Prognostic significance of lymphadenectomy and prevalence of lymph node metastasis in clinically-apparent stage I endometrioid and mucinous ovarian carcinoma

Gynecol Oncol. 2017 Feb;144(2):414-419. doi: 10.1016/j.ygyno.2016.11.038. Epub 2016 Nov 28.

Abstract

Objective: The aim of the present study was to investigate the prevalence of lymph node (LN) metastasis in women with apparent stage I ovarian carcinoma of endometrioid or mucinous histology and to examine the prognostic significance of LN sampling/dissection (LND) on patient survival.

Methods: The National Cancer Institute's Surveillance, Epidemiology, and End Results database was accessed and a cohort of surgically-staged women, diagnosed between 1988 and 2013, with apparent stage I ovarian carcinoma of mucinous or endometrioid histology was selected. Information derived from the histopathology report was employed to determine whether LND was performed and the status of harvested LNs. Five-year cancer-specific survival (CSS) rate was calculated following generation of Kaplan-Meier curves. Comparisons were made using the log-rank test. Cox proportional hazard models were constructed to evaluate the effect of LND on survival.

Results: A total of 3354 and 2855 women with endometrioid and mucinous tumors who met the inclusion criteria were identified. LND was performed in 2307 (68.8%) and 1602 (56.1%) of them (p<0.001), respectively. The rate of histopathologically confirmed LN metastasis was 2.1% and 1.7%, respectively. By multivariate analysis LND was associated with superior cancer-specific mortality only for women with endometrioid carcinoma.

Conclusions: Lymph node involvement in women with mucinous and endometrioid ovarian carcinoma grossly confined to the ovary is infrequent. LND is associated with a survival advantage for those with endometrioid carcinoma.

Keywords: Lymphadenectomy; Mucinous adenocarcinoma; Ovarian neoplasms; Ovary; Serous adenocarcinoma.

MeSH terms

  • Adenocarcinoma, Mucinous / mortality*
  • Adenocarcinoma, Mucinous / pathology
  • Aged
  • Carcinoma, Endometrioid / mortality*
  • Carcinoma, Endometrioid / pathology
  • Female
  • Humans
  • Lymph Node Excision*
  • Lymphatic Metastasis
  • Middle Aged
  • Neoplasm Staging
  • Ovarian Neoplasms / mortality*
  • Ovarian Neoplasms / pathology
  • Prognosis
  • Proportional Hazards Models