Abstract
Purpose
To delineate the relevance of pelvic and para-aortic node involvement in optimally cytoreduced (residual tumour <1 cm) stage IIIC ovarian cancer patients.
Methods
Ninety-five consecutive optimally cytoreduced (R ≤ 1 cm) patients with primary stage IIIc ovarian cancer underwent stage-related surgery and got adjuvant platinum-based chemotherapy. Median follow-up: 53.5 months. All patients got systematic lymphadenectomy. On average, 24.7 pelvic and para-aortic lymph nodes were removed per patient (range 1–60 nodes). Patients were stratified into three groups to evaluate node involvement (ratio: affected to resected nodes): (1) (=0); (2) (>0–≤0.5) >0 and ≤50 % of affected nodes; (3) (>0.5–≤1) >50 % of affected nodes. Clinical parameters were retrospectively evaluated. Kaplan–Meier survival curve was used to evaluate the prognostic value.
Results
Most often serous histology, histologic grade 3 and a node ratio >0–≤0.5 (61.1 %) were detected. Complete cytoreduction (R = 0 mm) has significant best prognostic impact compared to R > 0 mm–1 cm (OS: p = 0.047, PFS: p = 0.00). Node involvement was associated with serous histology and grade 3. Increasing node ratio leads to significant decreased OS (p = 0.019) and significant best OS was associated with node ratio >0–≤0.5.
Conclusions
The goal is optimal cytoreduction in advanced ovarian cancer. More extensive lymphadenectomy seems to play an important role in providing an accurate staging, and the node ratio might give prognostic information. Current prospective studies like the LION study (AGO-Ovar) had to investigate if these data have therapeutic implications and may be considered in future staging.
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References
Abe A, Furumoto H, Irahara M, Ino H, Kamada M, Naka O, Sasaki M, Kagawa T, Okitsu O, Kushiki N (2010) The impact of systematic para-aortic and pelvic lymphadenectomy on survival in patients with optimally debulked ovarian cancer. J Obstet Gynaecol Res 36(5):1023–1030
Aletti GD, Dowdy S, Podratz KC et al (2006) Role of lymphadenectomy in the management of grossly apparent advanced stage epithelial ovarian cancer. Am J Obstet Gynecol 195(6):1862–1868
Bachmann C, Bachmann S, Fehm T, Staebler A, Becker S, Rothmund R, Gardanis C, Grischke EM, Wallwiener D, Solomayer EF (2012) Nodal status—its impact on prognosis in advanced ovarian cancer. J Cancer Res Clin Oncol 138(2):261–267
Bakkar R, Gershenson D, Fox P, Vu K, Zenali M, Silva E (2014) Stage IIIC ovarian/peritoneal serous carcinoma: a heterogeneous group of patients with different prognoses. Int J Gynecol Pathol 33(3):302–308. doi:10.1097/PGP.0b013e3182988dfd
Balbi G, Manganaro MA, Monteverde A, Landino I, Franzese C, Gioia F (2009) Ovarian cancer: lymph node metastases. Eur J Gynaecol Oncol 30(3):289–291
Bristow RE, Tomacruz RS et al (2002) Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol 20(5):1248–1259
Carnino F, Fuda G et al (1997) Significance of lymph node sampling in epithelial carcinoma of the ovary. Gynecol Oncol 65(3):467–472
Chan JK, Urban R, Hu JM et al (2007) The potential therapeutic role of lymph node resection in epithelial ovarian cancer: a study of 13918 patients. Br J Cancer 96(12):1817–1822 Epub 2007 May 22
Chang SJ, Bristow RE, Ryu HS (2012) Prognostic significance of systematic lymphadenectomy as part of primary debulking surgery in patients with advanced ovarian cancer. Gynecol Oncol 126(3):381–386
Chekerov R, Braicu I, Castillo-Tong DC, Richter R, Cadron I, Mahner S, Woelber L, Marth C, Van Gorp T, Speiser P, Zeillinger R, Vergote I, Sehouli J (2013) Outcome and clinical management of 275 patients with advanced ovarian cancer International Federation of Obstetrics and Gynecology II to IV inside the European Ovarian Cancer Translational Research Consortium-OVCAD. Int J Gynecol Cancer 23(2):268–275
Denny L, Quinn M, Hacker N (2012) FIGO cancer report. Int J Gynaecol Obstet 119(Suppl 2):S89
di Re F, Baiocchi G, Fontanelli R, Grosso G, Cobellis L, Raspagliesi F, di Re E (1996) Systematic pelvic and paraaortic lymphadenectomy for advanced ovarian cancer: prognostic significance of node metastases. Gynecol Oncol 62(3):360–365
Du Bois A et al (2009) `Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials. Cancer 15:1234–1244
