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Should We Abandon Systematic Pelvic and Paraaortic Lymphadenectomy in Low-Grade Serous Ovarian Cancer?

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Low-grade serous ovarian carcinoma (LGSOC) is a rare disease that accounts for 5% of all ovarian cancers and requires surgical complete debulking. To date, the prognostic value of pelvic and paraaortic lymphadenectomy remains unclear in this population.

Patients and Methods

This retrospective cohort of patients with a diagnosis of LGSOC was registered in the Tumeurs Malignes Rares Gynécologiques national network, between January 2000 and July 2017, at 25 centers. All LGSOC were confirmed after pathological review and operated by primary debulking surgery (PDS) or interval debulking surgery after neoadjuvant chemotherapy (NACT-IDS). Primary endpoints were overall survival (OS) and progression-free survival (PFS).

Results

A total of 126 patients were included, 86.1% were stage III/IV, and 74.6% underwent lymph node dissection (LND). According to the Completeness of Cancer Resection (CCR) score, 83.7% had complete resection. Median OS was 130 months, and median PFS was 41 months. Pelvic and paraaortic LND had no significant impact on OS (p = 0.78) or DFS (p = 0.93), and this was confirmed in subgroups (advanced stages FIGO III/IV, CCR score 0/1 or 2/3, and timing of surgery PDS or NACT-IDS). Histological positive paraaortic lymph nodes had a significant negative impact on PFS in the whole population (HR 2.21, 1.18–4.39, p = 0.02) and in the CC0/CC1 population (HR, 2.28, 1.13–4.59, p = 0.02).

Conclusions

Systematic pelvic and paraaortic LND in patients with LGSOC improved neither overall nor PFS. A prospective trial would be necessary to validate these results but would be difficult to conduct due to the rarity of this disease.

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References

  1. Malpica A, Deavers MT, Lu K et al. Grading ovarian serous carcinoma using a two-tier system. Am J Surg Pathol. 2004;28(4):496–504.

    Article  Google Scholar 

  2. Kurman RJ, Shih I-M. The origin and pathogenesis of epithelial ovarian cancer: a proposed unifying theory. Am J Surg Pathol. 2010;34(3):433–43.

    Article  Google Scholar 

  3. Gourley C, Farley J, Provencher DM et al. Gynecologic Cancer InterGroup (GCIG) consensus review for ovarian and primary peritoneal low-grade serous carcinomas. Int J Gynecol Cancer. 2014;24(9):S9.

    Article  Google Scholar 

  4. Plaxe SC. Epidemiology of low-grade serous ovarian cancer. Am J Obstet Gynecol. 2008;198(4):459.e1–9.

    Article  Google Scholar 

  5. Gershenson DM, Sun CC, Bodurka D et al. Recurrent low-grade serous ovarian carcinoma is relatively chemoresistant. Gynecol Oncol. 2009;114(1):48–52.

    Article  Google Scholar 

  6. Schmeler KM, Gershenson DM. Low-grade serous ovarian cancer: a unique disease. Curr Oncol Rep. 2008;10(6):519–23.

    Article  Google Scholar 

  7. Kimyon Comert G, Turkmen O, Mesci CG et al. Maximal cytoreduction is related to improved disease-free survival in low-grade ovarian serous carcinoma. Tumori J. 2019;105(3):259–64.

    Article  Google Scholar 

  8. Burghardt E, Girardi F, Lahousen M et al. Patterns of pelvic and paraaortic lymph node involvement in ovarian cancer. Gynecol Oncol. 1991;40(2):103–6.

    Article  CAS  Google Scholar 

  9. Morice P, Joulie F, Camatte S et al. Lymph node involvement in epithelial ovarian cancer: analysis of 276 pelvic and paraaortic lymphadenectomies and surgical implications. J Am Coll Surg. 2003;197(2):198–205.

    Article  Google Scholar 

  10. Wafa M, Braicu EI, Muallem MZ et al. Incidence and pattern of spread of lymph node metastasis in patients with low-grade serous ovarian cancer. Anticancer Res. 2019;39(10):5617–21.

    Article  Google Scholar 

  11. Harter P, Sehouli J, Lorusso D et al. A randomized trial of lymphadenectomy in patients with advanced ovarian neoplasms. N Engl J Med. 2019;380(9):822–32.

    Article  Google Scholar 

  12. Pomel C, Dauplat J. Management of malignant epithelial tumors of the ovary. J Chir. 2004;141(5):277–84.

    Article  CAS  Google Scholar 

  13. Aletti GD, Dowdy SC, Podratz KC, Cliby WA. Relationship among surgical complexity, short-term morbidity, and overall survival in primary surgery for advanced ovarian cancer. Am J Obstet Gynecol. 2007;197(6):676.e1–7.

    Article  Google Scholar 

  14. Gockley A, Melamed A, Bregar AJ et al. Outcomes of women with high-grade and low-grade advanced-stage serous epithelial ovarian cancer. Obstet Gynecol. 2017;129(3):439–47.

    Article  Google Scholar 

  15. Stewart JM, Tone AA, Jiang H et al. The optimal time for surgery in women with serous ovarian cancer. Can. J. Surg. J. Can. Chir. 2016;59(4):223–32.

    Article  Google Scholar 

  16. Škof E, Merlo S, Pilko G, Kobal B. The role of neoadjuvant chemotherapy in patients with advanced (stage IIIC) epithelial ovarian cancer. Radiol. Oncol. 2016;50(3):341–6.

