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KMID : 1137020180290050069
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Journal of Gynecologic Oncology
2018 Volume.29 No. 5 p.69 ~ p.69
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Adequate pelvic lymphadenectomy and survival of women with early-stage epithelial ovarian cancer
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Matsuo Koji
Machida Hiroko
Mariani Andrea
Mandelbaum Rachel S.
Glaser Gretchen E.
Gostout Bobbie S.
Roman Lynda D.
Wright Jason D.
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Abstract
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Objective: To examine the trends and survival for women with early-stage epithelial ovarian cancer who underwent adequate lymphadenectomy during surgical treatment.
Methods: This is a retrospective observational study examining the Surveillance, Epidemiology, End Results program between 1988 and 2013. We evaluated 21,537 cases of stage I?II epithelial ovarian cancer including serous (n=7,466), clear cell (n=6,903), mucinous (n=4,066), and endometrioid (n=3,102) histology. A time-trend analysis of the proportion of patients who underwent adequate pelvic lymphadenectomy (≥8 per Gynecologic Oncology Group [GOG] criteria, ≥12 per Collaborative Group Report [CGR] criteria for bladder cancer, and >22 per Mayo criteria for endometrial cancer) and a survival analysis associated with adequate pelvic lymphadenectomy were performed.
Results: There were significant increases in the proportion of women who underwent adequate lymphadenectomy: GOG criteria 3.6% to 28.6% (1988?2010); CGR criteria 2.4% to 22.4% (1988?2013); and Mayo criteria 0.7% to 9.5% (1988?2013) (all, p<0.05). On multivariable analysis, adequate lymphadenectomy was independently associated with improved cause-specific survival compared to inadequate lymphadenectomy: GOG criteria, adjusted-hazard ratio (HR)=0.75, CGR criteria, adjusted-HR=0.77, and Mayo criteria, adjusted-HR=0.85 (all, p<0.05). Compared to inadequate lymphadenectomy, adequate lymphadenectomy was significantly associated with improved cause-specific survival for serous (HR range=0.67?0.73), endometrioid (HR range=0.59?0.61), and clear cell types (HR range=0.66?0.73) (all, p<0.05) but not in mucinous type (HR range=0.80?0.91; p>0.05).
Conclusion: Quality of lymphadenectomy during the surgical treatment for early-stage epithelial ovarian cancer has significantly improved. Adequate lymphadenectomy is associated with a 15%?25% reduction in ovarian cancer mortality compared to inadequate lymphadenectomy.
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KEYWORD
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Ovarian Neoplasms, Early-stage, Lymph Node Excision, Adequate, Trend, Survival
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