Gynecologic Oncology Division, ObGyn and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.
Int J Gynecol Cancer. 2013 Sep;23(7):1226-30. doi: 10.1097/IGC.0b013e3182856736.
The objective of this study was to estimate the prevalence and prognostic impact of lymphadenectomy and lymph node involvement in patients with ovarian clear cell carcinoma (OCCC) grossly confined to the ovary.
Patients with a diagnosis of OCCC grossly confined to the ovary were identified from Surveillance, Epidemiology, and End Results program from 1988 to 2007. Only surgically treated patients were included. Statistical analysis using Student t test, Kaplan-Meier survival methods, and Cox proportional hazards regression were performed.
One thousand eight hundred ninety-seven patients with OCCC who have undergone surgical treatment and deemed at time of the surgery to have disease grossly confined to the ovary were included: 538 (28.3%) had no lymphadenectomy (LND -1), and 1359 (71.7%) had lymphadenectomy. Of the 1359 patients who had lymphadenectomy, 1298 (95.5%) were International Federation of Gynecology and Obstetrics (FIGO) surgical stage I (LND +1), and 61 (4.5%) were upstaged to FIGO stage IIIC due to nodal metastasis (LND +3C). The 5-year disease-specific survival was 84.9% for LND -1, 88.0% for LND +1, and 65.0% for LND +3C (P < 0.001). Among those with histologically negative lymph nodes, the 5-year disease-specific survival was 85% for patients with 1 to 10 nodes removed, and 91% for those with more than 10 nodes removed (P = 0.054). On multivariate analysis after controlling for stage, age, and race, lymph node metastasis was an independent predictor of poor disease-specific survival (hazard ratio, 3.1; 95% confidence interval, 1.86-5.28; P < 0.001). On other hand, there was a trend toward an improved survival when more extensive lymphadenectomy is performed in patients with histologically negative nodes (1-10 vs >10 nodes), but it did not reach statistical significance (hazard ratio, 0.71; 95% confidence interval, 0.49-1.02; P = 0.064).
Lymph node metastasis was uncommon in patients diagnosed with OCCC grossly confined to the ovary; however, patients with positive nodes were more likely to die compared to those with negative nodes. More extensive lymphadenectomy plays an important role in providing accurate staging and prognostic information.
本研究旨在评估大体局限于卵巢的卵巢透明细胞癌（OCCC）患者行淋巴结切除术和淋巴结受累的患病率和预后影响。
本研究从 1988 年至 2007 年的监测、流行病学和最终结果（SEER）计划中确定了大体局限于卵巢的 OCCC 患者。仅纳入接受手术治疗的患者。采用学生 t 检验、Kaplan-Meier 生存分析和 Cox 比例风险回归进行统计分析。
本研究共纳入 1897 例接受手术治疗且术前诊断为大体局限于卵巢的 OCCC 患者：538 例（28.3%）未行淋巴结切除术（LND-1），1359 例（71.7%）行淋巴结切除术。在 1359 例行淋巴结切除术的患者中，1298 例（95.5%）为国际妇产科联合会（FIGO）手术分期 I 期（LND+1），61 例（4.5%）因淋巴结转移（LND+3C）被升级为 FIGO 分期 III 期。LND-1、LND+1 和 LND+3C 的 5 年疾病特异性生存率分别为 84.9%、88.0%和 65.0%（P<0.001）。在淋巴结组织学阴性的患者中，切除 1-10 个淋巴结的患者 5 年疾病特异性生存率为 85%，切除 10 个以上淋巴结的患者为 91%（P=0.054）。在控制分期、年龄和种族后进行多变量分析，淋巴结转移是疾病特异性生存率的独立预后因素（风险比，3.1；95%置信区间，1.86-5.28；P<0.001）。另一方面，在淋巴结组织学阴性的患者中，行更广泛的淋巴结切除术有改善生存的趋势（1-10 个 vs >10 个），但未达到统计学意义（风险比，0.71；95%置信区间，0.49-1.02；P=0.064）。
大体局限于卵巢的 OCCC 患者淋巴结转移并不常见，但淋巴结转移阳性的患者更有可能死亡。更广泛的淋巴结切除术在提供准确分期和预后信息方面发挥着重要作用。
