Survival Analysis of Lymph Node Resection in Ovarian Cancer: A Population-Based Study

Abstract

Objective: This study aimed at comprehensively investigating the survival impact of lymphadenectomy during primary surgery in ovarian cancer. Methods: Based on the surveillance, epidemiology, and end results registry (SEER) database, we included ovarian cancer patients with detailed information between 2010 and 2016. Cox regression was performed to select prognostic factors. We conducted propensity score-weighted survival analysis to balance baseline variables, and series of stratified analyses to control main confounding factors. Results: A total of 8,652 patients were ultimately identified. Among 4,360 patients with advanced disease, lymphadenectomy did not show significant survival benefit in general (median overall survival 44 months in non-lymphadenectomy vs. 49 months in lymphadenectomy group, P = 0.055). In subgroup analysis on patients received optimal debulking, lymphadenectomy did not significantly benefit the survival outcome (median overall survival 51, 47, 60, and 58 months in the non-lymphadenectomy, 1-9 lymph nodes, 10-19 lymph nodes, ≥20 lymph nodes groups, respectively, P = 0.287). Consistent results were observed in further stratification analyses. In optimal debulking subgroup, lymph node metastasis indicated worse survival. However, when limited the number of removed lymph nodes to more than 15, there was a marginal statistical difference in overall survival (P = 0.0498) while no significant difference presented in cause-specific survival (P = 0.129) between non-lymphadenectomy, pathological negative lymph node group and positive lymph node group. And the regions of lymph metastasis were also not significantly associate with survival (P = 0.123). Among 3,266 (75%) patients with apparent early-stage disease received lymphadenectomy, 7.75% of whom were reported isolated lymph nodes metastasis and have a poorer survival (P < 0.05). Conclusions: In primary debulking for patients with advanced ovarian cancer, lymphadenectomy was not associated with more favorable outcomes when compared to no lymphadenectomy. The value of lymphadenectomy lies more in staging for apparent early disease rather than therapeutic benefit.

Prognostic Outcome of Mesenchymal Transition Biomarkers in Correlation with EGFR Expression in Epithelial Ovarian Carcinoma Patients

“…This finding disagreed with Gockley et al, (2017) study in which 96% of total cases were high-grade ovarian carcinomas. Cheng et al, (2020) study revealed that only 38% of cases had grade 3 EOC. Paes et al, (2011) andEdrem et al, (2018) also showed that 41% of cases were grade 2.…”

Survival Impact of Number of Removed Para-Aortic Lymph Nodes in Stage I Epithelial Ovarian Cancer

“…Although the quality of lymphadenectomy has improved with the experience of surgeons and improvement of surgical techniques by years, lymphadenectomy is absolutely associated with increased risk of complications [4,6] and this leads to some concerns about performing or canceling this approach. However, lymphadenectomy is a part of EOC surgery and is particularly important in early stage EOC when compared to advanced stage disease [11].…”

Management of nodal disease in advanced-stage ovarian cancer: porta hepatis, celiac, pelvic and paraaortic lymphadenectomy

“…However, results from randomized controlled studies demonstrate that lymphadenectomy was not associated with improved OS (HR: 1.02; 95% CI: 0.85-1.22). Similarly, in a population-based study, Cheng et al [11] showed that lymphadenectomy did not have a significant survival benefit among 4360 patients with advanced-stage ovarian cancer (median OS: 44 months in no-lymphadenectomy group and 49 months in lymphadenectomy group, p = 0.055). In a meta-analysis involving 1607 patients by Lin et al [26], systematic lymphadenectomy in patients with ovarian cancer was not associated with longer OS (HR: 1.00; 95% CI: 0.94, 1.07; p = 0.90) or PFS (HR: 0.97; 95% CI: 0.87, 1.08; p = 0.62) when optimal cytoreduction was achieved.…”

“…Systematic pelvic and paraaortic lymphadenectomy is a major component of the surgical staging procedure in apparent stage I disease. On the contrary, in advanced stages, retrospective studies have indicated an improved survival in patients who underwent systematic lymphadenectomy; randomized controlled studies reported no better outcomes [9][10][11][12]. Recently, differently from previous studies, the LION study, which was a well-designed randomized controlled trial, did not report any survival advantage for systematic lymphadenectomy in patients without bulky lymphadenopathy [12].…”