Department of Surgery, Comprehensive Regional Cancer Center, Institut Bergonié, Bordeaux, France.
Int J Gynecol Cancer. 2009 Nov;19(8):1307-13. doi: 10.1111/IGC.0b013e3181b8a07c.
To perform a cartography of lymph node metastases in epithelial ovarian cancer and to determine predictive factors of lymph node metastases.
The charts of 355 patients with epithelial ovarian cancer who underwent lymphadenectomy during a primary (n = 252) or secondary debulking surgery (n = 103) were analyzed. The topography of the lymph node metastases was notified for the whole group according to the stage of the disease, the histological type, and the moment of surgery. In patients who underwent a primary surgery before chemotherapy, independent prognostic variables for the risk of lymph node involvement were tested with a multivariate analysis. Independent prognostic factors were combined to determine risk profiles in individual patients.
The main area of the lymph node metastases was para-aortic. Isolated pelvic lymph node involvement was 10%. Three variables independently predicted lymph node invasion: advanced T stage, high-risk histological profile, and metastases.
When lymphadenectomy is recommended, systematic lymph node dissections in the aortic and pelvic areas are warranted. An isolated pelvic lymph node assessment, particularly in the early stages, is inappropriate. By combining independent risk factors, a useful tool for individual risk assessment of lymph node involvement could be established, helping to decide whether to perform a lymph node dissection, especially at restaging surgery.
对上皮性卵巢癌的淋巴结转移进行绘图，并确定淋巴结转移的预测因素。
分析了 355 例接受淋巴结切除术的上皮性卵巢癌患者的图表，这些患者在初次（n=252）或二次减瘤手术（n=103）期间进行了淋巴结切除术。根据疾病分期、组织学类型和手术时机，通知了整个组的淋巴结转移的分布情况。对于在化疗前接受初次手术的患者，使用多变量分析测试了淋巴结受累风险的独立预后变量。将独立的预后因素相结合，以确定个体患者的风险特征。
淋巴结转移的主要区域是腹主动脉旁。孤立的盆腔淋巴结受累为 10%。三个变量独立预测淋巴结侵犯：晚期 T 分期、高危组织学特征和转移。
当建议进行淋巴结切除术时，有必要对主动脉和盆腔区域进行系统的淋巴结清扫。单独的盆腔淋巴结评估，特别是在早期阶段，是不适当的。通过结合独立的风险因素，可以建立一种用于个体淋巴结受累风险评估的有用工具，有助于决定是否进行淋巴结清扫术，特别是在重新分期手术时。
