Lymph node dissection in early epithelial ovarian cancer (EOC) – Results from a population based study

Background

For patients with early epithelial ovarian cancer (EOC), current guidelines recommend adequate surgical assessment including bilateral salpingo-oophorectomy, total hysterectomy, omentectomy, multiple peritoneal biopsies, peritoneal washings and lymph node assessment. However the extent of lymph node assessment is not well defined and practices are variable. The clinical benefit of lymphadenectomy in women with early disease apart from providing more accurate staging is unclear. The aims of this project are to determine the rate of lymphadenectomy and assess its association with disease recurrence in early EOC in a large population based study.

Methods

Patients with FIGO stage I and II EOC were identified through the Australian Ovarian Cancer Study (AOCS) database. Details on the extent of surgical staging including lymph node assessment were collected from pathology and operation reports. Cox proportional hazards model was used to assess the factors associated with disease progression.

Results

Among 317 women with early EOC in the AOCS database, pathological report review was conducted in 241 (76.0%) cases. After a median follow-up of 73 months, 77 (32.0%) patients had disease recurrence. Lymph node assessment was conducted in 154 (63.9%) patients, with pelvic nodal dissection in 148 (61.4%), para-aortic node dissection in 76 (31.5%) and both in 70 (29%). The median number of lymph nodes removed was 8 (range 1-35). A lower disease recurrence rate was seen in patients who underwent lymph node dissection (41.3% vs. 26.2%, p = 0.018). The extent of lymphadenectomy (0 nodes, less than 5 nodes, and 5 or more nodes) decreased the recurrence rate from 41.4% to 33.3% to 24.1%, respectively (p = 0.041).

Conclusions

Early EOC patients who underwent lymphadenectomy in our study had a lower disease recurrence rate. This may be due to the identification of higher stage disease at the time of lymphadenectomy, and subsequent exclusion from analysis. Further analysis, including a review of cases with lymph node metastasis in otherwise early EOC is required to address this question.

Clinical trial identification

Legal entity responsible for the study

Western Sydney Local Health District

Funding

Crown Princess Mary Cancer Care Center, Westmead Hospital

Disclosure

All authors have declared no conflicts of interest.