Clinical significance of para-aortic lymph node dissection and prognosis in ovarian cancer

Abstract

Lymph node metastasis has an important effect on prognosis of patients with ovarian cancer. Moreover, the impact of para-aortic lymph node (PAN) removal on patient prognosis is still unclear. In this study, 80 patients were divided into groups A and B. Group A consisted of 30 patients who underwent PAN+ pelvic lymph node (PLN) dissection, whereas group B consisted of 50 patients who only underwent PLN dissection. Analysis of the correlation between PAN clearance and prognosis in epithelial ovarian cancer was conducted. Nineteen cases of lymph node metastasis were found in group A, among whom seven cases were positive for PAN, three cases for PLN, and nine cases for both PAN and PLN. In group B, 13 cases were positive for lymph node metastasis. Our study suggested that the metastatic rate of lymph node is 40.0%. Lymph node metastasis was significantly correlated with FIGO stage, tumor differentiation, and histological type both in groups A and B (P<0.05). In groups A and B, the three-year survival rates were 77.9% and 69.0%, and the five-year survival rates were 46.7% and 39.2%, respectively. However, the difference was not statistically significant (P>0.05). The three-year survival rates of PLN metastasis in groups A and B were 68.5% and 41.4%, and the five-year survival rates were 49.7% and 26.4%, respectively. Furthermore, PLN-positive patients who cleared PAN had significantly higher survival rate (P=0.044). In group A, the three-year survival rates of positive and negative lymph nodes were 43.5% and 72.7%, and the five-year survival rates were 27.2% and 58.5%, respectively. The difference was statistically significant (P=0.048). Cox model analysis of single factor suggested that lymph node status affected the survival rate (P<0.01), which was the death risk factor. Consequently, in ovarian carcinoma cytoreductive surgery, resection of the para-aortic lymph node, which has an important function in clinical treatment and prognosis of patients with ovarian cancer, is necessary.

Keywords

ovarian cancer / para-aortic lymph node / pelvic lymph node

References

[1] Fotopoulou C, Savvatis K, Steinhagen-Thiessen E, Bahra M, Lichtenegger W, Sehouli J. Primary radical surgery in elderly patients with epithelial ovarian cancer: analysis of surgical outcome and long-term survival. Int J Gynecol Cancer2010; 20(1): 34-40

[2] Heintz AP, Odicino F, Maisonneuve P, Quinn MA, Benedet JL, Creasman WT, Ngan HY, Pecorelli S, Beller U. Carcinoma of the ovary. FIGO 6th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet2006; 95(S1): S161-S192

[3] Mujezinović F, Takac I. Pelvic lymph node dissection in early ovarian cancer: success of retrieval of lymph nodes by individual lymph node groups in respect to pelvic laterality. Eur J Obstet Gynecol Reprod Biol2010; 151(2): 208-211

[4] Pereira A, Pérez-Medina T, Magrina JF, Magtibay PM, Rodríguez-Tapia A, Pérez-Milán F, Ortiz-Quintana L. The impact of pelvic retroperitoneal invasion and distant nodal metastases in epithelial ovarian cancer. Surg Oncol. 2013 Oct 25. [Epub ahead of print]

[5] Morice P, Joulie F, Camatte S, Atallah D, Rouzier R, Pautier P, Pomel C, Lhommé C, Duvillard P, Castaigne D. Lymph node involvement in epithelial ovarian cancer: analysis of 276 pelvic and paraaortic lymphadenectomies and surgical implications. J Am Coll Surg2003; 197(2): 198-205

[6] Powless CA, Aletti GD, Bakkum-Gamez JN, Cliby WA. Risk factors for lymph node metastasis in apparent early-stage epithelial ovarian cancer: implications for surgical staging. Gynecol Oncol2011; 122(3): 536-540

[7] Karabuk E, Kose MF, Hizli D, Taşkin S, Karadağ B, Turan T, Boran N, Ozfuttu A, Ortaç UF. Comparison of advanced stage mucinous epithelial ovarian cancer and serous epithelial ovarian cancer with regard to chemosensitivity and survival outcome: a matched case-control study. J Gynecol Oncol2013; 24(2): 160-166

[8] Cass I, Li AJ, Runowicz CD, Fields AL, Goldberg GL, Leuchter RS, Lagasse LD, Karlan BY. Pattern of lymph node metastases in clinically unilateral stage I invasive epithelial ovarian carcinomas. Gynecol Oncol2001; 80(1): 56-61

[9] Hiura M, Nogawa T, Matsumoto T, Yokoyama T, Shiroyama Y, Wroblewski J. Long-term survival in patients with para-aortic lymph node metastasis with systematic retroperitoneal lymphadenectomy followed by adjuvant chemotherapy in endometrial carcinoma. Int J Gynecol Cancer2010; 20(6): 1000-1005

[10] Zinzindohoue C, Lujan R, Boulet S, Spirito C, Bobin JY. Pelvic and para-aortic lymphadenectomy in epithelial ovarian cancer. Report of a series of 86 cases. Ann Chir2000; 125(2): 163-172 (in French)

[11] Polverino G, Parazzini F, Stellato G, Scarfone G, Cipriani S, Bolis G. Survival and prognostic factors of women with advanced ovarian cancer and complete response after a carboplatin-paclitaxel chemotherapy. Gynecol Oncol2005; 99(2): 343-347

Acknowledgements

This work was supported by the Special Scientific Foundation of Health Industry of China (No. 201002013) and the Natural Science Foundation of Hubei Province of China (No. 2012FFB01904).

Compliance with ethics guidelines

Xianxian Li, Hui Xing, Lin Li, Yanli Huang, Min Zhou, Qiong Liu, Xiaomin Qin, and Min He declare that they have no conflict of interest. All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients included in the study.

RIGHTS & PERMISSIONS

2014 Higher Education Press and Springer-Verlag Berlin Heidelberg