Abstract
Background
To evaluate the patterns of lymphatic spread in epithelial ovarian cancer (EOC) macroscopically confined to the ovary and to determine risk factors for lymph node metastasis.
Materials and methods
All patients with clinically apparent stage IA/B/C EOCs who underwent staging surgery between January 2003 and February 2013 were retrospectively identified.
Results
Two hundred and thirty-six (n = 236) consecutive patients were operated for primary epithelial ovarian carcinoma. Sixty-two of these patients (26.2 %) who underwent a comprehensive staging procedure including pelvic and paraaortic lymphadenectomy were diagnosed with tumors confined to one or two ovaries (stage IA/B/C). Of these 62 patients, 17 (27.4 %) had upstaged disease and 8 (12.9 %) had lymph node metastasis. Tumor histology was serous in 25 patients (40.3 %), mucinous in 23 patients (37 %), endometrioid in 9 patients (14.5 %), and clear cell in 5 patients (8 %). Positive lymph node status was found in 20 % (5/25) of those with serous histology while this rate was only 8.1 % (3/37) in those with non-serous disease. Although the presence of ascites was not associated with an increased risk of lymph node involvement (p = 0.24), positive peritoneal cytology (p = 0.001) and grade 3 disease (p = 0.001) were significant predictors of lymph node involvement.
Conclusion
All patients diagnosed with EOC macroscopically confined to the ovary should be considered for comprehensive staging surgery including pelvic and paraaortic lymphadenectomy.
Similar content being viewed by others
References
Kwon YS, Hahn HS, Kim TJ, Lee IH, Lim KT, Lee KH et al (2009) Fertility preservation in patients with early epithelial ovarian cancer. J Gynecol Oncol 20(1):44–47
Powless CA, Aletti GD, Bakkum-Gamez JN, Cliby WA (2011) Risk factors for lymph node metastasis in apparent early-stage epithelial ovarian cancer: implications for surgical staging. Gynecol Oncol 122(3):536–540
Benedet JL, Bender H, Jones H 3rd, Ngan HY, Pecorelli S (2000) FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology. Int J Gynaecol Obstet 70:209–262
Maggioni A, Benedetti Panici P, Dell’Anna T, Landoni F, Lissoni A, Pellegrino A et al (2006) Randomised study of systematic lymphadenectomy in patients with epithelial ovarian cancer macroscopically confined to the pelvis. Br J Cancer 95(6):699–704
Chan JK, Urban R, Hu JM, Shin JY, Husain A, Teng NN 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
Desteli GA, Gultekin M, Usubutun A, Yuce K, Ayhan A (2010) Lymph node metastasis in grossly apparent clinical stage Ia epithelial ovarian cancer: hacettepe experience and review of literature. World J Surg Oncol 30(8):106
Benedetti-Panici P, Greggi S, Maneschi F, Scambia G, Amoroso M, Rabitti C et al (1993) Anatomical and pathological study of retroperitoneal nodes in epithelial ovarian cancer. Gynecol Oncol 51(2):150–154
Onda T, Yoshikava H, Yokota H, Yasugi T, Taketani Y (1996) Assessment of metastases to aortic and pelvic lymph nodes in epithelial ovarian carcinoma. A proposal for essential sites for lymph node biopsy. Cancer 78(4):803–808
Chen SS, Lee L (1983) Incidence of para-aortic and pelvic lymph-node metastases in epithelial carcinoma of the ovary. Gynecol Oncol 16(1):95–100
Carnino F, Fuda G, Ciccone G, Iskra L, Guercio E, Dadone D et al (1997) Significance of lymph nodes sampling in epithelial carcinoma of the ovary. Gynecol Oncol 65(3):467–472
Petru E, Lahousen M, Tamussino K, Pickel H, Stranzl H, Stettner H et al (1994) Lymphadenectomy in stage I ovarian cancer. Am J Obstet Gynecol 170(2):656–662
