Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea.
Gynecol Oncol. 2012 Sep;126(3):381-6. doi: 10.1016/j.ygyno.2012.05.014. Epub 2012 May 18.
The objective of this study was to evaluate the impact of systematic pelvic and para-aortic lymphadenectomy on survival in patients with advanced ovarian cancer.
We retrospectively analyzed the data of 189 consecutive patients with FIGO stage IIIC ovarian cancer between 2000 and 2011, who underwent primary cytoreductive surgery followed by platinum- and taxane-based chemotherapy. All patients were classified into two groups - patients who underwent systematic pelvic and para-aortic lymphadenectomy and those who did not. Progression-free (PFS) and overall survival (OS) times were analyzed using Kaplan-Meier method and Cox proportional hazards model.
Patients who underwent systematic lymphadenectomy had significantly improved PFS (22 versus 9 months, p<0.01) and OS (66 versus 40 months, p<0.01). In patients with no gross residual disease (NGR) or residual disease 0.1-1cm (GR-1), the median OS time of those who had lymphadenectomy was significantly longer than those who did not (86 versus 46 months, p=0.02). However, in patients with residual disease >1cm (GR-B), there was no significant difference in OS according to lymphadenectomy (39 versus 40 months, p=0.50). Among patients with NGR, the median OS time of those who underwent systematic lymphadenectomy was significantly longer than those who did not undergo lymphadenectomy (not yet reached [>96] and 56 months, p<0.01). No significant difference of OS between patients with and without lymphadenectomy was observed in the subgroup of patients with GR-1 (50 versus 38 months, p=0.44). The performance of lymphadenectomy was a statistically significant and independent predictor of improved OS in addition to the status of residual disease and the performance of radical cytoreductive procedures (hazard ratio, 0.34; [95% CI, 0.23-0.52]; p<0.01).
Systematic lymphadenectomy may have a therapeutic value and be significantly associated with improved survival in stage IIIC ovarian cancer patients with grossly no visible residual disease.
本研究旨在评估系统盆腔和腹主动脉旁淋巴结清扫术对晚期卵巢癌患者生存的影响。
我们回顾性分析了 2000 年至 2011 年间 189 例 FIGO 分期为 III C 期卵巢癌患者的资料，这些患者均接受了初次减瘤性手术，随后进行铂类和紫杉烷类化疗。所有患者分为两组 - 接受系统盆腔和腹主动脉旁淋巴结清扫术的患者和未接受系统淋巴结清扫术的患者。采用 Kaplan-Meier 法和 Cox 比例风险模型分析无进展生存期（PFS）和总生存期（OS）。
接受系统淋巴结清扫术的患者 PFS（22 个月比 9 个月，p<0.01）和 OS（66 个月比 40 个月，p<0.01）均显著改善。在无肉眼残留疾病（NGR）或残留疾病 0.1-1cm（GR-1）的患者中，接受淋巴结清扫术的患者中位 OS 时间明显长于未接受淋巴结清扫术的患者（86 个月比 46 个月，p=0.02）。然而，在残留疾病>1cm（GR-B）的患者中，淋巴结清扫术对 OS 无显著影响（39 个月比 40 个月，p=0.50）。在 NGR 患者中，接受系统淋巴结清扫术的患者中位 OS 时间明显长于未接受淋巴结清扫术的患者（未达到[>96]和 56 个月，p<0.01）。在 GR-1 患者亚组中，接受淋巴结清扫术和未接受淋巴结清扫术的患者 OS 无显著差异（50 个月比 38 个月，p=0.44）。除残留疾病状态和根治性减瘤术的效果外，淋巴结清扫术的实施是 OS 改善的统计学上显著且独立的预测因素（风险比，0.34；[95%CI，0.23-0.52]；p<0.01）。
系统淋巴结清扫术可能具有治疗价值，并与大体无可见残留疾病的 III C 期卵巢癌患者的生存改善显著相关。
