Lucas Minig1, Florian Heitz2, David Cibula3, Jamie N Bakkum-Gamez4, Anna Germanova3, Sean C Dowdy4, Eleftheria Kalogera4, Ignacio Zapardiel5, Kristina Lindemann6,7, Philipp Harter2, Giovanni Scambia8, Marco Petrillo8, Cristina Zorrero9, Vanna Zanagnolo10, José Miguel Cárdenas Rebollo11, Andreas du Bois2, Christina Fotopoulou12. 1. Department of Gynecology, Instituto Valenciano de Oncología (IVO), Valencia, Spain. miniglucas@gmail.com. 2. Department of Gynecology and Gynecologic Oncology, Kliniken Essen Mitte, Henricistrasse 92, 45136, Essen, Germany. 3. Department of Obstetrics and Gynecology, Gynecologic Oncology Centre, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic. 4. Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA. 5. Gynecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain. 6. Department of Gynecologic Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway. 7. Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 8. Department of Women's and Children's Health, Catholic University of the Sacred Heart, Rome, Italy. 9. Department of Gynecology, Instituto Valenciano de Oncología (IVO), Valencia, Spain. 10. Department of Gynecology, European Institute of Oncology, Milan, Italy. 11. Department of Applied Mathematics and Statistics, CEU San Pablo University, Madrid, Spain. 12. Department of Gynaecology, Imperial College London, London, UK.
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.
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.
Authors: Victor Lago; Pilar Bello; Beatriz Montero; Luis Matute; Pablo Padilla-Iserte; Susana Lopez; Tiermes Marina; Marc Agudelo; Santiago Domingo Journal: Int J Gynecol Cancer Date: 2020-05-23 Impact factor: 3.437
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