Skip to main content

Advertisement

SpringerLink
Log in

Nodal status—its impact on prognosis in advanced ovarian cancer

  • Original Paper
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Prognostic impact of nodal status or lymphadenectomy in advanced ovarian cancer is still unclear. Known best prognostic impact in advanced ovarian cancer has the residual tumor mass. The aim of this retrospective study is to examine the importance of nodal status in correlation with residual tumor mass.

Methods

One hundred and fifty-seven consecutive patients with primary stage III ovarian cancer underwent surgery between 01/2000 and 06/2007 at the Department of gynecology and obstetrics, University Hospital, Tübingen, Germany. All patients got stage-related surgery and platin-based chemotherapy. Median follow-up time was 53.5 months, and all patients were included in the study.

Results

Resection status and nodal status are significant prognostic factors in our study (P < 0.001). In FIGO III, patients without residual tumor (R0) had significant best OS and PFS independent to node status (N0/N+; P = 0.002) compared to patients with residual tumor. In contrast, node status had significant positive impact on PFS in patients without residual tumor and node negativity. With theincrease in residual tumor, the influence of lymphnode metastases on prognosis is decreasing.

Conclusion

Main intention of primary surgery is R0 resection with best prognosis in advanced stages. A systematic lymphadenectomy in cases with R0 resection or residual tumor <1 cm seems to be reasonable with positive impact on prognosis. Node status has impact on prognosis in patients with negative node after R0 resection with best PFS in FIGO III. Further prospective studies had to show whether systematic lymphadenectomy in suboptimally tumor-reduced patients can improve prognosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

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

    Article  PubMed  Google Scholar 

  • Aletti GD, Dowdy S 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

    Article  PubMed  Google Scholar 

  • Balbi G, Manganaro MA, Monteverde A, Landino I, Franzese C, Gioia F (2009) Ovarian cancer: lymphnode metastases. Eur J Gynaecol Oncol 30(3):289–291

    PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Carnino F, Fuda G et al (1997) Significance of lymph node sampling in epithelial carcinoma of the ovary. Gynecol Oncol 65(3):467–472

    Article  PubMed  CAS  Google Scholar 

  • Chan JK, Urban R 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

    Article  PubMed  CAS  Google Scholar 

  • Crawford SC, Vasey PA et al (2005) Does aggressive surgery only benefit patients with less advanced ovarian cancer? Results from an international comparison within the SCOTROC-1 trial. J Clin Oncol 23(34):8802–8811

    Article  PubMed  Google Scholar 

  • 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):5–360

    Google Scholar 

  • 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

    Article  Google Scholar 

  • Eisenkop SM, Friedman RL et al (1998) Complete cytoreductive surgery is feasible and maximizes survival in patients with advanced epithelial ovarian cancer: a prospective study. Gynecol Oncol 69(2):103–108

    Article  PubMed  CAS  Google Scholar 

  • Harter P, Bois A et al (2006) Surgery in recurrent ovarian cancer: the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR trial. Ann Surg Oncol 13(12):1702–1710

    Article  PubMed  Google Scholar 

  • Harter P, Gnauert K et al (2007) Pattern and clinical predictors of lymph node metastases in epithelial ovarian cancer. Int J Gynecol Cancer 17:1238–1244

    Article  PubMed  CAS  Google Scholar 

  • Harter P, Hahmann M, Lueck HJ, Poelcher M, Wimberger P, Ortmann O, Canzler U, Richter B, Wagner U, Hasenburg A, Burges A, Loibl S, Meier W, Huober J, Fink D, Schroeder W, Muenstedt K, Schmalfeldt B, Emons G, du Bois A (2009) Surgery for recurrent ovarian cancer: role of peritoneal carcinomatosis: exploratory analysis of the DESKTOP I trial about risk factors, surgical implications, and prognostic value of peritoneal carcinomatosis. Ann Surg Oncol 16:1324–1330

    Article  PubMed  CAS  Google Scholar 

  • Hoskins WJ, McGuir WP 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 70(4):974–979

    Google Scholar 

  • Kaku T, Ogawa S et al (2003) Histological classification of ovarian cancer. Med Electron Microsc 36(1):9–17

    Article  PubMed  Google Scholar 

  • Kim HS et al (2010) Systematic lymphadenectomy for survival in epithelial ovarian cancer. Int J Gynecol Cancer 20(4):520–528

    Article  PubMed  Google Scholar 

  • Mayr D, Diebold J (2000) Grading of ovarian carcinomas. Int J Gynecol Pathol 19(4):348–353

    Article  PubMed  CAS  Google Scholar 

  • Onda T, Yoshikawa H 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

    Article  PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Runnebaum IB, Stickeler E (2001) Epidemiological and molecular aspects of ovarian cancer risk. J Cancer Res Clin Oncol 127(2):73–79

    Article  PubMed  CAS  Google Scholar 

  • Saygili (2002) The effect of ascites, mass volume, and peritoneal carcinomatosis on serum CA125 levels in patients with ovarian carcinoma. Int J Gynecol Cancer 12(5):438–442

    Article  PubMed  CAS  Google Scholar 

  • Scarabelli C, Gallo A 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

    Article  PubMed  CAS  Google Scholar 

  • Stickeler E, Klar M, Watermann D, Geibel A, Földi M, Hasenburg A, Gitsch G (2009) Pegylated liposomal doxorubicin and trastuzumab as 1st and 2nd line therapy in her2/neu positive metastatic breast cancer: a multicenter phase II trial. Breast Cancer Res Treat 17:591–598

    Article  Google Scholar 

  • Takeshima N et al (2005) Lymph node metastasis in ovarian cancer: difference between serous and non-serous primary tumors. Gynecol Oncol 99(2):427–431

    Article  PubMed  Google Scholar 

  • Whittemore AS (1994) Characteristics relating to ovarian cancer risk: implications for prevention and detection. Gynecol Oncol 55(3 Pt 2):S15–S19

    Article  PubMed  CAS  Google Scholar 

  • Wimberger P, Lehmann N, Kimmig R, Burges A, Meier W, Du Bois A, Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group (2007) Prognostic factors for complete debulking in advanced ovarian cancer, 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

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that there are no conflicts of interest. None of the authors have a conflict of interest to disclose

Ethical standards

Our investigation of about 160 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.

Author information

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, University of Tübingen, Calwer Str. 7, 72070, Tübingen, Germany

    C. Bachmann, S. Bachmann, T. Fehm, S. Becker, R. Rothmund, C. Gardanis, E. M. Grischke & D. Wallwiener

  2. Department of Pathology, University of Tübingen, Liebermeisterstraße 8, 72076, Tübingen, Germany

    A. Staebler

  3. Department of Gynecology and Obstetrics, University of Homburg/Saar, KirrbergerStraße 100, 66424, Homburg/Saar, Germany

    E. F. Solomayer

Authors
  1. C. Bachmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Bachmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Fehm
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Staebler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Becker
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. Rothmund
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. C. Gardanis
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. E. M. Grischke
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. D. Wallwiener
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. E. F. Solomayer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Bachmann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bachmann, C., Bachmann, S., Fehm, T. et al. Nodal status—its impact on prognosis in advanced ovarian cancer. J Cancer Res Clin Oncol 138, 261–267 (2012). https://doi.org/10.1007/s00432-011-1094-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-011-1094-x

Keywords

Search

Navigation