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Prognostic significance of systematic pelvic and paraaortic lymphadenectomy (SLA) in apparent stage I epithelial ovarian carcinoma (EOC)



Prognostic significance of systematic pelvic and paraaortic lymphadenectomy (SLA) in apparent stage I epithelial ovarian carcinoma (EOC)



Journal of Clinical Oncology 26(15_suppl): 16502-16502



NlmCategory="UNASSIGNED">16502 Background: To assess the prognostic significance of SLA up to the upper level of renal vessels in apparent stage I EOC. Between 1/90 and 12/04, 250 consecutive patients (pts) with apparent stage I EOC received SLA in addition to hysterectomy, bilateral adnectomy, omentectomy with more extensive surgery including intestinal resections. Six cycles of cisplatin-based chemotherapy were given in pts with stage IB to IV EOC and at least 3 cycles given in pts with grade 2 or 3 stage IA. Of 250 pts with apparent stage I EOC, 46 pts (18.4%) were upstaged to IIA (4), IIB (8), IIC (27), and IIIA (7) with abdominal staging. Retroperitoneal staging with SLA upstaged 54 pts (21.6%) of apparent stage I to IIIC. Totally, 79 pts (31.6%) were upstaged and the remaining 171 pts (68.4%) were found to have true stage I EOC. Thus, if the comprehensive surgery including SLA will not be done, 32% of apparent stage I EOC would be incorrectly under-staged. Lymph node (LN) involvement by pT1 subcategory was 8% in 96 pT1A pts, 56% in 11 pT1B, and 20% in 97 pT1C, respectively. Totally, 16% of 204 pT1 pts had LN involvement. Of 33 node-positive pts, 22 pts had positive paraaortic LNs without pelvic LN involvement, and paraaortic LNs were involved in 30 of the 33 node-positive pts. Multivariate analysis revealed tumor grade, substage, and endometrioid histology (favorable) were significant prognostic factor for LN involvement. Five-year survival was 98% for pT1N0M0 vs 75% for pT1N1M0 (p=0.0000). Five-yr survival was 93% for 204 pts with pT1 receiving SLA and 81% for pts with pT1 without SLA (p=0.0064), and it was 97% for SLA (+) vs 96% for SLA (-) in pts with pT1A, and 85% for SLA (+) vs 45% for SLA (-) (p=0.0029) in pts with pT1C, respectively. The present retrospective analyses demonstrated that SLA might bring a survival benefit in apparent stage I EOC. Thus, comprehensive surgical staging including SLA is valid for apparent stage I EOC in terms of both correct staging (diagnosis) and treatment (prognosis). No significant financial relationships to disclose.

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Accession: 058637339

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PMID: 27948767


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