Chen Jiayu, Yin Jie, Li Yan, Gu Yu, Wang Wei, Shan Ying, Wang Yong-Xue, Qin Meng, Cai Yan, Jin Ying, Pan Lingya
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Oncol. 2021 Sep 6;11:705720. doi: 10.3389/fonc.2021.705720. eCollection 2021.
To investigate whether systematic lymph node dissection can confer clinical benefits in patients with apparent early-stage low-grade epithelial ovarian cancer.
Patients with apparent early-stage low-grade epithelial ovarian cancer seen at Peking Union Medical College Hospital from January 1, 2005, to December 31, 2015, were retrospectively enrolled. Patients with other histological types and those who did not receive necessary adjuvant chemotherapy were excluded. Data collection and long-term follow-up were performed. According to the removed lymph node number, three groups based on surgical methods were used: abnormal lymph node resection, pelvic lymphadenectomy, and systematic lymph node dissection to control surgical quality. Their effects on prognosis were analyzed in pathological subgroups.
A total of 196 patients were enrolled; 30.1% of patients had serous, 42.3% of patients had mucinous, and 27.6% of patients had endometrioid carcinoma, of which 51 (26.0%), 96 (49.0), and 49 (25.0%) patients were treated with the above surgical methods, respectively. The occult lymph node metastasis rate was 14 (7.1%), and only five (2.6%) of apparent early-stage patients were upstaged due to lymph node metastasis alone. Systematic lymph node dissection did not benefit progression-free survival or disease-specific overall survival of apparent early-stage low-grade mucinous and endometrioid epithelial ovarian cancer but prolonged progression-free survival of apparent early-stage low-grade serous patients (OR, 0.231, 95% CI, 0.080, 0.668, p = 0.007).
Systematic lymph node dissection may be abolished in patients with apparent early-stage low-grade mucinous and endometrioid epithelial ovarian cancer but may be considered for apparent early-stage low-grade serous patients.
探讨系统性淋巴结清扫术对早期低度上皮性卵巢癌患者是否具有临床益处。
回顾性纳入2005年1月1日至2015年12月31日在北京协和医院就诊的早期低度上皮性卵巢癌患者。排除其他组织学类型患者及未接受必要辅助化疗的患者。进行数据收集及长期随访。根据切除淋巴结数量，基于手术方式分为三组：异常淋巴结切除术、盆腔淋巴结清扫术及系统性淋巴结清扫术，以控制手术质量。在病理亚组中分析其对预后的影响。
共纳入196例患者；浆液性癌患者占30.1%，黏液性癌患者占42.3%，子宫内膜样癌患者占27.6%，其中分别有51例（26.0%）、96例（49.0%）和49例（25.0%）患者接受上述手术方式治疗。隐匿性淋巴结转移率为14例（7.1%），仅5例（2.6%）早期患者单纯因淋巴结转移而分期上调。系统性淋巴结清扫术对早期低度黏液性和子宫内膜样上皮性卵巢癌患者的无进展生存期或疾病特异性总生存期无益处，但可延长早期低度浆液性患者的无进展生存期（OR，0.231；95%CI，0.080，0.668；p = 0.007）。
对于早期低度黏液性和子宫内膜样上皮性卵巢癌患者，可废除系统性淋巴结清扫术，但对于早期低度浆液性患者可考虑采用。
