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Nasioudis D, Gysler S, Latif NA, Giuntoli RL, Kim SH, Ko EM. Role of systematic lymphadenectomy at the time of interval debulking surgery for patients with advanced-stage epithelial ovarian carcinoma who achieved complete gross resection. Int J Gynecol Cancer 2024:ijgc-2024-005291. [PMID: 38754968 DOI: 10.1136/ijgc-2024-005291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE To evaluate the role of systematic lymphadenectomy at the time of interval cytoreductive surgery for patients with advanced-stage epithelial ovarian carcinoma who achieved complete gross resection. METHODS The National Cancer DataBase was accessed, and patients diagnosed between 2010 and 2015 with advanced-stage ovarian carcinoma who underwent interval cytoreductive surgery and achieved complete gross resection were identified. Patients who did not undergo lymphadenectomy and those who underwent systematic lymphadenectomy (defined as at least 20 lymph nodes removed) were selected for further analysis. Median overall survival was compared with the log-rank test and controlled for a priori selected confounders. RESULTS A total of 1060 patients were identified. Systematic lymphadenectomy was performed for 125 (11.8%) patients with a median of 29 lymph nodes (range 20-72) removed. Rate of lymph node metastasis was 62.4%. Patients who underwent systematic lymphadenectomy had higher rate of unplanned readmission (8.9% vs 1.6%, p<0.001), and median hospital stay (6 vs 4 days, p<0.001). Median overall survival for patients who did and did not undergo systematic lymphadenectomy was 44.2 and 40.4 months, respectively, p=0.40. After controlling for confounders, performance of systematic lymphadenectomy was not associated with better survival (HR=0.98, 95% CI 0.80 to 1.19). CONCLUSION Systematic lymphadenectomy is rarely performed at the time of interval cytoreductive surgery and not associated with a survival benefit for patients who achieved complete gross resection.
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Affiliation(s)
- Dimitrios Nasioudis
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stefan Gysler
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nawar A Latif
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert L Giuntoli
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sarah H Kim
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emily M Ko
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Odajima S, Tanabe H, Koike Y, Onishi J, Ichikawa T, Yokosu K, Takaneka S, Okamoto A. Short- and long-term morbidity of total parietal peritonectomy for advanced ovarian cancer. Int J Gynecol Cancer 2023; 33:1771-1777. [PMID: 37875321 DOI: 10.1136/ijgc-2023-004742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
OBJECTIVE Total parietal peritonectomy is gradually being recognized as a surgical option for advanced ovarian cancer; however, evidence regarding its efficacy and safety remains insufficient. Herein, we aimed to assess the short- and long-term post-operative safety profiles of total parietal peritonectomy. METHODS We reviewed the medical records of post-operative morbidity and mortality of patients who underwent cytoreductive surgery with total parietal peritonectomy for stage III and IV ovarian cancer between April 2018 and January 2023. RESULTS Fifty patients were enrolled in the study: 31 who underwent primary cytoreductive surgery and 19 who underwent interval cytoreductive surgery. The median age of all patients was 57 (range, 23-74) years. The median follow-up period was 22 (range, 3-59) months. Of 44 patients (88%) with stage IIIC/IV, 38 patients (76%) had high-grade serous carcinoma. The complete resection rates were 94%, 91%, and 100% in all patients, the primary cytoreductive surgery group, and the interval cytoreductive surgery group, respectively. There were 63 post-operative complication events overall, including 17 (27%) major complication events in 15 patients within 1 year post-operatively. Ten major complications occurred within 30 days of surgery, mainly in the primary cytoreductive surgery group (9 cases). Regarding complication type, the most frequent major event was pleural effusion (3 cases, 7%). After 30 days, there were a total of 17 all-grade complication events, of which ileus and hydronephrosis were major complications in 3 cases each (18%). There were no mortalities related to cytoreductive surgery. The scheduled adjuvant chemotherapy could be completed in 96% of patients. CONCLUSIONS Total parietal peritonectomy is a feasible procedure for managing advanced ovarian cancer. Short- and long-term complications may include pleural effusion and ileus/hydronephrosis, respectively.
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Affiliation(s)
- Suguru Odajima
- Department of Gynecology, National Cancer Center-Hospital East, Kashiwa, Chiba, Japan
- Department of Obstetrics and Gynecology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Hiroshi Tanabe
- Department of Gynecology, National Cancer Center-Hospital East, Kashiwa, Chiba, Japan
- Department of Obstetrics and Gynecology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Yuki Koike
- Department of Obstetrics and Gynecology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Junki Onishi
- Department of Gynecology, National Cancer Center-Hospital East, Kashiwa, Chiba, Japan
- Department of Obstetrics and Gynecology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Teppei Ichikawa
- Department of Gynecology, National Cancer Center-Hospital East, Kashiwa, Chiba, Japan
| | - Kota Yokosu
- Department of Obstetrics and Gynecology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Shin Takaneka
- Department of Gynecology, National Cancer Center-Hospital East, Kashiwa, Chiba, Japan
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
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Coada CA, Dondi G, Ravegnini G, Di Costanzo S, Tesei M, Fiuzzi E, Di Stanislao M, Giunchi S, Zamagni C, Bovicelli A, Hrelia P, Angelini S, De Iaco P, Perrone AM. Optimal number of neoadjuvant chemotherapy cycles prior to interval debulking surgery in advanced epithelial ovarian cancer: a systematic review and meta-analysis of progression-free survival and overall survival. J Gynecol Oncol 2023; 34:e82. [PMID: 37743060 PMCID: PMC10627748 DOI: 10.3802/jgo.2023.34.e82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/31/2023] [Accepted: 06/24/2023] [Indexed: 09/26/2023] Open
Abstract
OBJECTIVE Neoadjuvant chemotherapy (NACT) represents a treatment option in patients with advanced epithelial ovarian cancer (AEOC) who are not good candidates for primary debulking surgery. Usually, 3 cycles of chemotherapy before surgery have been considered the best option for patient survival, although quite often some patients receive more than 3 cycles. The aim of this systematic review and meta-analysis was to identify the optimal number of NACT cycles reporting better survival in AEOC patients. METHODS PubMed, Cochrane Library, and Scopus were searched for original articles that analyzed the relationship between the number of chemotherapy cycles and clinical outcomes in AEOC patients before interval debulking surgery (IDS). The main outcomes were progression-free survival (PFS) and overall survival (OS). RESULTS A total of 22 studies comprising 7,005 patients diagnosed with AEOC were included in our analysis. In terms of survival, the reviewed studies dividing the patients in ≤3 NACT cycles vs. >3, showed a trend for a decrease in PFS and a significant reduction in OS with an increasing number of cycles, while a difference in both PFS and OS was revealed if early IDS included patients with 4 NACT cycles. These results should be interpreted with caution due to the complex characteristics of AEOC patients. CONCLUSION In conclusion, our review and meta-analysis revealed that there is not enough evidence to determine the optimal number of NACT treatments before surgery. Further research in the form of well-designed randomized controlled trials is necessary to address this issue. TRIAL REGISTRATION PROSPERO Identifier: CRD42022334959.
