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Utilization of sentinel lymph node biopsy in the early ovarian cancer surgery

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

Sentinel lymph node (SLN) biopsy has been incorporated into surgical care for many malignancies; however, the utility has not been examined in ovarian cancer. This study examined population-level trends, characteristics, and outcomes related to SLN biopsy in early stage ovarian cancer.

Methods

This is a retrospective cohort study querying the National Cancer Institute's Surveillance, Epidemiology, and End Result Program from 2003–2018. The study population consisted of 11,512 women with stage I ovarian cancer who had adnexectomy-based surgical staging including lymph node evaluation. Exposure allocation was based on SLN biopsy use. Main outcomes measured were (i) trends and characteristics associated with SLN biopsy use, assessed by multivariable logistic regression model, and (ii) overall survival assessed with inverse provability of treatment weighting propensity score.

Results

SLN biopsy was performed in less than 1% of study population. In a multivariable analysis, recent surgery (2011–2018 versus 2003–2010, odds ratio [OR] 1.64, 95% confidence interval [CI] 1.03–2.59), smaller tumor size (< 10 versus ≥ 10 cm, OR 3.07, 95% CI 1.20–7.84), and East registry area (OR 2.74, 95% CI 1.73–4.36) remained independent characteristics for SLN biopsy use. In a propensity score weighted model, 5-year overall survival rate was 90.5% for the SLN biopsy-incorporated group and 88.6% for the lymphadenectomy group (hazard ratio 0.96, 95% CI 0.53–1.73).

Conclusion

SLN biopsy was rarely performed for early ovarian cancer surgery during the study period with insufficient evidence to interpret the survival effect. SLN biopsy in early ovarian cancer appears to be in early development phase, warranting further study and careful evaluation to assess feasibility and oncologic outcome.

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Data availability statement

The data that support the findings of this study are openly available in The National Cancer Institute’s Surveillance, Epidemiology, and End Results Program at http://seer.cancer.gov/.

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Funding

Ensign Endowment for Gynecologic Cancer Research (K.M.). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90033, USA

    Koji Matsuo, Syem K. Barakzai, Neda D. Jooya & Lynda D. Roman

  2. Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA

    Koji Matsuo & Lynda D. Roman

  3. Department of Obstetrics and Gynecology, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Maximilian Klar

  4. Section of Urology, University of Chicago Medicine, Chicago, IL, USA

    David J. Nusbaum

  5. Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan

    Muneaki Shimada

  6. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA

    Jason D. Wright

Authors
  1. Koji Matsuo
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  2. Maximilian Klar
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  7. Lynda D. Roman
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Contributions

Conceptualization: K.M.; data curation: K.M.; formal analysis: K.M.; funding acquisition: K.M. and L.D.R.; investigation: all authors; methodology: K.M..; project administration: K.M.; resources: all; software: K.M.; supervision: M.K., L.D.R., and J.D.W.; validation: K.M.; visualization: K.M.; writing—original draft: K.M.; writing—review & editing: all authors.

Corresponding author

Correspondence to Koji Matsuo.

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Conflict of interest

all were unrelated to this work: consultant, research grant, Merck, and royalties, UpToDate (J.D.W.); consultant, Quantgene (L.D.R.); none for others.

Ethical approval

University of Southern California Institutional Review Board exemption (HS-16-00481).

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Not applicable.

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Not applicable.

Transparency

The manuscript’s corresponding author (K.M.) affirms that the manuscript is​ a honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. The National Cancer Institute's Surveillance, Epidemiology, and End Results Program is the source of the de-identified data used; and the program has not verified and is not responsible for the statistical validity of the data analysis or the conclusions ​derived by the study team. Race/ethnicity was grouped per the program definition.

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Matsuo, K., Klar, M., Barakzai, S.K. et al. Utilization of sentinel lymph node biopsy in the early ovarian cancer surgery. Arch Gynecol Obstet 307, 525–532 (2023). https://doi.org/10.1007/s00404-022-06595-0

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  • DOI: https://doi.org/10.1007/s00404-022-06595-0

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