Adequate pelvic lymphadenectomy and survival of women with early-stage epithelial ovarian cancer

Koji Matsuo; Hiroko Machida; Andrea Mariani; Rachel S Mandelbaum; Gretchen E Glaser; Bobbie S Gostout; Lynda D Roman; Jason D Wright

doi:10.3802/jgo.2018.29.e69

Adequate pelvic lymphadenectomy and survival of women with early-stage epithelial ovarian cancer

J Gynecol Oncol. 2018 Sep;29(5):e69. doi: 10.3802/jgo.2018.29.e69. Epub 2018 May 4.

Authors

Koji Matsuo^{1

2}, Hiroko Machida³, Andrea Mariani⁴, Rachel S Mandelbaum¹, Gretchen E Glaser⁴, Bobbie S Gostout⁴, Lynda D Roman^{1

5}, Jason D Wright⁶

Affiliations

¹ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
² Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA. [email protected].
³ Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan.
⁴ Division of Gynecologic Oncology, Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA.
⁵ Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
⁶ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA.

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.

Keywords: Adequate; Early-stage; Lymph Node Excision; Ovarian Neoplasms; Survival; Trend.

Publication types

Observational Study

MeSH terms

Adult
Aged
Carcinoma, Ovarian Epithelial / mortality
Carcinoma, Ovarian Epithelial / pathology
Carcinoma, Ovarian Epithelial / secondary*
Carcinoma, Ovarian Epithelial / surgery
Female
Humans
Kaplan-Meier Estimate
Lymph Node Excision / methods
Lymph Node Excision / standards*
Lymphatic Metastasis
Middle Aged
Neoplasm Staging
Ovarian Neoplasms / mortality
Ovarian Neoplasms / pathology*
Pelvis
Registries
Retrospective Studies
Treatment Outcome
United States / epidemiology