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Affiliation(s)
| | - Giulia Dondi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gloria Ravegnini
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Stella Di Costanzo
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Marco Tesei
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Enrico Fiuzzi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marco Di Stanislao
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Susanna Giunchi
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Claudio Zamagni
- Addarii Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandro Bovicelli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Patrizia Hrelia
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Sabrina Angelini
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Pierandrea De Iaco
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Anna Myriam Perrone
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Bryant A, Hiu S, Kunonga PT, Gajjar K, Craig D, Vale L, Winter-Roach BA, Elattar A, Naik R. Impact of residual disease as a prognostic factor for survival in women with advanced epithelial ovarian cancer after primary surgery. Cochrane Database Syst Rev 2022; 9:CD015048. [PMID: 36161421 PMCID: PMC9512080 DOI: 10.1002/14651858.cd015048.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Ovarian cancer is the seventh most common cancer among women and a leading cause of death from gynaecological malignancies. Epithelial ovarian cancer is the most common type, accounting for around 90% of all ovarian cancers. This specific type of ovarian cancer starts in the surface layer covering the ovary or lining of the fallopian tube. Surgery is performed either before chemotherapy (upfront or primary debulking surgery (PDS)) or in the middle of a course of treatment with chemotherapy (neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS)), with the aim of removing all visible tumour and achieving no macroscopic residual disease (NMRD). The aim of this review is to investigate the prognostic impact of size of residual disease nodules (RD) in women who received upfront or interval cytoreductive surgery for advanced (stage III and IV) epithelial ovarian cancer (EOC). OBJECTIVES To assess the prognostic impact of residual disease after primary surgery on survival outcomes for advanced (stage III and IV) epithelial ovarian cancer. In separate analyses, primary surgery included both upfront primary debulking surgery (PDS) followed by adjuvant chemotherapy and neoadjuvant chemotherapy followed by interval debulking surgery (IDS). Each residual disease threshold is considered as a separate prognostic factor. SEARCH METHODS We searched CENTRAL (2021, Issue 8), MEDLINE via Ovid (to 30 August 2021) and Embase via Ovid (to 30 August 2021). SELECTION CRITERIA We included survival data from studies of at least 100 women with advanced EOC after primary surgery. Residual disease was assessed as a prognostic factor in multivariate prognostic models. We excluded studies that reported fewer than 100 women, women with concurrent malignancies or studies that only reported unadjusted results. Women were included into two distinct groups: those who received PDS followed by platinum-based chemotherapy and those who received IDS, analysed separately. We included studies that reported all RD thresholds after surgery, but the main thresholds of interest were microscopic RD (labelled NMRD), RD 0.1 cm to 1 cm (small-volume residual disease (SVRD)) and RD > 1 cm (large-volume residual disease (LVRD)). DATA COLLECTION AND ANALYSIS Two review authors independently abstracted data and assessed risk of bias. Where possible, we synthesised the data in meta-analysis. To assess the adequacy of adjustment factors used in multivariate Cox models, we used the 'adjustment for other prognostic factors' and 'statistical analysis and reporting' domains of the quality in prognosis studies (QUIPS) tool. We also made judgements about the certainty of the evidence for each outcome in the main comparisons, using GRADE. We examined differences between FIGO stages III and IV for different thresholds of RD after primary surgery. We considered factors such as age, grade, length of follow-up, type and experience of surgeon, and type of surgery in the interpretation of any heterogeneity. We also performed sensitivity analyses that distinguished between studies that included NMRD in RD categories of < 1 cm and those that did not. This was applicable to comparisons involving RD < 1 cm with the exception of RD < 1 cm versus NMRD. We evaluated women undergoing PDS and IDS in separate analyses. MAIN RESULTS We found 46 studies reporting multivariate prognostic analyses, including RD as a prognostic factor, which met our inclusion criteria: 22,376 women who underwent PDS and 3697 who underwent IDS, all with varying levels of RD. While we identified a range of different RD thresholds, we mainly report on comparisons that are the focus of a key area of clinical uncertainty (involving NMRD, SVRD and LVRD). The comparison involving any visible disease (RD > 0 cm) and NMRD was also important. SVRD versus NMRD in a PDS setting In PDS studies, most showed an increased risk of death in all RD groups when those with macroscopic RD (MRD) were compared to NMRD. Women who had SVRD after PDS had more than twice the risk of death compared to women with NMRD (hazard ratio (HR) 2.03, 95% confidence interval (CI) 1.80 to 2.29; I2 = 50%; 17 studies; 9404 participants; moderate-certainty). The analysis of progression-free survival found that women who had SVRD after PDS had nearly twice the risk of death compared to women with NMRD (HR 1.88, 95% CI 1.63 to 2.16; I2 = 63%; 10 studies; 6596 participants; moderate-certainty). LVRD versus SVRD in a PDS setting When we compared LVRD versus SVRD following surgery, the estimates were attenuated compared to NMRD comparisons. All analyses showed an overall survival benefit in women who had RD < 1 cm after surgery (HR 1.22, 95% CI 1.13 to 1.32; I2 = 0%; 5 studies; 6000 participants; moderate-certainty). The results were robust to analyses of progression-free survival. SVRD and LVRD versus NMRD in an IDS setting The one study that defined the categories as NMRD, SVRD and LVRD showed that women who had SVRD and LVRD after IDS had more than twice the risk of death compared to women who had NMRD (HR 2.09, 95% CI 1.20 to 3.66; 310 participants; I2 = 56%, and HR 2.23, 95% CI 1.49 to 3.34; 343 participants; I2 = 35%; very low-certainty, for SVRD versus NMRD and LVRD versus NMRD, respectively). LVRD versus SVRD + NMRD in an IDS setting Meta-analysis found that women who had LVRD had a greater risk of death and disease progression compared to women who had either SVRD or NMRD (HR 1.60, 95% CI 1.21 to 2.11; 6 studies; 1572 participants; I2 = 58% for overall survival and HR 1.76, 95% CI 1.23 to 2.52; 1145 participants; I2 = 60% for progression-free survival; very low-certainty). However, this result is biased as in all but one study it was not possible to distinguish NMRD within the < 1 cm thresholds. Only one study separated NMRD from SVRD; all others included NMRD in the SVRD group, which may create bias when comparing with LVRD, making interpretation challenging. MRD versus NMRD in an IDS setting Women who had any amount of MRD after IDS had more than twice the risk of death compared to women with NMRD (HR 2.11, 95% CI 1.35 to 3.29, I2 = 81%; 906 participants; very low-certainty). AUTHORS' CONCLUSIONS In a PDS setting, there is moderate-certainty evidence that the amount of RD after primary surgery is a prognostic factor for overall and progression-free survival in women with advanced ovarian cancer. We separated our analysis into three distinct categories for the survival outcome including NMRD, SVRD and LVRD. After IDS, there may be only two categories required, although this is based on very low-certainty evidence, as all but one study included NMRD in the SVRD category. The one study that separated NMRD from SVRD showed no improved survival outcome in the SVRD category, compared to LVRD. Further low-certainty evidence also supported restricting to two categories, where women who had any amount of MRD after IDS had a significantly greater risk of death compared to women with NMRD. Therefore, the evidence presented in this review cannot conclude that using three categories applies in an IDS setting (very low-certainty evidence), as was supported for PDS (which has convincing moderate-certainty evidence).
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Affiliation(s)
- Andrew Bryant
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Shaun Hiu
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Patience T Kunonga
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ketankumar Gajjar
- Department of Gynaecological Oncology, 1st Floor Maternity Unit, City Hospital Campus, Nottingham, UK
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Brett A Winter-Roach
- The Department of Surgery, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Ahmed Elattar
- City Hospital & Birmingham Treatment Centre, Birmingham, UK
| | - Raj Naik
- Gynaecological Oncology, Northern Gynaecological Oncology Centre, Gateshead, UK
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Caruso G, Palaia I, Bogani G, Tomao F, Perniola G, Benedetti Panici P, Muzii L, Di Donato V. Systematic lymph node dissection during interval debulking surgery for advanced epithelial ovarian cancer: a systematic review and meta-analysis. J Gynecol Oncol 2022; 33:e69. [PMID: 35882606 PMCID: PMC9428300 DOI: 10.3802/jgo.2022.33.e69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/27/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the efficacy and safety of systematic lymph node dissection (SyLND) at the time of interval debulking surgery (IDS) for advanced epithelial ovarian cancer (AEOC). Methods Systematic literature review of studies including AEOC patients undergoing SyLND versus selective lymph node dissection (SeLND) or no lymph node dissection (NoLND) after neoadjuvant chemotherapy (NACT). Primary endpoints included progression-free survival (PFS) and overall survival (OS). Secondary endpoints included severe postoperative complications, lymphocele, lymphedema, blood loss, blood transfusions, operative time, and hospital stay. Results Nine retrospective studies met the eligibility criteria, involving a total of 1,660 patients: 827 (49.8%) SyLND, 490 (29.5%) SeLND, and 343 (20.7%) NoLND. The pooled estimated hazard ratios (HR) for PFS and OS were, respectively, 0.88 (95% confidence interval [CI]=0.65–1.20; p=0.43) and 0.80 (95% CI=0.50–1.30; p=0.37). The pooled estimated odds ratios (ORs) for severe postoperative complications, lymphocele, lymphedema, and blood transfusions were, respectively, 1.83 (95% CI=1.19–2.82; p=0.006), 3.38 (95% CI=1.71–6.70; p<0.001), 7.23 (95% CI=3.40–15.36; p<0.0001), and 1.22 (95% CI=0.50–2.96; p=0.67). Conclusion Despite the heterogeneity in the study designs, SyLND after NACT failed to demonstrate a significant improvement in PFS and OS and resulted in a higher risk of severe postoperative complications. Trial Registration PROSPERO Identifier: CRD42022303577 Systematic lymph node dissection (SyLND) during interval debulking surgery (IDS) for advanced epithelial ovarian cancer failed to demonstrate a significant improvement in survival rates. The risk of postoperative complications was higher when SyLND was performed. The role of imaging for nodal evaluation after neoadjuvant chemotherapy remains a matter of debate. Further high-quality evidence is required before definitively omitting SyLND during IDS.