    Article  Google Scholar 

  17. Gershenson DM, Sun CC, Lu KH et al. Clinical behavior of stage II–IV low-grade serous carcinoma of the ovary. Obstet Gynecol. 2006;108(2):361–8.

    Article  Google Scholar 

  18. ESGO: Ovarian Cancer Surgery Guidelines. https://guidelines.esgo.org/media/2017/03/ESGO_ovarian_cancer_surgery_brA5_V01-website.pdf. Accessed Feb 2017

  19. Harter P, Gnauert K, Hils R et al. Pattern and clinical predictors of lymph node metastases in epithelial ovarian cancer. Int. J. Gynecol. Cancer Off. J. Int. Gynecol. Cancer Soc. 2007;17(6):1238–44.

    Article  CAS  Google Scholar 

  20. Onda T, Yoshikawa H, Yokota H et al. Assessment of metastases to aortic and pelvic lymph nodes in epithelial ovarian carcinoma. A proposal for essential sites for lymph node biopsy. Cancer 1996;78(4):803–8.

    Article  CAS  Google Scholar 

  21. Minig L, Heitz F, Cibula D et al. Patterns of lymph node metastases in apparent stage I low-Grade epithelial ovarian cancer: A multicenter study. Ann. Surg. Oncol. 2017;24(9):2720–6.

    Article  Google Scholar 

  22. Nasioudis D, Mastroyannis SA, Ko EM, Latif NA. Does tumor grade influence the rate of lymph node metastasis in apparent early stage ovarian cancer? Arch. Gynecol. Obstet. 2018;298(1):179–82.

    Article  Google Scholar 

  23. Scarabelli C, Gallo A, Visentin MC et al. Systematic pelvic and para-aortic lymphadenectomy in advanced ovarian cancer patients with no residual intraperitoneal disease. Int J Gynecol Cancer. 1997;7(1):18–26.

    Article  CAS  Google Scholar 

  24. du Bois A, Reuss A, Harter P et al. Potential role of lymphadenectomy in advanced ovarian cancer: a combined exploratory analysis of three prospectively randomized phase III multicenter trials. J Clin Oncol. 2010;28(10):1733–9.

    Article  Google Scholar 

  25. Panici PB, Maggioni A, Hacker N et al. Systematic aortic and pelvic lymphadenectomy versus resection of bulky nodes only in optimally debulked advanced ovarian cancer: a randomized clinical trial. J Natl Cancer Inst. 2005;97(8):560–6.

    Article  Google Scholar 

  26. Onda T, Yoshikawa H, Yasugi T et al. Patients with ovarian carcinoma upstaged to stage III after systematic lymphadenectomy have similar survival to stage I/II patients and superior survival to other stage III patients. Cancer 1998;83(8):1555–60.

    Article  CAS  Google Scholar 

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Funding

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Authors and Affiliations

  1. Gynecologic and Breast Oncologic Surgical Department, Georges Pompidou European Hospital, Paris, France

    V. Simon MD

  2. Gynecological and Breast Surgery and Cancerology Center, RAMSAY-Générale de Santé, Hôpital Privé des Peupliers, Paris, France

    C. Ngo MD, PhD & H. Bonsang-Kitzis MD, PhD

  3. Medical Oncology Department, Paris Descartes University, Hôpital Hôtel-Dieu, Paris, France

    E. Pujade-Lauraine MD, PhD

  4. ARCAGY – GINECO Cooperative Group, Paris, France

    E. Pujade-Lauraine MD, PhD, G. Ferron MD, PhD, C. Pomel MD, PhD, E. Leblanc MD, PhD, C. Nadeau MD, I. Ray-Cocquard MD, PhD, F. Lecuru MD, PhD & H. Bonsang-Kitzis MD, PhD

  5. Department of Surgical Oncology, Claudius Regaud Institute, IUCT Oncopole, Toulouse, France

    G. Ferron MD, PhD

  6. Department of Surgical Oncology, Centre Jean Perrin, Clermont-Ferrand, France

    C. Pomel MD, PhD

  7. Department of Surgical Oncology, Centre Oscar Lambret, Lille Cedex, France

    E. Leblanc MD, PhD

  8. Department of Surgical Oncology, CHU de Poitiers, Poitiers, France

    C. Nadeau MD

  9. Medical Oncology Department, Centre Leon Berard, Lyon, France

    I. Ray-Cocquard MD, PhD

  10. Breast, Gynecology and Reconstructive Surgical Department, Curie Institute, Paris, France

    F. Lecuru MD, PhD

  11. Université de Paris, Paris, France

    F. Lecuru MD, PhD

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  1. V. Simon MD
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  2. C. Ngo MD, PhD
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  6. E. Leblanc MD, PhD
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  10. H. Bonsang-Kitzis MD, PhD
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Correspondence to H. Bonsang-Kitzis MD, PhD.

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Simon, V., Ngo, C., Pujade-Lauraine, E. et al. Should We Abandon Systematic Pelvic and Paraaortic Lymphadenectomy in Low-Grade Serous Ovarian Cancer?. Ann Surg Oncol 27, 3882–3890 (2020). https://doi.org/10.1245/s10434-020-08361-5

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  • DOI: https://doi.org/10.1245/s10434-020-08361-5

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