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abstract
Highlights
- In early stage ovarian cancer:
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- Lymph node dissection improves relative survival.
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- Chemotherapy after adequate lymph node dissection does not improve survival also in case of high-risk features.
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- Preferably 20 or more lymph nodes should be removed for an adequate staging.
Introduction
To
establish the impact of lymph node dissection and chemotherapy on
survival in patients with early-stage epithelial ovarian cancer (EOC).
Methods
All
Dutch patients with International Federation of Gynaecology and
Obstetrics (FIGO) stage I–IIA and IIIA1 EOC between 2000 and 2012 were
included. Data concerning age, stage, tumour grade, histological
subtype, hospital type, lymph node dissection, adjuvant chemotherapy and
survival were extracted from the Netherlands Cancer Registry.
Results
Of
3658 patients included, 1813 (49.6%) had lymph nodes removed. Relative
survival of patients with lymph node dissection (including those with
lymph node metastases) was significantly better than that of patients
without, also after correcting for stage, tumour grade, histology and
age (89% and 82%, respectively; relative excess risk [RER], 0.64; 95%
confidence interval [CI]: 0.52–0.78). There was a positive correlation
between the number of removed lymph nodes and overall survival (after
excluding patients with lymph node metastases). Of patients with stage
I–IIA EOC who had ≥10 lymph nodes removed, there was no difference in
relative survival between those who received chemotherapy and those who
did not (RER, 0.51; 95% CI: 0.15–1.64). This was also true for a
subgroup of patients with high-risk features (stage IC and IIA and/or
tumour grade 3 and/or clear cell histology [RER, 0.90; 95% CI:
0.46–1.99]).
Conclusion
Adequate
dissection of at least 10 but preferably ≥20 lymph nodes should be
standard procedure for the staging of early-stage EOC. Adjuvant
chemotherapy after an adequate lymph node dissection does not seem to
contribute to a better relative survival.
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