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Affiliation(s)
- Giuseppe Caruso
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.
| | - Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Giorgio Bogani
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Federica Tomao
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Giorgia Perniola
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
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AlMahdy AM, Elassall GM, Abdelbadee AY, Abd-Elkariem AY, Atef F, Ahmed IA, Sayed EG, Salah MA, Ali AK, Ragab EY, Abd Elazeem HAS, Saad MM, Shazly SA. Prognostic value of systematic lymphadenectomy in patients with ovarian cancer: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 267:179-185. [PMID: 34814044 DOI: 10.1016/j.ejogrb.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/17/2020] [Accepted: 02/09/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To appraise clinical outcomes of systematic lymphadenectomy in women with ovarian cancer based on stage, control group and type of chemotherapy. STUDY DESIGN A literature search was conducted on SCOPUS, PUBMED, COCHRANE, MEDLINE, and WEB OF SCIENCE databases. All comparative studies that assess outcomes of systematic lymphadenectomy in patients with ovarian cancer were eligible. Overall survival was analyzed by pooling log hazard ratio (HR) and standard error of multivariable Cox regression models. MOGGE Meta-analysis Matrix is a novel illustration tool that was used to demonstrate multiple subgroup analyses of included studies. RESULTS Twenty-two studies were eligible. Systematic lymphadenectomy was associated with better overall survival, that was close to significance, compared to control group (HR 0.93, 95 %CI 0.86-1.00). Among women treated with adjuvant chemotherapy, overall survival improved in women with stage IIB-IV who underwent systematic lymphadenectomy (HR 0.91, 95 %CI 0.84-0.99) and was most significant among patients with stage III to IV (HR 0.85, 95 %CI 0.73-0.99). Systematic lymphadenectomy did not improve survival in women who received neoadjuvant chemotherapy (HR 0.97, 95 %CI 0.73-1.29). Systematic lymphadenectomy was associated with improved progress-free survival compared to control group (HR 0.88, 95 %CI 0.79-0.99). CONCLUSION Although data from clinical trials do not support role of systematic lymphadenectomy in advanced ovarian cancer, overall data conveys stage-specific survival benefit. Further clinical trials may be warranted to assess substage survival outcomes in women with advanced stages.
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Affiliation(s)
- AlBatool M AlMahdy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Gena M Elassall
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed Y Abdelbadee
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed Y Abd-Elkariem
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Fatma Atef
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Islam A Ahmed
- Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Esraa G Sayed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed Ashraf Salah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed K Ali
- Department of Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Esraa Y Ragab
- Department of Anaesthesia, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Mahmoud M Saad
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Sherif A Shazly
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.
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7
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Benoit L, Koual M, Le Frère-Belda MA, Zerbib J, Fournier L, Nguyen-Xuan HT, Delanoy N, Bentivegna E, Bats AS, Azaïs H. Risks and benefits of systematic lymphadenectomy during interval debulking surgery for advanced high grade serous ovarian cancer. Eur J Surg Oncol 2021; 48:275-282. [PMID: 34753619 DOI: 10.1016/j.ejso.2021.10.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/18/2021] [Accepted: 10/28/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Lymphadenectomy is debated in patients with ovarian cancer. The aim of our study was to evaluate the impact of lymphadenectomy in patients with high-grade serous ovarian cancer receiving neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). METHODS A retrospective, unicentric study including all patients undergoing NACT and IDS was carried out from 2005 to 2018. Patients with and without lymphadenectomy were compared in terms of recurrence free survival (RFS), overall survival (OS), and complication rates. RESULTS We included 203 patients. Of these, 133 had a lymphadenectomy (65.5%) and 77 had involved nodes (57.9%). Patients without a lymphadenectomy were older, had a more extensive disease and less complete CRS. No differences were noted between the lymphadenectomy and no lymphadenectomy group concerning 2-year RFS (47.4% and 48.6%, p = 0.87, respectively) and 5-year OS (63.2% versus 58.6%, p = 0.41, respectively). Post-operative complications tended to be more frequent in the lymphadenectomy group (18.57% versus 31.58%, p = 0.09). In patients with a lymphadenectomy, survival was significantly altered if the nodes were involved (positive nodes: 2-year RFS 42.5% and 5-year OS 49.4%, negative nodes: 2-year RFS 60.7% and 5-year OS 82.2%, p = 0.03 and p < 0.001, respectively). CONCLUSION Lymphadenectomy during IDS does not improve survival and increases post-operative complications.
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Affiliation(s)
- Louise Benoit
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP. Centre, Paris, France; Paris University, Faculty of Medicine, Paris, France; INSERM UMR-S 1124, Université de Paris, Centre Universitaire des Saint-Père, Paris, France.
| | - Meriem Koual
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP. Centre, Paris, France; Paris University, Faculty of Medicine, Paris, France; INSERM UMR-S 1124, Université de Paris, Centre Universitaire des Saint-Père, Paris, France
| | | | - Jonathan Zerbib
- Radiology Department, Georges Pompidou European Hospital, APHP. Centre, Paris, France
| | - Laure Fournier
- Radiology Department, Georges Pompidou European Hospital, APHP. Centre, Paris, France
| | - Huyen-Thu Nguyen-Xuan
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP. Centre, Paris, France; Paris University, Faculty of Medicine, Paris, France
| | - Nicolas Delanoy
- Oncology Department, Georges Pompidou European Hospital, APHP. Centre, Paris, France
| | - Enrica Bentivegna
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP. Centre, Paris, France; Paris University, Faculty of Medicine, Paris, France
| | - Anne-Sophie Bats
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP. Centre, Paris, France; Paris University, Faculty of Medicine, Paris, France; INSERM UMR-S 1147, Université de Paris, Centre de Recherche des Cordeliers, Paris, France
| | - Henri Azaïs
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP. Centre, Paris, France; Paris University, Faculty of Medicine, Paris, France; INSERM UMR-S 1147, Université de Paris, Centre de Recherche des Cordeliers, Paris, France
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8
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Benoit L, Zerbib J, Koual M, Nguyen-Xuan HT, Delanoy N, Le Frère-Belda MA, Bentivegna E, Bats AS, Fournier L, Azaïs H. What can we learn from the 10 mm lymph node size cut-off on the CT in advanced ovarian cancer at the time of interval debulking surgery? Gynecol Oncol 2021; 162:667-673. [PMID: 34217542 DOI: 10.1016/j.ygyno.2021.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The benefit of a systematic lymphadenectomy is still debated in patients undergoing neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) in ovarian cancer (OC). The objective of this study was to evaluate the predictive value of the pre-NACT and post-NACT CT in predicting definitive histological lymph node involvement. The prognostic value of a positive node on the CT was also assessed. MATERIEL AND METHODS A retrospective, unicentric cohort study was performed including all patients with ovarian cancer who underwent NACT and IDS with a lymphadenectomy between 2005 and 2018. CT were analyzed blinded to pathology, and nodes with small axis ≥ 10 mm on CT were considered positive. Sensitivity (Se), specificity (Sp), and negative (NPV) and positive predictive values (PPV) and their CI95% were calculated. The 2-year recurrence free survival (RFS) and 5-year overall survival (OS) was compared. RESULTS 158 patients were included, among which 92 (58%) had histologically positive lymph nodes. CT had a Se, Sp, NPV and PPV of 35%, 82%, 47% and 73% before NACT and 20%, 97%, 47% and 91% after NACT, respectively. Patients with nodes considered positive had a non-significant lower 2-year RFS and 5-year OS on the pre-NACT and post-NACT CT. Patients at 'high risk' (nodes stayed positive on the CT or became positive after NACT) also had a non-significant lower 2-year RFS and 5-year OS. CONCLUSION Presence of enlarged lymph nodes on CT is a weak indicator of lymph node involvement in patients with advanced ovarian cancer undergoing NACT. However, it could be used to assess prognosis.
