Gynecologic and Breast Oncologic Surgery Department, European Georges-Pompidou Hospital, APHP Centre, Paris, France; Paris University, Faculty of Medicine, Paris, France; INSERM UMR-S 1124, Université de Paris, Centre Universitaire des Saint-Père, Paris, France.
Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, Department of Radiology, PARCC UMRS 970, INSERM, Paris, France.
Gynecol Oncol. 2021 Sep;162(3):667-673. doi: 10.1016/j.ygyno.2021.06.025. Epub 2021 Jun 30.
The benefit of a systematic lymphadenectomy is still debated in patients undergoing neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) in ovarian cancer (OC). The objective of this study was to evaluate the predictive value of the pre-NACT and post-NACT CT in predicting definitive histological lymph node involvement. The prognostic value of a positive node on the CT was also assessed.
A retrospective, unicentric cohort study was performed including all patients with ovarian cancer who underwent NACT and IDS with a lymphadenectomy between 2005 and 2018. CT were analyzed blinded to pathology, and nodes with small axis ≥ 10 mm on CT were considered positive. Sensitivity (Se), specificity (Sp), and negative (NPV) and positive predictive values (PPV) and their CI95% were calculated. The 2-year recurrence free survival (RFS) and 5-year overall survival (OS) was compared.
158 patients were included, among which 92 (58%) had histologically positive lymph nodes. CT had a Se, Sp, NPV and PPV of 35%, 82%, 47% and 73% before NACT and 20%, 97%, 47% and 91% after NACT, respectively. Patients with nodes considered positive had a non-significant lower 2-year RFS and 5-year OS on the pre-NACT and post-NACT CT. Patients at 'high risk' (nodes stayed positive on the CT or became positive after NACT) also had a non-significant lower 2-year RFS and 5-year OS.
Presence of enlarged lymph nodes on CT is a weak indicator of lymph node involvement in patients with advanced ovarian cancer undergoing NACT. However, it could be used to assess prognosis.
在接受新辅助化疗（NACT）后行间隔减瘤术（IDS）的卵巢癌（OC）患者中，系统淋巴结切除术的益处仍存在争议。本研究旨在评估 NACT 前和 NACT 后 CT 预测明确组织学淋巴结受累的预测价值。还评估了 CT 阳性淋巴结的预后价值。
进行了一项回顾性、单中心队列研究，纳入了 2005 年至 2018 年间接受 NACT 和 IDS 并进行淋巴结切除术的所有卵巢癌患者。CT 分析是盲法进行的，CT 上小轴≥10mm 的淋巴结被认为是阳性。计算了敏感性（Se）、特异性（Sp）、阴性（NPV）和阳性预测值（PPV）及其 95%CI。比较了 2 年无复发生存率（RFS）和 5 年总生存率（OS）。
共纳入 158 例患者，其中 92 例（58%）有组织学阳性淋巴结。NACT 前 CT 的 Se、Sp、NPV 和 PPV 分别为 35%、82%、47%和 73%，NACT 后分别为 20%、97%、47%和 91%。NACT 前和 NACT 后 CT 认为阳性的患者 2 年 RFS 和 5 年 OS 无显著降低。“高危”患者（CT 上的淋巴结仍为阳性或 NACT 后变为阳性）的 2 年 RFS 和 5 年 OS 也无显著降低。
在接受 NACT 的晚期卵巢癌患者中，CT 上存在增大的淋巴结是淋巴结受累的一个较弱指标。然而，它可以用于评估预后。
