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Annals of Surgical Oncology

, Volume 24, Issue 9, pp 2720–2726 | Cite as

Patterns of Lymph Node Metastases in Apparent Stage I Low-Grade Epithelial Ovarian Cancer: A Multicenter Study

  • Lucas MinigEmail author
  • Florian Heitz
  • David Cibula
  • Jamie N. Bakkum-Gamez
  • Anna Germanova
  • Sean C. Dowdy
  • Eleftheria Kalogera
  • Ignacio Zapardiel
  • Kristina Lindemann
  • Philipp Harter
  • Giovanni Scambia
  • Marco Petrillo
  • Cristina Zorrero
  • Vanna Zanagnolo
  • José Miguel Cárdenas Rebollo
  • Andreas du Bois
  • Christina Fotopoulou
Gynecologic Oncology

Abstract

Objective

The aim of this study was to determine oncological outcomes and incidence of lymph node (LN) metastases in women who underwent systematic pelvic and paraaortic lymphadenectomy for surgical staging of apparent stage I low-grade epithelial ovarian cancer (LGEOC).

Materials and Methods

A retrospective study was performed at nine institutions across Europe and the US, and patients who underwent surgical staging for presumed stage I LGEOC between 2000 and 2016 were included. To ensure surgical quality, a minimum number of ≥10 pelvic and ≥10 paraaortic LNs was required. Patients with preoperative radiologic or clinical evidence of extraovarian or LN disease, and those with nonepithelial histology, were excluded.

Results

The overall incidence of LN metastases was 4.3% in the 163 evaluated patients, and the incidence of LN involvement in serous, endometrioid, and mucinous subtypes was 10.7, 1.5, and 0%, respectively. However, Upstaging due to LN involvement alone occurred in only 2.4% of the patients. Eighty-nine (54.6%) patients received adjuvant chemotherapy due to International Federation of Gynecology and Obstetrics stage IC or higher disease. The 5-year progression-free survival (PFS) and overall survival (OS) were 93.2% (95% confidence interval [CI] 89.4–97.1%) and 94.5% (95% CI 90.9–98.0%), respectively. There was no significant difference in PFS or OS between LN-negative and LN-positive patients. However, fewer patients received adjuvant chemotherapy in the LN-negative group. Multivariate analysis did not identify any independent prognostic factor of survival.

Conclusion

The risk of LN involvement in nonserous apparent stage I LGEOC appears low, with a rate of <1% in this retrospective analysis, raising questions about the value of lymphadenectomy in those patients. Larger-scale prospective studies are warranted to evaluate the oncologic safety of omitting systematic LN staging in apparent stage I nonserous LGEOC.

Notes

Disclosure

Lucas Minig, Florian Heitz, David Cibula, Jamie N. Bakkum-Gamez, Anna Germanova, Sean C. Dowdy, Eleftheria Kalogera, Ignacio Zapardiel, Kristina Lindemann, Philip Harter, Giovanni Scambia, Marco Petrillo, Cristina Zorrero, Vanna Zanagnolo, José Miguel Cárdenas Rebollo, Andreas du Bois, and Christina Fotopoulou declare that there are no conflicts of interest.

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Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Lucas Minig
    • 1
    Email author
  • Florian Heitz
    • 2
  • David Cibula
    • 3
  • Jamie N. Bakkum-Gamez
    • 4
  • Anna Germanova
    • 3
  • Sean C. Dowdy
    • 4
  • Eleftheria Kalogera
    • 4
  • Ignacio Zapardiel
    • 5
  • Kristina Lindemann
    • 6
    • 7
  • Philipp Harter
    • 2
  • Giovanni Scambia
    • 8
  • Marco Petrillo
    • 8
  • Cristina Zorrero
    • 1
  • Vanna Zanagnolo
    • 9
  • José Miguel Cárdenas Rebollo
    • 10
  • Andreas du Bois
    • 2
  • Christina Fotopoulou
    • 11
  1. 1.Department of GynecologyInstituto Valenciano de Oncología (IVO)ValenciaSpain
  2. 2.Department of Gynecology and Gynecologic OncologyKliniken Essen MitteEssenGermany
  3. 3.Department of Obstetrics and Gynecology, Gynecologic Oncology Centre, First Faculty of Medicine and General University HospitalCharles University in PraguePragueCzech Republic
  4. 4.Division of Gynecologic SurgeryMayo ClinicRochesterUSA
  5. 5.Gynecologic Oncology UnitLa Paz University Hospital - IdiPAZMadridSpain
  6. 6.Department of Gynecologic Oncology, The Norwegian Radium HospitalOslo University HospitalOsloNorway
  7. 7.Faculty of Medicine, Institute of Clinical MedicineUniversity of OsloOsloNorway
  8. 8.Department of Women’s and Children’s HealthCatholic University of the Sacred HeartRomeItaly
  9. 9.Department of GynecologyEuropean Institute of OncologyMilanItaly
  10. 10.Department of Applied Mathematics and StatisticsCEU San Pablo UniversityMadridSpain
  11. 11.Department of GynaecologyImperial College LondonLondonUK

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