Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Int J Gynaecol Obstet. 2021 Sep;154(3):550-557. doi: 10.1002/ijgo.13627. Epub 2021 Mar 24.
To explore the impact of lymphadenectomy on the prognosis of women of reproductive age with clinically apparent Stage I epithelial ovarian cancer (EOC).
Data of women of reproductive age with Stage I EOC, diagnosed between 2010 and 2016, were extracted from the Surveillance, Epidemiology, and End Results database. Five-year cancer-specific survival (CSS) was evaluated using the Kaplan-Meier method. Multivariate Cox analysis was performed to evaluate the effect of lymph node dissection on survival. Propensity score (PS) matching was conducted to balance various clinicopathologic factors.
Of 2222 patients included, 1609 (72.4%) received lymph node dissection. The rate of histopathologically confirmed lymph node metastasis was highest in serous subtype (10.2%) and lowest in mucinous subtype (2.2%). No significant difference between the lymphadenectomy and non-lymphadenectomy groups in 5-year CSS was observed in the original cohort (P = 0.364) or in the PS matching cohort (P = 0.248). Nevertheless, there was a significant difference between the lymphadenectomy and non-lymphadenectomy groups for patients with Stage IC EOC (92.4% vs. 88.1%, P = 0.027). According to the multivariate analysis, performance of the lymphadenectomy was not significantly associated with CSS in the original cohort (P = 0.163) or the PS matching cohort (P = 0.101).
Dissection of lymph nodes was not significantly associated with improved prognosis for most Stage I EOC, but, lymphadenectomy may be necessary for women of reproductive age with Stage IC subtype.
探讨淋巴结清扫术对临床Ⅰ期上皮性卵巢癌（EOC）有生育能力的妇女预后的影响。
从监测、流行病学和最终结果数据库中提取了 2010 年至 2016 年间诊断为Ⅰ期 EOC 的有生育能力的妇女的数据。使用 Kaplan-Meier 方法评估 5 年癌症特异性生存率（CSS）。多变量 Cox 分析用于评估淋巴结清扫术对生存的影响。进行倾向评分（PS）匹配以平衡各种临床病理因素。
在 2222 例患者中，有 1609 例（72.4%）接受了淋巴结清扫术。在组织病理学上证实有淋巴结转移的患者中，浆液性亚型（10.2%）的比例最高，粘液性亚型（2.2%）的比例最低。在原始队列中（P=0.364）或在 PS 匹配队列中（P=0.248），淋巴结清扫组和非淋巴结清扫组在 5 年 CSS 方面无显著差异。然而，在临床ⅠC 期 EOC 患者中，淋巴结清扫组与非淋巴结清扫组之间存在显著差异（92.4% vs. 88.1%，P=0.027）。根据多变量分析，在原始队列（P=0.163）或 PS 匹配队列（P=0.101）中，淋巴结清扫术与 CSS 无显著相关性。
淋巴结清扫术与大多数Ⅰ期 EOC 的预后改善无显著相关性，但对于临床ⅠC 期的有生育能力的妇女，淋巴结清扫术可能是必要的。