Harter P, Gnauert K, Hils R et al (2007) Pattern and clinical predictors of lymph node metastases in epithelial ovarian cancer. Int J Gynecol Cancer 17(6):1238–1244. Epub 2007 Apr 12
Höhn AK, Einenkel J, Wittekind C, Horn LC (2014) New FIGO classification of ovarian, fallopian tube and primary peritoneal cancer. Pathologe 35(4):322–326. doi:10.1007/s00292-014-1908-0. German
Hoskins McGuir et al (1994) The effect of diameter of largest residual disease on survival after primary cytoreductive surgery in patients with suboptimal residual epithelial ovarian carcinoma. Am J Obstet Gynecol 170(4):974–979
Kim HS, Ju W, Jee BC et al (2010) Systematic lymphadenectomy for survival in epithelial ovarian cancer. Int J Gynecol Cancer 20(4):520–528. doi:10.1111/IGC.0b013e3181d6de1d
Mahdi H, Thrall M, Kumar S, Hanna R, Seward S, Lockhart D, Morris RT, Swensen R, Munkarah AR (2011) The prognostic impact of the ratio of positive lymph nodes on survival of epithelial ovarian cancer patients. J Surg Oncol 103(7):724–729
Nomura H, Tsuda H, Susumu N, Fujii T, Banno K, Kataoka F, Tominaga E, Suzuki A, Chiyoda T, Aoki D (2011) Lymph node metastasis in grossly apparent stages I and II epithelial ovarian cancer. J Surg Oncol
Onda T, Yoshikawa H, Yasugi T et al (1998) Patients with ovarian carcinoma upstaged to stage III after systematic lymphadenctomy have similar survival to Stage I/II patients and superior survival to other Stage III patients. Cancer 83(8):1555–1560
Panici PB, Maggioni A et al (2005) 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 97(8):560–566
Pereira A, Pérez-Medina T, Magrina JF, Magtibay PM, Millan I, Iglesias E (2012) The role of lymphadenectomy in node-positive epithelial ovarian cancer. Int J Gynecol Cancer 22(6):987–992
Scarabelli C, Gallo A, Visentin MC et al (1997) Systematic pelvic and para-aortic lymphadenectomy in advanced ovarian cancer patients with no residual intraperitoneal disease. Int J Gynecol Cancer 7(1):18–26
Suh DH, Kim TH, Kim JW, Kim SY, Kim HS, Lee TS, Chung HH, Kim YB, Park NH, Song YS (2013) Improvements to the FIGO staging for ovarian cancer: reconsideration of lymphatic spread and intraoperative tumor rupture. J Gynecol Oncol 24(4):352–358
Takeshima N et al (2005) Lymph node metastasis in ovarian cancer: difference between serous and non-serous primary tumours. Gynecol Oncol 99(2):427–431
Ulker V, Kuru O, Numanoglu C, Akbayır O, Polat I, Uhri M (2014) Lymph node metastasis in patients with epithelial ovarian cancer macroscopically confined to the ovary: review of a single-institution experience. Arch Gynecol Obstet 289(5):1087–1092. doi:10.1007/s00404-013-3078-3. Epub 2013 Nov 9
Wimberger P, Lehmann N, Kimmig R, Burges A, Meier W, Du Bois A (2007) Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group. Prognostic factors for complete debulking in advanced ovarian cancer and its impact on survival. An exploratory analysis of a prospectively randomized phase III study of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group (AGO-OVAR). Gynecol Oncol 106(1):69–74
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The authors declare that there are no conflict of interests.
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Our investigation of 95 patients has been approved by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. All persons gave their informed consent prior to their inclusion in the study.
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The Editor-in-Chief has decided to retract this article. Upon investigation by an independent researcher, it has been found that the authors have duplicated data from the following article: Role of Pelvic and Para-aortic Lymph Node Metastases in Optimally Cytoreduced Advanced Ovarian Cancer; Bachmann C, Brucker SY, Kraemer B, Rothmund R, Staebler A, Fend F, Wallwiener D, Grischke EM. Anticancer Res. 2015 Jun;35(6):3479-84
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Bachmann, C., Brucker, S.Y., Kraemer, B. et al. RETRACTED ARTICLE: The prognostic relevance of node metastases in optimally cytoreduced advanced ovarian cancer. J Cancer Res Clin Oncol 141, 1475–1480 (2015). https://doi.org/10.1007/s00432-015-1945-y
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DOI: https://doi.org/10.1007/s00432-015-1945-y