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Affiliation(s)
- Louise Benoit
- Gynecologic and Breast Oncologic Surgery Department, European Georges-Pompidou Hospital, APHP Centre, Paris, France; Paris University, Faculty of Medicine, Paris, France; INSERM UMR-S 1124, Université de Paris, Centre Universitaire des Saint-Père, Paris, France.
| | - Jonathan Zerbib
- Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, Department of Radiology, PARCC UMRS 970, INSERM, Paris, France
| | - Meriem Koual
- Gynecologic and Breast Oncologic Surgery Department, European Georges-Pompidou Hospital, APHP Centre, Paris, France; Paris University, Faculty of Medicine, Paris, France; INSERM UMR-S 1124, Université de Paris, Centre Universitaire des Saint-Père, Paris, France
| | - Huyen-Thu Nguyen-Xuan
- Gynecologic and Breast Oncologic Surgery Department, European Georges-Pompidou Hospital, APHP Centre, Paris, France
| | - Nicolas Delanoy
- Oncology Department, Georges Pompidou European Hospital, APHP. Centre, Paris, France
| | | | - Enrica Bentivegna
- Gynecologic and Breast Oncologic Surgery Department, European Georges-Pompidou Hospital, APHP Centre, Paris, France
| | - Anne-Sophie Bats
- Gynecologic and Breast Oncologic Surgery Department, European Georges-Pompidou Hospital, APHP Centre, Paris, France; Paris University, Faculty of Medicine, Paris, France; INSERM UMR-S 1147, Université de Paris, Centre de Recherche des Cordeliers, Paris, France
| | - Laure Fournier
- Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, Department of Radiology, PARCC UMRS 970, INSERM, Paris, France
| | - Henri Azaïs
- Gynecologic and Breast Oncologic Surgery Department, European Georges-Pompidou Hospital, APHP Centre, Paris, France; Paris University, Faculty of Medicine, Paris, France; INSERM UMR-S 1147, Université de Paris, Centre de Recherche des Cordeliers, Paris, France
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9
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Lopes A, Genta MLND, da Costa Miranda V, Aranha A, Lopez RVM, Piato DSAM, Anton C, Carvalho FM, Del Pilar Esteves Diz M, Carvalho JP. Role of systematic pelvic and para-aortic lymphadenectomy in delayed debulking surgery after six neoadjuvant chemotherapy cycles for high-grade serous ovarian carcinoma. J Obstet Gynaecol Res 2021; 47:2737-2744. [PMID: 33998104 DOI: 10.1111/jog.14838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/14/2021] [Accepted: 05/03/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION We analyzed the role of systematic pelvic and para-aortic lymphadenectomy in delayed debulking surgery after six neoadjuvant chemotherapy (NACT) cycles for advanced high-grade serous ovarian carcinoma. MATERIALS AND METHODS We retrospectively reviewed patients with advanced ovarian carcinoma who underwent NACT with carboplatin-paclitaxel between 2008 and 2016. Patients were included only if they had FIGO IIIC-IVB high-grade serous carcinoma with clinically negative lymph nodes after six NACT cycles (carboplatin-paclitaxel) and underwent complete or near complete cytoreduction. Patients with partial lymphadenectomy or bulky nodes were excluded. Patients who underwent systematic pelvic and aortic lymphadenectomy and those who did not undergo lymph node dissection were compared. Progression-free and overall survivals were analyzed using the Kaplan-Meier method. RESULTS Totally, 132 patients with FIGO IIIC-IVB epithelial ovarian carcinoma were surgically treated after NACT. Sixty patients were included (39 and 21 in the lymphadenectomy and nonlymphadenectomy group, respectively); 40% had suspicious lymph nodes before NACT. Patient characteristics, blood transfusion numbers, and complication incidence were similar between the groups. In the lymphadenectomy group, 12 patients (30.8%) had histologically positive lymph nodes and the surgical time was longer (229 vs. 164 min). The median overall survival in the lymphadenectomy and nonlymphadenectomy groups, respectively, was 56.7 (95% CI 43.4-70.1) and 61.2 (21.4-101.0) months (p = 0.934); the corresponding disease-free survival was 8.1 (6.2-10.1) and 8.3 (5.1-11.6) months (p = 0.878). Six patients exclusively presented with lymph node recurrence. CONCLUSIONS Systematic lymphadenectomy after six NACT cycles may have no influence on survival.
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Affiliation(s)
- Andre Lopes
- Discipline of Gynecology, Department of Obstetrics and Gynecology, Instituto do Cancer do Estado de Sao Paulo ICESP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.,Gastroenterology Department, Digestive Surgery Division, Instituto do Cancer do Estado de Sao Paulo ICESP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Maria L N D Genta
- Discipline of Gynecology, Department of Obstetrics and Gynecology, Instituto do Cancer do Estado de Sao Paulo ICESP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Vanessa da Costa Miranda
- Department of Radiology and Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Andrea Aranha
- Department of Radiology and Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Rossana V M Lopez
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Dariane S A M Piato
- Discipline of Gynecology, Department of Obstetrics and Gynecology, Instituto do Cancer do Estado de Sao Paulo ICESP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Cristina Anton
- Discipline of Gynecology, Department of Obstetrics and Gynecology, Instituto do Cancer do Estado de Sao Paulo ICESP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Filomena M Carvalho
- Department of Pathology, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Maria Del Pilar Esteves Diz
- Department of Radiology and Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Jesus P Carvalho
- Discipline of Gynecology, Department of Obstetrics and Gynecology, Instituto do Cancer do Estado de Sao Paulo ICESP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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10
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He M, Lai Y, Peng H, Tong C. Role of Lymphadenectomy During Interval Debulking Surgery Performed After Neoadjuvant Chemotherapy in Patients With Advanced Ovarian Cancer. Front Oncol 2021; 11:646135. [PMID: 33842358 PMCID: PMC8034395 DOI: 10.3389/fonc.2021.646135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/02/2021] [Indexed: 11/13/2022] Open
Abstract
Objective The role of lymphadenectomy in interval debulking surgery (IDS) performed after neoadjuvant chemotherapy (NACT) in advanced ovarian cancer remains unclear. We aimed to investigate the clinical significance of lymphadenectomy in IDS. Methods We retrospectively reviewed and analyzed the data of patients with advanced ovarian cancer who underwent NACT followed by IDS. Results In 303 patients receiving NACT-IDS, lymphadenectomy was performed in 127 (41.9%) patients. One hundred and sixty-three (53.8%) patients achieved no gross residual disease (NGRD), and 69 (22.8%) had residual disease < 1 cm, whereas 71 (23.4%) had residual disease ≥ 1cm. No significant difference in progression-free survival (PFS) and overall survival (OS) was observed between the lymphadenectomy group and the no lymphadenectomy group in patients with NGRD, residual disease < 1 cm, and residual disease ≥ 1 cm, respectively. The proportions of pelvic, para-aortic and distant lymph node recurrence were 7.9% (10/127), 4.7% (6/127) and 5.5% (7/127) in the lymphadenectomy group, compared with 5.7% (10/176, P = 0.448), 4.5% (8/176, P = 0.942) and 5.1% (9/176, P = 0.878), respectively, in no lymphadenectomy group. Multivariate analysis identified residual disease ≥ 1 cm [hazard ratios (HR), 4.094; P = 0.008] and elevated CA125 levels after 3 cycles of adjuvant chemotherapy (HR, 2.883; P = 0.004) were negative predictors for OS. Conclusion Lymphadenectomy may have no therapeutic value in patients with advanced ovarian cancer underwent NACT-IDS. Our findings may help to better the therapeutic strategy for advanced ovarian cancer. More clinical trials are warranted to further clarify the real role of lymphadenectomy in IDS.