Cass I, Runowicz CD, Fields AL, Goldberg GL, Leuchter RS, Lagasse LD, Karlan BY (2001) Pattern of lymph node metastases in clinically unilateral stage I invasive epithelial ovarian carcinomas. Gynecol Oncol 80(1):56–61
Chan JK, Munro EG, Cheung MK, Husain A, Teng NN, Berek JS, Osann K (2007) Association of lymphadenectomy and survival in stage I ovarian cancer patients. Obstet Gynecol 109(1):12–19
Ayhan A, Gultekin M, Taskiran C, Celik NY, Usubutun A, Kucukali T, Yuce K (2005) Lymphatic metastasis in epithelial ovarian carcinoma with espect to clinicopathological variables. Gynecol Oncol 97(2):400–404
Aletti GD, Dowdy S, Podratz KC, Cliby WA (2006) Role of lymphadenectomy in the management of grossly apparent advanced stage epithelial ovarian cancer. Am J Obstet Gynecol 195(6):1862–1868
Ditto A, Martinelli F, Reato C, Kusamura S, Solima E, Fontanelli R et al (2012) Systematic para-aortic and pelvic lymphadenectomy in early stage epithelial ovarian cancer: a prospective study. Ann Surg Oncol 19(12):3849–3855
Frumovitz M, Schmeler KM, Malpica A, Sood AK, Gershenson DM (2010) Unmasking the complexities of mucinous ovarian carcinoma. Gynecol Oncol 117(3):491–496
Ji J, Försti A, Sundquist J, Lenner P, Hemminki K (2008) Survival in ovarian cancer patients by histology and family history. Acta Oncol 47(6):1133–1139
Cho YH, Kim DY, Kim JH, Kim YM, Kim KR, Kim YT et al (2006) Is complete surgical staging necessary in patients with stage I mucinous epithelial ovarian tumors? Gynecol Oncol 103(3):878–882
Suzuki M, Ohwada M, Yamada T, Kohno T, Sekiguchi I, Sato I (2000) Lymph node metastasis in stage I epithelial ovarian cancer. Gynecol Oncol 79(2):305–308
Havrilesky LJ, Peterson BL, Dryden DK, Soper JT, Clarke-Pearson DL, Berchuck A (2003) Predictors of clinical outcomes in the laparoscopic management of adnexal masses. Obstet Gynecol 102(2):243
Canis M, Botchorishvili R, Manhes H, Wattiez A, Mage G, Pouly JL et al (2000) Management of adnexal masses: role and risk of laparoscopy. Semin Surg Oncol 19(1):28–35
Canis M, Rabischong B, Botchorishvili R, Tamburro S, Wattiez A, Mage G et al (2001) Risk of spread of ovarian cancer after laparoscopic surgery. Curr Opin Obstet Gynecol 13(1):9–14
Leminen A, Lehtovirta P (1999) Spread of ovarian cancer after laparoscopic surgery: report of eight cases. Gynecol Oncol 75(3):387–390
Sainz de la Cuesta R, Goff BA, Fuller AF Jr, Nikrui N, Eichhorn JH, Rice LW (1994) Prognostic importance of intraoperative rupture of malignant ovarian epithelial neoplasms. Obstet Gynecol 84(1):1–7
Vergote I, De Brabanter J, Fyles A, Bertelsen K, Einhorn N, Sevelda P et al (2001) Prognostic importance of degree of differentiation and cyst rupture in stage I invasive epithelial ovarian carcinoma. Lancet 357(9251):176–182
Nezhat FR, Ezzati M, Chuang L, Shamshirsaz AA, Rahaman J, Gretz H (2009) Laparoscopic management of early ovarian and fallopian tube cancers: surgical and survival outcome. Am J Obstet Gynecol 200(1):83
Park JY, Kim DY, Suh DS, Kim JH, Kim YM, Kim YT et al (2008) Comparison of laparoscopy and laparotomy in surgical staging of early-stage ovarian and fallopian tubal cancer. Ann Surg Oncol 15(7):2012–2019
Le T, Adolph A, Krepart GV, Lotocki R, Heywood MS (2002) The benefits of comprehensive surgical staging in the management of early-stage epithelial ovarian carcinoma. Gynecol Oncol 85(2):351–355
Conflict of interest
We declare that we have no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ulker, V., Kuru, O., Numanoglu, C. et al. Lymph node metastasis in patients with epithelial ovarian cancer macroscopically confined to the ovary: review of a single-institution experience. Arch Gynecol Obstet 289, 1087–1092 (2014). https://doi.org/10.1007/s00404-013-3078-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-013-3078-3