J Gynecol Oncol.
2018 Sep;29(5):e69. 10.3802/jgo.2018.29.e69.
Adequate pelvic lymphadenectomy and survival of women with early-stage epithelial ovarian cancer
- Affiliations
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- 1Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA. koji.matsuo@med.usc.edu
- 2Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
- 3Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan.
- 4Division of Gynecologic Oncology, Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA.
- 5Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
- KMID: 2417464
- DOI: http://doi.org/10.3802/jgo.2018.29.e69
Abstract
OBJECTIVE
To examine the trends and survival for women with early-stage epithelial ovarian cancer who underwent adequate lymphadenectomy during surgical treatment.
METHODS
This is a retrospective observational study examining the Surveillance, Epidemiology, End Results program between 1988 and 2013. We evaluated 21,537 cases of stage I-II epithelial ovarian cancer including serous (n=7,466), clear cell (n=6,903), mucinous (n=4,066), and endometrioid (n=3,102) histology. A time-trend analysis of the proportion of patients who underwent adequate pelvic lymphadenectomy (≥ 8 per Gynecologic Oncology Group [GOG] criteria, ≥ 12 per Collaborative Group Report [CGR] criteria for bladder cancer, and > 22 per Mayo criteria for endometrial cancer) and a survival analysis associated with adequate pelvic lymphadenectomy were performed.
RESULTS
There were significant increases in the proportion of women who underwent adequate lymphadenectomy: GOG criteria 3.6% to 28.6% (1988-2010); CGR criteria 2.4% to 22.4% (1988-2013); and Mayo criteria 0.7% to 9.5% (1988-2013) (all, p < 0.05). On multivariable analysis, adequate lymphadenectomy was independently associated with improved cause-specific survival compared to inadequate lymphadenectomy: GOG criteria, adjusted-hazard ratio (HR)=0.75, CGR criteria, adjusted-HR=0.77, and Mayo criteria, adjusted-HR = 0.85 (all, p < 0.05). Compared to inadequate lymphadenectomy, adequate lymphadenectomy was significantly associated with improved cause-specific survival for serous (HR range = 0.67-0.73), endometrioid (HR range = 0.59-0.61), and clear cell types (HR range = 0.66-0.73) (all, p < 0.05) but not in mucinous type (HR range = 0.80-0.91; p > 0.05).
CONCLUSION
Quality of lymphadenectomy during the surgical treatment for early-stage epithelial ovarian cancer has significantly improved. Adequate lymphadenectomy is associated with a 15%-25% reduction in ovarian cancer mortality compared to inadequate lymphadenectomy.
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