Is there any association between retroperitoneal lymphadenectomy and survival benefit in ovarian clear cell carcinoma patients?

Suzuki, Shiro; Kajiyama, Hiroaki; Shibata, Kiyosumi; Ino, Kazuhiko; Nawa, Akihiro; Sakakibara, Katsumi; Matsuzawa, Katsuji; Takeda, Akihiro; Kinoshita, Yoshito; Kawai, Michiyasu; Nagasaka, Tetsuro; Kikkawa, Fumitaka

doi:10.1093/annonc/mdn059

Cited by 69 publications

(50 citation statements)

References 12 publications

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“…Saygili et al (15): had no conflict of interest statement; without long enough follow-up time; high rate of defaulters. The remaining 11 observational studies whose scores ranged from 7 to 9 with a median score of 8 (16)(17)(18)(19)(20)(23)(24)(25)(27)(28)(29) and three RCTs (21-22,26) with scores from 4 to 5 were finally included in our analyses. Figure 1 shows an overview of the process of selection.…”

Section: Literature Search and Quality Assessmentmentioning

confidence: 99%

“…These articles, including 1783 cases and 1705 controls, were published between 1994 and 2013 and consisted of 11 observational studies (16)(17)(18)(19)(20)(23)(24)(25)(27)(28)(29) and three RCTs (21)(22)26). Among the included studies, SL was defined as follows: (i) either pelvic or paraaortic lymphadenectomy or both (16)(17)(19)(20)21,(23)(24)(25)(26)(27)(28)(29); (ii) >20 resected pelvic and para-aortic lymph nodes (18,22). On the other hand, USL was defined as follows: not performed or no lymphadenectomy other than suspicious lymph nodes and the removal number was <20.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Systematic lymphadenectomy in the treatment of epithelial ovarian cancer: a meta-analysis of multiple epidemiology studies

Gao

Yang

Zhang

2014

Japanese Journal of Clinical Oncology

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Objective: To evaluate the role of systematic lymphadenectomy in epithelial ovarian cancer by comparing 5-year overall survival rates between systematic and unsystematic lymphadenectomies. Methods: A literature search of the Pubmed, Embase and Cochrane Library databases was performed up to 2014. Two authors independently determined the eligibility of the articles and extracted the available data. The role of systematic lymphadenectomy in epithelial ovarian cancer was analyzed by combining all qualified individual studies using a fixed-effect model. Then, subgroup analysis was performed by dividing articles according to type, cancer stage and residual tumor. Finally, heterogeneity and publication bias in all enrolled studies were assessed using Higgins I 2 statistics and funnel plots, respectively.Results: Fourteen relevant studies including 3488 subjects were included in the analysis. The value of pooled relative ratios of all qualified studies revealed that the 5-year overall survival rate in the lymphadenectomy group was higher than that in the unsystematic lymphadenectomy group (relative ratio = 1.08; P = 0.001), which was duplicated in the subgroup analysis of observational studies (relative ratio = 1.07; P = 0.002) and advanced stage (relative ratio = 1.21; P = 0.012) epithelial ovarian cancer. No significant differences were observed in randomized controlled trials (relative ratio = 1.01; P = 0.858), early stage epithelial ovarian cancer (relative ratio = 1.06; P = 0.064) or patients with residual tumor ≤2 cm (relative ratio = 1.05; P = 0.125). The heterogeneity and publication bias in the enrolled studies were within acceptable thresholds. Conclusions: Lymphadenectomy can improve the 5-year overall survival rate in advanced stage epithelial ovarian cancer but not in early stage epithelial ovarian cancer or in patients with residual tumor ≤2 cm.

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Section: Literature Search and Quality Assessmentmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Systematic lymphadenectomy in the treatment of epithelial ovarian cancer: a meta-analysis of multiple epidemiology studies

Gao

Yang

Zhang

2014

Japanese Journal of Clinical Oncology

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“…A total of 1809 articles were identified in the updated search for the most appropriate surgical procedure, of which sixteen met the inclusion criteria [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] .…”

