Prognostic significance of lymph node metastasis and lymphadenectomy in early-stage ovarian carcinosarcoma

Abstract

BackgroundThe role that lymph node dissection (LND) plays in the management of ovarian carcinosarcoma (OCS) is unclear due to its rarity. This study investigated lymph node metastasis (LNM) prevalence in women with early OCS and effects of LND and LNM on survival.MethodsData of women diagnosed with OCS, whose primary tumor was confined to ovaries (American Joint Committee on Cancer [AJCC] T1) or pelvic cavity (AJCC T2), between 1988 and 2010 were collected from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were classified into lymphadenectomy (LND [+]) and no lymphadenectomy (LND [−]) groups.ResultsA total of 363 women were included. The prevalence of LNM was 9.6% in AJCC T1 and 16.3% in AJCC T2. Multivariate analysis showed that LND and AJCC T categories were independent prognostic variables, irrespective of cancer-specific survival (CSS) or overall survival (OS). Subgroup analysis by AJCC T categories revealed that LND (+) group in AJCC T2 had a better survival outcome compared to LND (−) group (CSS, HR [95% CI] = 0.61 [0.43–0.87]; OS, HR [95% CI] = 0.59 [0.42–0.83]). There was no survival difference between groups in AJCC T1 (CSS, HR [95% CI] = 0.96 [0.56–1.65]; OS, HR [95% CI] = 0.88 [0.56–1.38]). Multivariate analysis was further carried out in LND (+) group and demonstrated that LNM and AJCC T2 had poor CSS and OS. Subgroup analysis by AJCC T categories showed that worse survival was observed in LNM (+) group compared to LNM (−) group in AJCC T2 (CSS, HR [95% CI] = 3.62 [1.50–8.73]; OS, HR [95% CI] = 3.71 [1.59–8.68]) but not in AJCC T1 (CSS, HR [95% CI] = 1.78 [0.50–6.37]; OS, HR [95% CI] = 1.97 [0.61–6.39]).ConclusionRegional lymphadenectomy should be performed in patients with AJCC T2 OCS. LND and LNM were not significantly associated with prognosis in AJCC T1 while LNM had a trend toward worse survival.

Development and Validation of Nomograms for Epithelial Ovarian Cancer: a SEER Population-Based, Real-World Study

“…However, previous studies on ovarian cancer prognosis were not comprehensive enough because they focused mainly on the effects of age, stage, metastases or marital status on survival [31][32][33][34]. Lymph node status works as a risk stratification for patients with EOC [35], and it is always absent in the nomogram for ovarian cancer. Our nomograms integrated personalized characteristics, tumor characteristics, lymph nodes status and treatment to predict the prognosis for OS and CSS of ovarian cancer.…”

Impact of Lymphadenectomy on Outcomes of Early-Stage Ovarian Cancer: A Systematic Review and Meta-Analysis

“…After reviewing them by the titles and abstracts, we excluded 3,504 studies due to nonrelevance with the review topic. Of the 38 studies selected for full-text analysis, 24 were excluded with reasons and a total of 12 studies were included in the review (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41). Details of included studies are presented in Table 1.…”

“…Only one study was an RCT while all others were retrospective observational studies. Six studies ( 30 , 31 , 33 , 34 , 36 , 41 ) were conducted on epithelial tumors, three on malignant germ-cell tumors ( 32 , 39 , 40 ), two on sex cord-stromal tumors ( 35 , 38 ) and one was only on ovarian carcinosarcoma ( 37 ). The sample size in the lymphadenectomy arm varied from 40 to 8,489 patients while in the control arm it varied from 22 to 4,628 patients.…”

Clinical Nomograms for Predicting the Overall Survival and Cancer-specific Survival of patients with Ovarian Carcinosarcoma patients after Primary Surgery

“…We found that grade was an important index for evaluating not only the degree of malignancy but also the prognosis of ovarian cancer. Grade has been found to be associated with the prognosis of OCS in many studies 20 . Paulsson et al found that the grade (i.e., grade 3 vs. 1-2) of the epithelial component of the tumor was a significant prognostic factor using multivariable Cox analysis 17 .…”

“…These results suggest that lymph node dissection is necessary for the treatment of OCS. Wang et al found that worse survival was observed in the lymph node (LN) (+) group than in the LN (-) group among patients with advanced OCS 20 . In the present study, using X-tile analysis, we adopted 9 and 10 as thresholds for the number of lymph node metastases for OCS prognosis analysis; we found that the number of lymph node metastases was an independent factor for OS.…”