Lago Victor, Minig Lucas, Fotopoulou Christina
*Department of Obstetrics Gynecology, University Hospital of Getafe, Madrid; †Department of Gynecology, Valencian Institute of Oncology, Valencia, Spain; and ‡Department of Gynecology, Imperial College London, London, United Kingdom.
Int J Gynecol Cancer. 2016 Oct;26(8):1407-14. doi: 10.1097/IGC.0000000000000787.
This study aimed to determine the incidence of lymph node (LN) metastases in presumed stage I-II low-grade epithelial ovarian cancer (EOC).
Eligible studies were identified from MEDLINE and EMBASE (time frame, 2015-1975), that analyzed patients with clinical or radiologic presumed early-stage EOC who underwent a complete pelvic and para-aortic lymphadenectomy as part of their surgical staging. The number and site of dissected and involved LNs and the correlation with overall outcome are analyzed. The term low grade and also the older term well differentiated were used.
Thirteen of 978 identified studies were selected, and 13 of 75 studies were identified as eligible. A total of 1403 patients were analyzed in these 13 retrospective studies. The final International Federation of Gynecology and Obstetrics staging after completed surgical staging was I to II in 912 patients (65%). A total of 338 patients (24%) had grade 1 tumors whereas 473 patients (34%) had grade 2, and 502 patients (36%) had grade 3 tumors. Systematic lymphadenectomy was performed in 1159 patients (83%), whereof 1142 (82%) were pelvic and para-aortic LN dissections.In 185 patients (13%), an upstaging from an apparent clinical stage I-II to IIIC occurred because of LN involvement: 64 (35%) of the patients had only pelvic LNs metastases, 69 (37%) had only para-aortic LNs metastasis, and 51 (28%) had both a pelvic and para-aortic LN involvement. When analyzing only the patients with low-grade (grade 1 as the old classification) presumed early-stage disease (n = 273), only 8 patients (2.9%; range, 0-6.2) were identified with LNs metastases present.
The incidence of occult LN metastases in apparent early-stage low-grade EOC is 2.9% in a metaanalysis of retrospective studies. Future larger-scale prospectively assessed studies with established surgical quality of the LN dissection are warranted to establish the true incidence of LN metastasis in presumed early low-grade disease.
本研究旨在确定假定为Ⅰ - Ⅱ期的低级别上皮性卵巢癌（EOC）患者的淋巴结（LN）转移发生率。
从MEDLINE和EMBASE（时间范围为1975 - 2015年）中检索符合条件的研究，这些研究分析了临床或影像学诊断为早期EOC且接受了完全盆腔及腹主动脉旁淋巴结清扫术作为手术分期一部分的患者。分析清扫及受累淋巴结的数量和部位以及与总体预后的相关性。使用了低级别一词以及旧术语高分化。
在978项已识别的研究中，选择了13项，在75项研究中确定了13项符合条件。在这13项回顾性研究中，共分析了1403例患者。完成手术分期后的最终国际妇产科联盟分期为Ⅰ - Ⅱ期的患者有912例（65%）。共有338例患者（24%）为1级肿瘤，473例患者（34%）为2级肿瘤，502例患者（36%）为3级肿瘤。1159例患者（83%）进行了系统性淋巴结清扫，其中1142例（82%）为盆腔及腹主动脉旁淋巴结清扫。185例患者（13%）因淋巴结受累从明显的临床Ⅰ - Ⅱ期上调至ⅡIC期：64例（35%）患者仅有盆腔淋巴结转移，69例（37%）仅有腹主动脉旁淋巴结转移，51例（28%）盆腔和腹主动脉旁淋巴结均受累。仅分析假定为早期疾病的低级别（旧分类为1级）患者（n = 273）时，仅8例患者（2.9%；范围为0 - 6.2）被确定存在淋巴结转移。
在回顾性研究的荟萃分析中，明显早期低级别EOC中隐匿性淋巴结转移的发生率为2.9%。未来有必要开展更大规模的前瞻性评估研究，并确保淋巴结清扫手术质量，以确定假定早期低级别疾病中淋巴结转移的真实发生率。