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Affiliation(s)
- Minjun He
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Yuerong Lai
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Hongyu Peng
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Chongjie Tong
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
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11
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Seidler S, Koual M, Achen G, Bentivegna E, Fournier L, Delanoy N, Nguyen-Xuan HT, Bats AS, Azaïs H. Clinical Impact of Lymphadenectomy after Neoadjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer: A Review of Available Data. J Clin Med 2021; 10:jcm10020334. [PMID: 33477449 PMCID: PMC7830759 DOI: 10.3390/jcm10020334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/09/2021] [Accepted: 01/13/2021] [Indexed: 12/02/2022] Open
Abstract
Recent robust data allow for omitting lymph node dissection for patients with advanced epithelial ovarian cancer (EOC) and without any suspicion of lymph node metastases, without compromising recurrence-free survival (RFS), nor overall survival (OS), in the setting of primary surgical treatment. Evidence supporting the same postulate for patients undergoing complete cytoreductive surgery after neoadjuvant chemotherapy (NACT) is lacking. Throughout a systematic literature review, the aim of our study was to evaluate the impact of lymph node dissection in patients undergoing surgery for advanced-stage EOC after NACT. A total of 1094 patients, included in six retrospective series, underwent either systematic, selective or no lymph node dissection. Only one study reveals a positive effect of lymphadenectomy on OS, and two on RFS. The four remaining series fail to demonstrate any beneficial effect on survival, neither for RFS nor OS. All of them highlight the higher peri- and post-operative complication rate associated with systematic lymph node dissection. Despite heterogeneity in the design of the studies included, there seems to be a trend showing no improvement on OS for systematic lymph node dissection in node negative patients. A well-conducted prospective trial is mandatory to evaluate this matter.
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Affiliation(s)
- Stephanie Seidler
- AP-HP.CUP, Service de Chirurgie Cancérologique Gynécologique et du Sein, Hôpital Européen Georges-Pompidou, 75015 Paris, France; (S.S.); (M.K.); (G.A.); (E.B.); (H.-T.N.-X.); (A.-S.B.)
- Swiss Medical Network, Clinique de Genolier, 1272 Genolier, Switzerland
| | - Meriem Koual
- AP-HP.CUP, Service de Chirurgie Cancérologique Gynécologique et du Sein, Hôpital Européen Georges-Pompidou, 75015 Paris, France; (S.S.); (M.K.); (G.A.); (E.B.); (H.-T.N.-X.); (A.-S.B.)
- Faculté de Médecine Paris-Descartes, Université de Paris, 75006 Paris, France;
- INSERM UMR-S 1124, Université de Paris, Centre Universitaire des Saints Pères, 75006 Paris, France
| | - Guillaume Achen
- AP-HP.CUP, Service de Chirurgie Cancérologique Gynécologique et du Sein, Hôpital Européen Georges-Pompidou, 75015 Paris, France; (S.S.); (M.K.); (G.A.); (E.B.); (H.-T.N.-X.); (A.-S.B.)
- Faculté de Médecine Paris-Descartes, Université de Paris, 75006 Paris, France;
| | - Enrica Bentivegna
- AP-HP.CUP, Service de Chirurgie Cancérologique Gynécologique et du Sein, Hôpital Européen Georges-Pompidou, 75015 Paris, France; (S.S.); (M.K.); (G.A.); (E.B.); (H.-T.N.-X.); (A.-S.B.)
| | - Laure Fournier
- Faculté de Médecine Paris-Descartes, Université de Paris, 75006 Paris, France;
- AP-HP.CUP, Service de Radiologie, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Nicolas Delanoy
- AP-HP.CUP, Service D’oncologie Médicale, Hôpital Européen Georges-Pompidou, 75015 Paris, France;
| | - Huyên-Thu Nguyen-Xuan
- AP-HP.CUP, Service de Chirurgie Cancérologique Gynécologique et du Sein, Hôpital Européen Georges-Pompidou, 75015 Paris, France; (S.S.); (M.K.); (G.A.); (E.B.); (H.-T.N.-X.); (A.-S.B.)
| | - Anne-Sophie Bats
- AP-HP.CUP, Service de Chirurgie Cancérologique Gynécologique et du Sein, Hôpital Européen Georges-Pompidou, 75015 Paris, France; (S.S.); (M.K.); (G.A.); (E.B.); (H.-T.N.-X.); (A.-S.B.)
- Faculté de Médecine Paris-Descartes, Université de Paris, 75006 Paris, France;
- Centre de Recherche des Cordeliers, INSERM UMR-S 1138, 75006 Paris, France
| | - Henri Azaïs
- AP-HP.CUP, Service de Chirurgie Cancérologique Gynécologique et du Sein, Hôpital Européen Georges-Pompidou, 75015 Paris, France; (S.S.); (M.K.); (G.A.); (E.B.); (H.-T.N.-X.); (A.-S.B.)
- Centre de Recherche des Cordeliers, INSERM UMR-S 1138, 75006 Paris, France
- Correspondence:
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12
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Komatsu H, Iida Y, Osaku D, Shimogai R, Chikumi J, Sato S, Oishi T, Harada T. Effects of pretreatment radiological and pathological lymph node statuses on prognosis in patients with ovarian cancer who underwent interval debulking surgery with lymphadenectomy following neoadjuvant chemotherapy. J Obstet Gynaecol Res 2020; 47:152-158. [PMID: 32830400 DOI: 10.1111/jog.14446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/13/2020] [Accepted: 07/30/2020] [Indexed: 12/24/2022]
Abstract
AIM To analyze whether radiological and pathological lymph node statuses affected prognosis in patients with epithelial ovarian cancer who underwent neoadjuvant chemotherapy followed by interval debulking surgery. METHODS In total, 82 patients undergoing interval debulking surgery, including systematic retroperitoneal lymphadenectomy, were eligible for this study. We retrospectively analyzed the association among radiological diagnosed retroperitoneal lymphadenopathy by computed tomographic scan before (rLN) and after (yrLN) neoadjuvant chemotherapy, pathological lymph node metastasis (pLN) and prognosis. Patient survival distribution was calculated using the Kaplan-Meier method. RESULTS There were 36 rLN+ cases (44%); there were no significant differences between rLN+ and rLN- with respect to progression-free survival and overall survival. Progression-free survival and overall survival did not differ between yrLN+ cases and yrLN- cases. Thirty-nine cases (47.5%) were pLN+, and both progression-free survival and overall survival were significantly shorter in pLN+ cases than in pLN- cases (P < 0.001 and P = 0.004, respectively). In univariate analysis, FIGO stage, pLN and surgical completion were prognostic factors for overall survival. Moreover, in multivariate analysis, pLN+ was the independent prognostic factor for progression-free survival (P = 0.001, 95% confidence interval: 1.911-15.69), and pLN and surgical completion were the only independent prognostic factors for overall survival (P = 0.046, P = 0.012). CONCLUSION Radiological lymph node status may not be a prognostic factor in patients with ovarian cancer who underwent neoadjuvant chemotherapy followed by interval debulking surgery. Pathological lymph node metastasis affects progression-free survival and overall survival.
