Stage IIIC Ovarian/Peritoneal Serous Carcinoma

Abstract

Primary ovarian serous carcinoma patients presenting with regional lymph node metastasis without extrapelvic peritoneal metastasis are considered International Federation of Gynecology and Obstetrics (FIGO) Stage IIIC. We studied their controversial survival compared with patients with extrapelvic peritoneal metastasis in same Stage IIIC. We included primary peritoneal carcinoma patients with lymph node metastasis to investigate whether primary site of tumor has a prognostic role. Charts of patients treated at the MD Anderson Cancer Center in Houston, TX; from 1992 to 2010 were reviewed. Primary ovarian serous carcinoma patients were grouped into patients with lymph node metastasis without extrapelvic involvement (Group 1, n=13) and patients with additional extrapelvic peritoneal involvement (Group 2, n=43). Group 3 patients (n=38) were selected using similar criteria as Group 2 but with negative lymph nodes. Group 4 patients were those with primary peritoneal serous carcinoma with lymph node metastasis (n=13). Group 1 patients had statistically significant better overall survival compared with the rest of the groups. Overall survival was significantly better in Groups 4 versus 2 and Groups 3 versus 2. Primary ovarian serous carcinoma patients with lymph node metastasis without extrapelvic peritoneal involvement have better survival than those with additional extrapelvic peritoneal involvement. Primary peritoneal serous carcinoma patients with lymph node metastasis have better survival than those with primary ovarian serous carcinoma with peritoneal and lymph node metastasis. Ovarian serous carcinoma patients with extrapelvic peritoneal involvement alone have better survival than those with extrapelvic peritoneal involvement and lymph node metastasis. These findings support the proposition to revise the FIGO staging system, especially for Stage IIIC patients, in order to reflect these prognostic differences.

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

“…These group of patients showed significant best OS in our study (table 4), as described in one report that ovarian serous carcinoma patients with sole extrapelvic peritoneal involvement have better survival than those with extrapelvic peritoneal involvement and lymph node metastases 11. Additionally, an adequate staging is possible by performing a lymphadenectomy 5.…”

“…All surgical pathologic samples were examined by a gynecological pathologist. The histological diagnosis was classified according to FIGO- stages 11. Residual tumor mass was subdivided in the following groups: R0 = complete cytoreduction (=0mm) and R>0mm- ≤10mm.…”

Survival analysis of revised 2013 FIGO staging classification of epithelial ovarian cancer and comparison with previous FIGO staging classification

“…It has been also suggested that Stage IIIC in previous FIGO stage may be consisted of heterogeneous groups [ 5 ]. The most important issue that has been raised is the differences in prognosis between stage IIIC with intra-abdominal metastasis and IIIC with isolated lymph node metastasis without coelomic metastasis which is reported to be associated with better prognosis [ 6 , 7 , 8 , 9 , 10 , 11 , 12 ].…”

“…Surgical exploration and pathological staging is standard procedure for classification of EOC and International Federation of Gynecology and Obstetrics (FIGO) classification is widely used. However, there have been debates on the issues that existing FIGO staging of EOC classifies heterogeneous groups of population as same stage [ 5 , 6 ]. For example, FIGO stage IIIC patients with only isolated lymph node metastasis have been shown better prognosis compared to the patients with stage IIIC with peritoneal carcinomatosis or abdominal metastatic lesion more than 2 cm [ 6 , 7 , 8 , 9 , 10 , 11 , 12 ].…”

FIGO's staging classification for cancer of the ovary, fallopian tube, and peritoneum: abridged republication

“…Less than 10% of ovarian carcinomas extend beyond the pelvis with exclusively retroperitoneal lymph node involvement. Evidence in the literature indicates that these cases have a better prognosis than that of tumors with abdominal peritoneal involvement [ 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. The new staging includes a revision of stage III patients and assignment to stage IIIA1 based on spread to the retroperitoneal lymph nodes without intraperitoneal dissemination.…”