The validity and significance of substage IIIC by node involvement in epithelial ovarian cancer: impact of nodal metastasis on patient survival.

OBJECTIVE

The aim of this study was to examine whether there is a possible difference in patient survival (1) between node-positive and node-negative groups for Stage I, II, IIIA+B, and IIIC disease and (2) between node-positive Stage I through IIIB disease and Stage IIIC disease.

METHODS

Medical records of 125 patients with Stage I, II, and III epithelial ovarian cancer were retrospectively analyzed for clinical and histological characteristics with special reference to node-positive or -negative status, and patient survival by lymph node status was compared for FIGO intraperitoneal stage.

RESULTS

One hundred eleven of 125 patients were explored for retroperitoneal and inguinal nodes and divided into a node-positive group [n = 35 (31.5%)] and a node-negative group [n = 76 (68.5%)]. Stage III disease and histological grade 3 disease were significantly more frequent in the node-positive group in comparison with the corresponding figures in the node-negative group (P = 0.0007 and P = 0.0005). The 10-year survival was not significantly different between the node-positive and the node-negative group for each of Stage I, II, IIIA+B, and IIIC disease. However, survival was considerably worse in the node-positive group compared to that in the node-negative group for each of Stage I and II disease, and was significantly worse for Stage I+II disease (P = 0.0172). The survival was significantly worse in the node-positive group compared to that in the node-negative group also for Stage I through IIIB disease taken as a whole (P = 0.0212), although not for Stage IIIA+B disease alone. On the other hand, patient survival of node-positive Stage I through IIIB disease, taken as a whole, was significantly better than that in Stage IIIC disease (P < 0.0001).

CONCLUSIONS

It might not be valid, on the basis of patient prognosis, to group node-positive Stage I, II, and IIIA+B disease into a criterion of Substage IIIC together with Stage III disease of abdominal implants greater than 2 cm in diameter outside the pelvis. For further evaluation of the prognostic significance of node involvement, survivals should be compared among patients with de novo node disease, with node disease removed, and otherwise similar patients without node disease, ideally in a prospective randomized trial with a large number of patients.