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Affiliation(s)
- Hiroaki Komatsu
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Tottori, Japan
| | - Yuki Iida
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Tottori, Japan
| | - Daiken Osaku
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Tottori, Japan
| | - Ruri Shimogai
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Tottori, Japan
| | - Jun Chikumi
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Tottori, Japan
| | - Shinya Sato
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Tottori, Japan
| | - Tetsuro Oishi
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Tottori, Japan
| | - Tasuku Harada
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Tottori, Japan
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13
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Bund V, Lecointre L, Velten M, Ouldamer L, Bendifallah S, Koskas M, Bolze PA, Collinet P, Canlorbe G, Touboul C, Huchon C, Coutant C, Faller E, Boisramé T, Gantzer J, Demarchi M, Baldauf JJ, Ballester M, Lavoué V, Akladios C. Impact of Lymphadenectomy on Survival of Patients with Serous Advanced Ovarian Cancer After Neoadjuvant Chemotherapy: A French National Multicenter Study (FRANCOGYN). J Clin Med 2020; 9:jcm9082427. [PMID: 32751303 PMCID: PMC7464978 DOI: 10.3390/jcm9082427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/15/2020] [Accepted: 07/23/2020] [Indexed: 11/24/2022] Open
Abstract
Background: The population of interest to this study comprised individuals with advanced-stage ovarian carcinoma who were exposed to neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS). Those who had not received systematic lymphadenectomy (SL; Group 1) were compared to those who had received SL (Group 2). Outcome measures included progression-free survival (PFS), overall survival (OS), and surgical complications. Methods: This was a retrospective, multicenter cohort study in nine referral centers of France between January 2000 and June 2017. OS analysis using the multivariate Cox regression model was performed. PFS and surgery-related morbidity were analyzed. Results: Of the 255 patients included, 100 were in Group 1 and 155 in Group 2. Patient majority was, on average, younger and less comorbid, with predominant R0 surgery in Group 2. Dindo–Clavien score was similar between the two groups (p = 0.15). Median OS was 26.8 months in Group 2 and 27.6 months in Group 1. SL was not statistically significant on OS (p = 0.7). Median PFS was 18.3 months in Group 2 and 16.6 months in Group 1. SL had positive impact on PFS (p = 0.005). Conclusions: patients who had received SL (Group 2) had significantly higher PFS regardless of node-positivity status when compared to those who had not received SL (Group 1).
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Affiliation(s)
- Virginie Bund
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (L.L.); (E.F.); (T.B.); (J.-J.B.); (C.A.)
- Department of Public Health, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France;
- Correspondence: ; Tel.: +33-(0)7-8170-2239
| | - Lise Lecointre
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (L.L.); (E.F.); (T.B.); (J.-J.B.); (C.A.)
- I-Cube UMR 7357—Laboratoire des Sciences de L’ingénieur, de L’informatique et de L’imagerie, Université de Strasbourg, 67081 Strasbourg, France
- Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, 67081 Strasbourg, France
| | - Michel Velten
- Department of Public Health, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France;
| | - Lobna Ouldamer
- Department of Gynecology, Hôpital Universitaire de Tours, 37000 Tours, France;
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Hôpital Tenon, AP-HP, 75020 Paris, France;
| | - Martin Koskas
- Department of Gynecology, Hôpital Bichat, AP-HP, 75018 Paris, France;
| | - Pierre-Adrien Bolze
- Gynecological Surgery Service, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France;
| | - Pierre Collinet
- Department of Gynecological Surgery, Hôpital Jeanne De Flandre, CHRU, 59000 Lille, France;
| | - Geoffroy Canlorbe
- Department of Gynecologic and Breast Surgery and Oncology, Hôpital la Pitié Salpétrière, AP-HP, 75013 Paris, France;
| | - Cyril Touboul
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, 94000 Créteil, France;
| | - Cyrille Huchon
- Department of Gynecology, Centre Hospitalier de Poissy, 78100 Poissy, France;
| | - Charles Coutant
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Center, 21000 Dijon, France;
| | - Emilie Faller
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (L.L.); (E.F.); (T.B.); (J.-J.B.); (C.A.)
| | - Thomas Boisramé
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (L.L.); (E.F.); (T.B.); (J.-J.B.); (C.A.)
| | - Justine Gantzer
- Department of Medical Oncology, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France;
| | - Martin Demarchi
- Medical Oncology Department, Centre Paul Strauss, 67000 Strasbourg, France;
| | - Jean-Jacques Baldauf
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (L.L.); (E.F.); (T.B.); (J.-J.B.); (C.A.)
| | - Marcos Ballester
- Department of Gynecologic and Breast Surgery, Groupe Hospitalier Diaconesses Croix, Saint-Simon, 75020 Paris, France;
| | - Vincent Lavoué
- Department of Gynecologic Surgery, Hôpital Universitaire de Rennes, 35000 Rennes, France;
| | - Chérif Akladios
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (L.L.); (E.F.); (T.B.); (J.-J.B.); (C.A.)
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14
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Fang C, Zhang Y, Zhao L, Chen X, Xia L, Zhang P. The relationship between retroperitoneal lymphadenectomy and survival in advanced ovarian cancer patients. BMC Cancer 2020; 20:654. [PMID: 32660444 PMCID: PMC7359502 DOI: 10.1186/s12885-020-07144-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 07/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systematic retroperitoneal lymphadenectomy has been widely used in the surgical treatment of advanced ovarian cancer patients. Nevertheless, the corresponding therapeutic may not provide a survival benefit. The aim of this study was to assess the effect of systematic retroperitoneal lymphadenectomy in such patients. METHODS Patients with advanced ovarian cancer (stage III-IV, according to the classification presented by the International Federation of Gynecology and Obstetrics) who were admitted and treated in Zhejiang Cancer Hospital from January 2004 to December 2013 were enrolled and reviewed retrospectively. All patients were optimally or suboptimally debulked (absent or residual tumor < 1 cm) and divided into two groups. Group A (no-lymphadenectomy group, n = 170): patients did not undergo lymph node resection; lymph nodes resection or biopsy were selective. Group B (n = 240): patients underwent systematic retroperitoneal lymphadenectomy. RESULTS A total of 410 eligible patients were enrolled in the study. The patients' median age was 51 years old (range, 28-72 years old). The 5-year overall survival (OS) and 2-year progression-free survival (PFS) rates were 78 and 24% in the no-lymphadenectomy group and 76 and 26% in the lymphadenectomy group (P = 0.385 and 0.214, respectively). Subsequently, there was no significant difference in 5-year OS and 2-year PFS between the two groups stratified to histological types (serous type or non-serous type), the clinical evaluation of negative lymph nodes or with macroscopic peritoneal metastasis beyond pelvic (IIIB-IV). Multivariate Cox regression analysis indicated that systematic retroperitoneal lymphadenectomy was not a significant factor influencing the patients' survival. Patients in the lymphadenectomy group had a higher incidence of postoperative complications (incidence of infection treated with antibiotics was 21.7% vs. 12.9% [P = 0.027]; incidence of lymph cysts was 20.8% vs. 2.4% [P < 0.001]). CONCLUSIONS Our study showed that systematic retroperitoneal lymphadenectomy did not significantly improve survival of advanced ovarian cancer patients with residual tumor < 1 cm or absent after cytoreductive surgery, and were associated with a higher incidence of postoperative complications.
