Marjolein Kleppe1, Maaike A van der Aa2, Toon Van Gorp3, Brigitte F M Slangen3, Roy F P M Kruitwagen4. 1. Maastricht University Medical Centre, Department of Obstetrics and Gynaecology, Maastricht, The Netherlands. 2. Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands. 3. Maastricht University Medical Centre, Department of Obstetrics and Gynaecology, Maastricht, The Netherlands; Maastricht University Medical Centre, GROW - School for Oncology and Developmental Biology, Maastricht, The Netherlands. 4. Maastricht University Medical Centre, Department of Obstetrics and Gynaecology, Maastricht, The Netherlands; Maastricht University Medical Centre, GROW - School for Oncology and Developmental Biology, Maastricht, The Netherlands. Electronic address: r.kruitwagen@mumc.nl.
Abstract
INTRODUCTION: To establish the impact of lymph node dissection and chemotherapy on survival in patients with early-stage epithelial ovarian cancer (EOC). METHODS: All Dutch patients with International Federation of Gynaecology and Obstetrics (FIGO) stage I-IIA and IIIA1 EOC between 2000 and 2012 were included. Data concerning age, stage, tumour grade, histological subtype, hospital type, lymph node dissection, adjuvant chemotherapy and survival were extracted from the Netherlands Cancer Registry. RESULTS: Of 3658 patients included, 1813 (49.6%) had lymph nodes removed. Relative survival of patients with lymph node dissection (including those with lymph node metastases) was significantly better than that of patients without, also after correcting for stage, tumour grade, histology and age (89% and 82%, respectively; relative excess risk [RER], 0.64; 95% confidence interval [CI]: 0.52-0.78). There was a positive correlation between the number of removed lymph nodes and overall survival (after excluding patients with lymph node metastases). Of patients with stage I-IIA EOC who had ≥10 lymph nodes removed, there was no difference in relative survival between those who received chemotherapy and those who did not (RER, 0.51; 95% CI: 0.15-1.64). This was also true for a subgroup of patients with high-risk features (stage IC and IIA and/or tumour grade 3 and/or clear cell histology [RER, 0.90; 95% CI: 0.46-1.99]). CONCLUSION: Adequate dissection of at least 10 but preferably ≥20 lymph nodes should be standard procedure for the staging of early-stage EOC. Adjuvant chemotherapy after an adequate lymph node dissection does not seem to contribute to a better relative survival.
INTRODUCTION: To establish the impact of lymph node dissection and chemotherapy on survival in patients with early-stage epithelial ovarian cancer (EOC). METHODS: All Dutch patients with International Federation of Gynaecology and Obstetrics (FIGO) stage I-IIA and IIIA1 EOC between 2000 and 2012 were included. Data concerning age, stage, tumour grade, histological subtype, hospital type, lymph node dissection, adjuvant chemotherapy and survival were extracted from the Netherlands Cancer Registry. RESULTS: Of 3658 patients included, 1813 (49.6%) had lymph nodes removed. Relative survival of patients with lymph node dissection (including those with lymph node metastases) was significantly better than that of patients without, also after correcting for stage, tumour grade, histology and age (89% and 82%, respectively; relative excess risk [RER], 0.64; 95% confidence interval [CI]: 0.52-0.78). There was a positive correlation between the number of removed lymph nodes and overall survival (after excluding patients with lymph node metastases). Of patients with stage I-IIA EOC who had ≥10 lymph nodes removed, there was no difference in relative survival between those who received chemotherapy and those who did not (RER, 0.51; 95% CI: 0.15-1.64). This was also true for a subgroup of patients with high-risk features (stage IC and IIA and/or tumour grade 3 and/or clear cell histology [RER, 0.90; 95% CI: 0.46-1.99]). CONCLUSION: Adequate dissection of at least 10 but preferably ≥20 lymph nodes should be standard procedure for the staging of early-stage EOC. Adjuvant chemotherapy after an adequate lymph node dissection does not seem to contribute to a better relative survival.
Authors: Miriam Rottmann; A Burges; S Mahner; C Anthuber; T Beck; D Grab; A Schnelzer; M Kiechle; D Mayr; M Pölcher; G Schubert-Fritschle; J Engel Journal: J Cancer Res Clin Oncol Date: 2017-04-26 Impact factor: 4.553
Authors: Koji Matsuo; Hiroko Machida; Andrea Mariani; Rachel S Mandelbaum; Gretchen E Glaser; Bobbie S Gostout; Lynda D Roman; Jason D Wright Journal: J Gynecol Oncol Date: 2018-05-04 Impact factor: 4.401
Authors: Koen De Decker; Henk G Ter Brugge; Joost Bart; Roy F P M Kruitwagen; Hans W Nijman; Arnold-Jan Kruse Journal: Gynecol Oncol Rep Date: 2018-12-10
Authors: Peter Widschwendter; Alexandra Blersch; Thomas W P Friedl; Wolfgang Janni; Christopher Kloth; Amelie de Gregorio; Niko de Gregorio Journal: Geburtshilfe Frauenheilkd Date: 2020-03-24 Impact factor: 2.915