Section: Resultsmentioning

confidence: 99%

Management of a Suspicious Adnexal Mass: A Clinical Practice Guideline

et al. 2012

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|| and the Gynecology Cancer Disease Site Groupultrasonography), there is currently no screening strategy for ovarian cancer.The purpose of this document is to identify evidence that would inform optimal recommended protocols for the identification and surgical management of adnexal masses suspicious for malignancy. OutcomesOutcomes of interest for the identification question included sensitivity and specificity. Outcomes of interest for the surgical question included optimal surgery, overall survival, progression-free or diseasefree survival, reduction in the number of surgeries, morbidity, adverse events, and quality of life. MethodologyAfter a systematic review, a practice guideline containing clinical recommendations relevant to patients in Ontario was drafted. The practice guideline was reviewed and approved by the Gynecology Disease Site Group and the Report Approval Panel of the Program in Evidence-based Care. External review by Ontario practitioners was obtained through a survey, the results of which were incorporated into the practice guideline. Practice GuidelineThese recommendations apply to adult women presenting with a suspicious adnexal mass, either symptomatic or asymptomatic. Identification of an Adnexal Mass Suspicious for Ovarian CancerSonography (particularly 3-dimensional sonography), magnetic resonance imaging (mri), and computed tomography (ct) imaging are each recommended for differentiating malignant from benign ovarian masses. However, the working group offers the following further recommendations, based on ABSTRACT QuestionsWhat is the optimal strategy for preoperative identification of the adnexal mass suspicious for ovarian cancer?What is the most appropriate surgical procedure for a woman who presents with an adnexal mass suspicious for malignancy? PerspectivesIn Canada in 2010, 2600 new cases of ovarian cancer were estimated to have been diagnosed, and of those patients, 1750 were estimated to have died, making ovarian cancer the 7th most prevalent form of cancer and the 5th leading cause of cancer death in Canadian women. Women with ovarian cancer typically have subtle, nonspecific symptoms such as abdominal pain, bloating, changes in bowel frequency, and urinary or pelvic symptoms, making early detection difficult. Thus, most ovarian cancer cases are diagnosed at an advanced stage, when the cancer has spread outside the pelvis. Because of late diagnosis, the 5-year relative survival ratio for ovarian cancer in Canada is only 40%. Unfortunately, because of the low positive predictive value of potential screening tests (cancer antigen 125 and

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“…On the basis of the results of a large-scale non-randomized epidemiological survey (n=6,686), Chan et al [17] suggested that lymphadenectomy for stage I disease improved survival in non-clear-cell EOC patients but not in OCCC patients. In a retrospective study (n=205), Suzuki et al [18] concluded that patients with early-stage OCCC who underwent lymphadenectomy did not show a significant improvement in survival. Therefore, the therapeutic value of retroperitoneal lymphadenectomy in patients with earlystage OCCC remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Prognostic Value of the Presence of Irregular Giant Nuclear Cells in pT1 Ovarian Clear Cell Carcinoma

Matsumoto

Umezawa

Sasaki

et al. 2011

Pathol. Oncol. Res.

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In the early stages of epithelial ovarian cancer, histopathological grading is important. However, the grading of ovarian clear cell carcinoma (OCCC) remains controversial. We aimed to identify irregular giant nuclear cells (IGNCs) by a simple method in clinical practice, and to evaluate the prognostic value of IGNCs in pT1 OCCC. Eighty-seven pT1 OCCC patients who underwent initial surgery at Jikei University Kashiwa Hospital, Chiba, Japan, were retrospectively assessed. Paraffin-embedded tissue sections (PTSs) stained with hematoxylin and eosin were reviewed. Giant nuclear cells (GNCs) were defined as cells with a nuclear length of more than twice the median nuclear length. GNCs with irregular nuclear circumferences were defined as IGNCs. Cases where one or more GNCs existed and where IGNCs accounted for >10% of the GNCs were classified as IGNC-positive. We also attempted to identify IGNCs on touch imprint cytology smears (TICSs). Among the 87 cases, 68 were IGNC-negative and 19 were IGNC-positive. The 5-year disease-free and overall survival rates were 88.9% and 90.3% in the total patients, 98.3% and 100% in the IGNC-negative group, and 59.7% and 62.0% in the IGNC-positive group, respectively. These survival rates were significantly lower in the IGNC-positive group than in the IGNC-negative group (adjusted hazard ratio = 14, 95% confidence interval = 2.7-124 and adjusted hazard ratio = 25, 95% confidence interval = 2.9-768, respectively). Prognostic differences were not identified for other factors. IGNC identification on 28 available TICSs predicted IGNC identification on PTSs (sensitivity = 50.0%, specificity = 100%, P = 0.007). The presence of IGNCs has clinical and prognostic value for pT1 OCCC.

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Is there any association between retroperitoneal lymphadenectomy and survival benefit in ovarian clear cell carcinoma patients?

Cited by 69 publications

References 12 publications

Systematic lymphadenectomy in the treatment of epithelial ovarian cancer: a meta-analysis of multiple epidemiology studies

Systematic lymphadenectomy in the treatment of epithelial ovarian cancer: a meta-analysis of multiple epidemiology studies

Management of a Suspicious Adnexal Mass: A Clinical Practice Guideline

Clinical and Prognostic Value of the Presence of Irregular Giant Nuclear Cells in pT1 Ovarian Clear Cell Carcinoma

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