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MESH Headings
- Adenocarcinoma, Clear Cell/mortality
- Adenocarcinoma, Clear Cell/secondary
- Adenocarcinoma, Clear Cell/surgery
- Adenocarcinoma, Mucinous/mortality
- Adenocarcinoma, Mucinous/secondary
- Adenocarcinoma, Mucinous/surgery
- Adult
- Aged
- Cystadenocarcinoma, Serous/mortality
- Cystadenocarcinoma, Serous/secondary
- Cystadenocarcinoma, Serous/surgery
- Cytoreduction Surgical Procedures/mortality
- Endometrial Neoplasms/mortality
- Endometrial Neoplasms/secondary
- Endometrial Neoplasms/surgery
- Female
- Follow-Up Studies
- Humans
- Lymph Node Excision/mortality
- Lymphatic Metastasis
- Middle Aged
- Neoplasm, Residual/mortality
- Neoplasm, Residual/pathology
- Neoplasm, Residual/surgery
- Ovarian Neoplasms/mortality
- Ovarian Neoplasms/pathology
- Ovarian Neoplasms/surgery
- Peritoneal Neoplasms/mortality
- Peritoneal Neoplasms/secondary
- Peritoneal Neoplasms/surgery
- Prognosis
- Retroperitoneal Space/pathology
- Retroperitoneal Space/surgery
- Retrospective Studies
- Survival Rate
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Affiliation(s)
- Chenyan Fang
- Department of Gynecological Oncology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer Research and Basic Medicine (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022 Zhejiang Province China
| | - Yingli Zhang
- Department of Gynecological Oncology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer Research and Basic Medicine (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022 Zhejiang Province China
| | - Lingqin Zhao
- Department of Gynecological Oncology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer Research and Basic Medicine (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022 Zhejiang Province China
| | - Xi Chen
- Department of Gynecological Oncology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer Research and Basic Medicine (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022 Zhejiang Province China
| | - Liang Xia
- Department of Neurosurgery, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer Research and Basic Medicine (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022 Zhejiang Province China
| | - Ping Zhang
- Department of Gynecological Oncology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer Research and Basic Medicine (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022 Zhejiang Province China
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15
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Yan H, Luo M, Wang L, Qiu Z, Mo Z, Xiang Z, Zhang Y, Chen G, Zhong Z, Wang X, Gao F, Zhang F. Clinical efficacy and prognostic factors of CT-guided 125I brachytherapy for the palliative treatment of retroperitoneal metastatic lymph nodes. Cancer Imaging 2020; 20:25. [PMID: 32252826 PMCID: PMC7137200 DOI: 10.1186/s40644-020-00299-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to the unique anatomical location of retroperitoneal metastatic lymph nodes, current treatment options are limited. This study was designed to explore the clinical efficacy and prognostic factors of CT-guided 125I brachytherapy for the treatment of retroperitoneal metastatic lymph nodes. METHODS We retrospectively evaluated 92 patients received 125I brachytherapy for retroperitoneal metastatic lymph nodes. A layered Cox proportional hazards model was established to filter out the independent factors affecting local tumor progression-free survival (LTPFS). RESULTS The median LTPFS was 8 months. Metastatic lymph node with uniform density (p-0.009), clear boundaries (p-0.011), regular morphology (P < 0.001), and < 3 organs at risk of metastasis (p-0.020) were associated with better LTPFS. Necrotic lymph nodes (p < 0.001), fusion (p-0.003), and invasion of vessels visible on images (p < 0.001) were associated with poor LTPFS. Puncture path through abdominal wall or paravertebral approach were also associated with better LTPFS than a hepatic approach (P < 0.05). A maximum diameter ≤ 3 cm (P-0.031) or 3-5 cm (P-0.018) were also associated with significantly better LTPFS than a maximum diameter ≥ 5 cm. The Cox proportional hazards model suggested that lymph nodes invaded the large vessels visible on images, maximum diameter and puncture path were independent risk factors for LTPFS. CONCLUSION CT-guided 125I brachytherapy is an optional palliative treatment modality for retroperitoneal metastatic lymph nodes, which can provide high local control without severe complications. Better preoperative planning, intraoperative implementation, better choice of puncture path, and selection of appropriate tumor size are important factors that can improve the clinical efficacy of 125I brachytherapy for retroperitoneal metastatic lymph nodes.
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Affiliation(s)
- Huzheng Yan
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 China
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road, East, Guangzhou, 510060 China
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road, East, Guangzhou, 510060 China
| | - Ma Luo
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 China
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road, East, Guangzhou, 510060 China
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road, East, Guangzhou, 510060 China
| | - Lifei Wang
- The Department of Radiology, The Third People’s Hospital of Shenzhen, Shenzhen, China
| | - Zhenkang Qiu
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 China
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road, East, Guangzhou, 510060 China
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road, East, Guangzhou, 510060 China
| | - Zhiqiang Mo
- Department of Interventional Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan No. 2 Road, Guangzhou, 510060 China
| | - Zhanwang Xiang
- The Third affiliated hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanling Zhang
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 China
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road, East, Guangzhou, 510060 China
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road, East, Guangzhou, 510060 China
| | - Guanyu Chen
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 China
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road, East, Guangzhou, 510060 China
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road, East, Guangzhou, 510060 China
| | - Zhihui Zhong
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 China
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road, East, Guangzhou, 510060 China
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road, East, Guangzhou, 510060 China
| | - Xiuchen Wang
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 China
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road, East, Guangzhou, 510060 China
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road, East, Guangzhou, 510060 China
| | - Fei Gao
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 China
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road, East, Guangzhou, 510060 China
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road, East, Guangzhou, 510060 China
| | - Fujun Zhang
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 China
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road, East, Guangzhou, 510060 China
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road, East, Guangzhou, 510060 China
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16
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Tato-Varela S, Kuhn W. Impact of retroperitoneal lymph node dissection in ovarian cancer - time for paradigm shift? Horm Mol Biol Clin Investig 2019; 41:hmbci-2019-0020. [PMID: 31398143 DOI: 10.1515/hmbci-2019-0020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/11/2019] [Indexed: 01/12/2023]
Abstract
Ovarian cancer is the second most common malignant neoplasm of the genital tract. Staging procedures for ovarian cancer include longitudinal laparotomy, hysterectomy, bilateral salpingo-oophorectomy and infragastric omentectomy as well as systematic pelvic and para-aortic lymphadenectomy. In general, the goal of this primary procedure is to achieve the maximum cytoreduction of all abdominal diseases; a residual disease <1 cm defines optimal cytoreduction, however, a maximal effort should be made to remove all gross disease as this offers superior survival outcomes. The role of lymphadenectomy in ovarian cancer has been the focus of gynecological oncologists during recent years. The core issue of the controversy is whether the removal of lymph nodes should be performed only to stage the disease or if the removal itself improves survival. To further comprehend the issue, one must take into account that several studies have shown that systematic lymphadenectomy is associated with a risk of vascular injury, lymph cyst formation, pulmonary embolism and increased post-operative mortality even when performed by surgeons with extensive experience. We present an extensive review of the available literature on the matter, hoping to provide some insight into the true need for such a procedure.
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Affiliation(s)
- Sara Tato-Varela
- Department of Gynecology and Obstetrics, Donau-Isar Klinikum Hospital, Perlasberger Straße 41, 94469Deggendorf, Lower Bavaria, Germany
| | - Walther Kuhn
- Department of Gynecology and Obstetrics, Donau-Isar Klinikum Hospital, Deggendorf, Lower Bavaria, Germany
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17
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Timmermans M, van der Hel O, Sonke G, Van de Vijver K, van der Aa M, Kruitwagen R. The prognostic value of residual disease after neoadjuvant chemotherapy in advanced ovarian cancer; A systematic review. Gynecol Oncol 2019; 153:445-451. [DOI: 10.1016/j.ygyno.2019.02.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 01/12/2023]
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18
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Wang J, Li J, Chen R, Lu X. Survival effect of different lymph node staging methods on ovarian cancer: An analysis of 10 878 patients. Cancer Med 2018; 7:4315-4329. [PMID: 30121963 PMCID: PMC6144146 DOI: 10.1002/cam4.1680] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 06/03/2018] [Indexed: 12/17/2022] Open
Abstract
Background To compare the survival impact of several lymph node staging methods and therapeutic role of lymphadenectomy in patients with epithelial ovarian cancer who had undergone lymphadenectomy. Methods Data were retrospectively collected from the Surveillance, Epidemiology, and End Results program between 1988 and 2013. Results An increasing number of resected lymph nodes (RLNs) was associated with a significant improvement in survival of FIGO stage II and III disease. However, for FIGO stage IV patients, better survival was not significantly associated with a more extensive lymphadenectomy. A higher lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) were associated with poorer survival regardless of stage. Nevertheless, four‐category classification of LODDS was more suitable for stage IV patients when three‐category classification was compatible with stage I‐III disease. Multivariate analysis demonstrated that LODDS and LNR were significant independent prognostic factors, but not RLN classification. Conclusion Sixteen to thirty RLNs are recommended for stage I disease. For stages II and III patients, the more lymph node excision, the better the prognosis. However, lymphadenectomy was nonessential for stage IV patients. Considering staging methods, for stages II and III patients, three‐category classification of LODDS was recommended to evaluate the prognosis. For stage I and IV, three‐category classification of positive LNR was idoneous.
