ovarian cancer, other studies presented higher rate of lymph nodes metastases in serous tumor [8,9,16,19,20]. Zhou et al showed higher risk (OR 2.728, 95% CI 1.072-6.945, p = 0.035) for nodal involvement in serous ovarian cancer [8].…”

Clinico‑morphological aspects and new immunohistochemistry characteristics of ovarian high‑grade serous carcinoma

“…The prognostic relevance of lymph node metastases in primary ovarian cancer is unclear, although seen as an important prognostic factor for advanced-stage ovarian cancer, there is contradictory data on survival after systematic lymphadenectomy versus bulky node resection [19][20][21][22] .…”

Inflammatory state of lymphatic vessels and miRNA profiles associated with relapse in ovarian cancer patients

“…Epithelial Ovarian cancer (EOC) accounts for over 4000 deaths in the UK every year [1]. Lymph nodes metastases are very common in EOC-patients and also associated with a more dismal overall prognosis [2-3]. Total macroscopic tumour clearance, is one of the most important prognostic factors for survival post-surgery in EOC, including also the removal of bulky lymph nodes [3-4].…”

“…Lymph nodes metastases are very common in EOC-patients and also associated with a more dismal overall prognosis [2-3]. Total macroscopic tumour clearance, is one of the most important prognostic factors for survival post-surgery in EOC, including also the removal of bulky lymph nodes [3-4]. There is no therapeutic value in the systematic removal of clinically normal appearing LN in the advanced disease setting, as shown in prospective randomised trials [5].…”