The potential therapeutic role of lymph node resection in epithelial ovarian cancer: A study of 13 918 patients

Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco School of Medicine, 1600 Divisadero Street, Box 1702, San Francisco, CA 94143, USA.
British Journal of Cancer (Impact Factor: 4.84). 07/2007; 96(12):1817-22. DOI: 10.1038/sj.bjc.6603803
Source: PubMed


The aim of the study is to determine the role of lymphadenectomy in advanced epithelial ovarian cancer. The data were obtained from the Surveillance, Epidemiology and End Results (SEER) program reported between 1988 and 2001. Kaplan-Meier estimates and Cox proportional hazards regression models were used for analysis. Of 13 918 women with stage III-IV epithelial ovarian cancer (median age: 64 years), 87.9% were Caucasian, 5.6% African Americans, and 4.4% Asians. A total of 4260 (30.6%) underwent lymph node dissections with a median number of six nodes reported. For all patients, a more extensive lymph node dissection (0, 1, 2-5, 6-10, 11-20, and >20 nodes) was associated with an improved 5-year disease-specific survival of 26.1, 35.2, 42.6, 48.4, 47.5, and 47.8%, respectively (P<0.001). Of the stage IIIC patients with nodal metastases, the extent of nodal resection (1, 2-5, 6-10, 11-20, and >20 nodes) was associated with improved survivals of 36.9, 45.0, 47.8, 48.7, and 51.1%, respectively (P=0.023). On multivariate analysis, the extent of lymph node dissection and number of positive nodes were significant independent prognosticators after adjusting for age, year at diagnosis, stage, and grade of disease. The extent of lymphadenectomy is associated with an improved disease-specific survival of women with advanced epithelial ovarian cancer.

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    • "Chan and colleagues found that resection of up to 25 total nodes (basins not specified) increased the likelihood of finding metastatic deposits and improved survival from both endometrial and ovarian carcinomas [32]. They further theorized that small nodes that are radiologically and even pathologically negative could still harbor microscopic metastatic disease and require more aggressive post-operative therapy [33] [34] [35]. This report demonstrates a similar significant relationship between the number of aortic nodes harvested from the inframesenteric and infrarenal basins, and the likelihood of finding nodal metastases in each of these basins. "
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    • "Systematic lymphadenectomy improves progression-free but not overall survival in women with optimally debulked advanced ovarian carci- noma [19] . However, it may be seen that survival of women with advanced epithelial ovarian cancer correlates with the extent of lymphadenectomy [20] . "
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