Bogani Giorgio, Tagliabue Elena, Ditto Antonino, Signorelli Mauro, Martinelli Fabio, Casarin Jvan, Chiappa Valentina, Dondi Giulia, Leone Roberti Maggiore Umberto, Scaffa Cono, Borghi Chiara, Montanelli Luca, Lorusso Domenica, Raspagliesi Francesco
Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
Statistics, IRCCS National Cancer Institute, Milan, Italy.
Gynecol Oncol. 2017 Oct;147(1):61-65. doi: 10.1016/j.ygyno.2017.07.139. Epub 2017 Aug 2.
To estimate the prevalence of lymph node involvement in early-stage epithelial ovarian cancer in order to assess the prognostic value of lymph node dissection.
Data of consecutive patients undergoing staging for early-stage epithelial ovarian cancer were retrospectively evaluated. Logistic regression and a nomogram-based analysis were used to assess the risk of lymph node involvement.
Overall, 290 patients were included. All patients had lymph node dissection including pelvic and para-aortic lymphadenectomy. Forty-two (14.5%) patients were upstaged due to lymph node metastatic disease. Pelvic and para-aortic nodal metastases were observed in 22 (7.6%) and 42 (14.5%) patients. Lymph node involvement was observed in 18/95 (18.9%), 1/37 (2.7%), 4/29 (13.8%), 11/63 (17.4%), 3/41 (7.3%) and 5/24 (20.8%) patients with high-grade serous, low-grade-serous, endometrioid G1, endometrioid G2&3, clear cell and undifferentiated, histology, respectively (p=0.12, Chi-square test). We observed that high-grade serous histology was associated with an increased risk of pelvic node involvement; while, histology rather than low-grade serous and bilateral tumors were independently associated with para-aortic lymph node involvement (p<0.05). Nomograms displaying the risk of nodal involvement in the pelvic and para-aortic areas were built. High-grade serous histology and bilateral tumors are the main characteristics suggesting lymph node positivity.
Our data suggested that high-grade serous and bilateral early-stage epithelial ovarian cancer are at high risk of having disease harboring in the lymphatic tissues of both pelvic and para-aortic area. After receiving external validation, our data will help to identify patients deserving comprehensive retroperitoneal staging.
评估早期上皮性卵巢癌淋巴结转移的发生率，以评估淋巴结清扫术的预后价值。
回顾性分析连续接受早期上皮性卵巢癌分期手术患者的数据。采用逻辑回归和基于列线图的分析方法评估淋巴结转移风险。
共纳入290例患者。所有患者均接受了包括盆腔和腹主动脉旁淋巴结清扫术在内的淋巴结清扫。42例（14.5%）患者因淋巴结转移而分期上调。盆腔和腹主动脉旁淋巴结转移分别见于22例（7.6%）和42例（14.5%）患者。高级别浆液性、低级别浆液性、子宫内膜样G1、子宫内膜样G2&3、透明细胞和未分化组织学类型的患者中，分别有18/95（18.9%）、1/37（2.7%）、4/29（13.8%）、11/63（17.4%）、3/41（7.3%）和5/24（20.8%）出现淋巴结转移（卡方检验，p=0.12）。我们观察到高级别浆液性组织学类型与盆腔淋巴结转移风险增加相关；而组织学类型而非低级别浆液性和双侧肿瘤与腹主动脉旁淋巴结转移独立相关（p<0.05）。构建了显示盆腔和腹主动脉旁区域淋巴结转移风险的列线图。高级别浆液性组织学类型和双侧肿瘤是提示淋巴结阳性的主要特征。
我们的数据表明，高级别浆液性和双侧早期上皮性卵巢癌在盆腔和腹主动脉旁区域的淋巴组织中发生转移的风险较高。经过外部验证后，我们的数据将有助于识别需要进行全面腹膜后分期的患者。