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Affiliation(s)
- Jieyu Wang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jun Li
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Ruifang Chen
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xin Lu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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19
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Prognostic assessment of sarcomatous histologic subtypes of ovarian carcinosarcoma. Obstet Gynecol Sci 2017; 60:350-356. [PMID: 28791266 PMCID: PMC5547082 DOI: 10.5468/ogs.2017.60.4.350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/03/2017] [Accepted: 03/16/2017] [Indexed: 11/17/2022] Open
Abstract
Objective Ovarian carcinosarcoma is a rare subtype of this disease that has not been thoroughly investigated. The aim of this study was to evaluate the prognostic factors and out comes in patients with ovarian carcinosarcoma. Methods All patients with histologically confirmed ovarian carcinosarcoma who were treated at Cheil General Hospital and Women's Healthcare Center between January 2000 and December 2015 were identified and analyzed. Data were extracted from medical records, and statistical analyses were performed to determine correlations between clinicopathological parameters and survival outcomes. Results Of the 822 patients diagnosed with ovarian cancer over 16 years, 11 (1.3%) had ovarian carcinosarcoma histology. Every patient underwent surgery as the initial treatment followed by intravenous adjuvant chemotherapy. Only 18.1% of cases were early stage (I or II) while 81.8% were advanced stage (III or IV) according to the FIGO (International Federation of Gynecology and Obstetrics) classification. Six cases were of the homologous subtype (54.5%) and five were of the heterologous subtype (45.5%). There was no significant difference in survival according to stage (P=0.24). The heterologous subtype and residual disease were associated with poor disease-free survival (P=0.02 and P=0.04) and overall survival (P=0.02 and P=0.04), On multivariate analysis, the histological subtype was an independent prognostic factor (P=0.02). Conclusion Optimal cytoreduction without gross residual disease and a homologous subtype are favorable prognostic factors in terms of disease relapse and survival.
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20
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Eoh KJ, Yoon JW, Lee I, Lee JY, Kim S, Kim SW, Kim YT, Nam EJ. The efficacy of systematic lymph node dissection in advanced epithelial ovarian cancer during interval debulking surgery performed after neoadjuvant chemotherapy. J Surg Oncol 2017; 116:329-336. [DOI: 10.1002/jso.24669] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 04/17/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Kyung Jin Eoh
- Institute of Women's Life Medical Science, Women's Cancer Clinic, Department of Obstetrics and Gynecology; Yonsei University College of Medicine; Seoul Korea
| | - Jung Won Yoon
- Institute of Women's Life Medical Science, Women's Cancer Clinic, Department of Obstetrics and Gynecology; Yonsei University College of Medicine; Seoul Korea
| | - Inok Lee
- Institute of Women's Life Medical Science, Women's Cancer Clinic, Department of Obstetrics and Gynecology; Yonsei University College of Medicine; Seoul Korea
| | - Jung-Yun Lee
- Institute of Women's Life Medical Science, Women's Cancer Clinic, Department of Obstetrics and Gynecology; Yonsei University College of Medicine; Seoul Korea
| | - Sunghoon Kim
- Institute of Women's Life Medical Science, Women's Cancer Clinic, Department of Obstetrics and Gynecology; Yonsei University College of Medicine; Seoul Korea
| | - Sang Wun Kim
- Institute of Women's Life Medical Science, Women's Cancer Clinic, Department of Obstetrics and Gynecology; Yonsei University College of Medicine; Seoul Korea
| | - Young Tae Kim
- Institute of Women's Life Medical Science, Women's Cancer Clinic, Department of Obstetrics and Gynecology; Yonsei University College of Medicine; Seoul Korea
| | - Eun Ji Nam
- Institute of Women's Life Medical Science, Women's Cancer Clinic, Department of Obstetrics and Gynecology; Yonsei University College of Medicine; Seoul Korea
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21
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Xu XL, Cheng H, Tang MS, Zhang HL, Wu RY, Yu Y, Li X, Wang XM, Mai J, Yang CL, Jiao L, Li ZL, Zhong ZM, Deng R, Li JD, Zhu XF. A novel nomogram based on LODDS to predict the prognosis of epithelial ovarian cancer. Oncotarget 2017; 8:8120-8130. [PMID: 28042955 PMCID: PMC5352387 DOI: 10.18632/oncotarget.14100] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 11/22/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND To develop and validate a nomogram based on log of odds between the number of positive lymph node and the number of negative lymph node (LODDS) in predicting the overall survival (OS) and cancer specific survival (CSS) for epithelial ovarian cancer (EOC) patients. MATERIALS AND METHODS A total of 10,692 post-operative EOC patients diagnosed between 2004 and 2013 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database and randomly divided into training (n = 7,021) and validation (n = 3,671) cohorts. Multiple clinical pathological parameters were assessed and compared with outcomes. Parameters significantly correlating with outcomes were used to build a nomogram. Bootstrap validation was subsequently used to assess the predictive value of the model. RESULTS In the training set, age at diagnosis, race, marital status, tumor location, stage, grade and LODDS were correlated significantly with outcome in both the univariate and multivariate analyses and were used to develop a nomogram. The nomogram demonstrated good accuracy in predicting OS and CSS, with a bootstrap-corrected concordance index of 0.757 (95% CI, 0.746-0.768) for OS and 0.770 (95% CI, 0.759-0.782) for CSS. Notably, in this population our model performed favorably compared to the currently utilized Federation of Gynecology and Obstetrics (FIGO) model, with concordance indices of 0.699 (95% CI, 0.688-0.710, P < 0.05) and 0.719 (95% CI, 0.709- 0.730, P < 0.05) for OS and CSS, respectively. Using our nomogram in the validation cohort, the C-indices were 0.757 (95% CI, 0.741-0.773, P < 0.05, compared to FIGO) for OS and 0.762 (95% CI, 0.746-0.779, P < 0.05, compared to FIGO) for CSS. CONCLUSIONS LODDS works as an independent prognostic factor for predicting survival in patients with EOC regardless of the tumor stage. By incorporating LODDS, our nomogram may be superior to the currently utilized FIGO staging system in predicting OS and CSS among post-operative EOC patients.
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Affiliation(s)
- Xue-Lian Xu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Cancer Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Hao Cheng
- The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510060, China
| | - Meng-Si Tang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Cancer Center, Sun Yat-sen University, Guangzhou 510060, China
- Department of Gynecological Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Hai-Liang Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Cancer Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Rui-Yan Wu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Cancer Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Yan Yu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Cancer Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Xuan Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Cancer Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Xiu-Min Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Cancer Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Jia Mai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Cancer Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Chen-Lu Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Cancer Center, Sun Yat-sen University, Guangzhou 510060, China
- Department of Gynecological Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Lin Jiao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Cancer Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Zhi-Ling Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Cancer Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Zhen-Mei Zhong
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Cancer Center, Sun Yat-sen University, Guangzhou 510060, China
- Department of Gynecological Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Rong Deng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Cancer Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Jun-Dong Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Cancer Center, Sun Yat-sen University, Guangzhou 510060, China
- Department of Gynecological Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xiao-Feng Zhu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Cancer Center, Sun Yat-sen University, Guangzhou 510060, China
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