Department of Gynecology and Obstetrics, Hopital Lariboisière, AP-HP, Paris, France; Department of Gynecology and Obstetrics, Hopital Tenon, AP-HP, 6 Sorbonne, 4 rue de la Chine, Paris 75020, France.
Department of Gynecology and Obstetrics, Hopital Lariboisière, AP-HP, Paris, France; Research Unit EA 7285 "Risk and Safety in Clinical Medicine for Women and Perinatal Health", University of Versailles Saint-Quentin (UVSQ), Poissy, France.
J Gynecol Obstet Hum Reprod. 2022 Nov;51(9):102464. doi: 10.1016/j.jogoh.2022.102464. Epub 2022 Aug 24.
Lymphadenectomy is part of cytoreductive surgery for patients with advanced epithelial ovarian cancer (AEOC) in case of abnormal lymph nodes before and during surgery. The aim of this study was to develop and validate a pre-operative radiological score to predict pelvic and/or para-aortic lymph node metastasis (LNM) in patients with AEOC undergoing cytoreductive surgery.
We conducted a multicentre retrospective study. The construction sample was composed of 53 patients operated within two referral centers. The validation sample was composed of 39 patients operated in a third referral center. The score was built with a logistic regression model with internal validation by bootstrap.
Two variables were associated with the prediction of pelvic and/or para-aortic LNM at computerized tomography (CT) and/or positron emission tomography (PET/CT): "para-aortic lymph node involvement" (adjusted diagnostic odds ratio) (aDOR) = 8.77 95CI [1.42-54.09], p = 0.02) and "colon involvement" (aDOR = 7.97 95CI [1.28-49.58], p = 0.03). Bootstrap procedure showed that the model was stable. The 2-points LNM pre-operative radiological score was derived from these 2 radiological variables and a high-risk group was identified for a score ≥ 1: the probability of pelvic and/or para-aortic LNM was 76%, the specificity was 85.7% 95CI [67.3-96.0] and the positive likelihood ratio was 3.6 95CI [1.4-9.7]. In the validation sample, a score ≥ 1 had a specificity of 78.3% and a LR+ of 1.2.
LNM pre-operative radiological score could help the surgeon's decision to perform pelvic and para-aortic lymphadenectomy in patients with AEOC undergoing cytoreductive surgery.
The research protocol was approved by the Ethics Committee for Research in Obstetrics and Gynecology (CEROG 2016-GYN 1003).
对于术前和术中发现异常淋巴结的晚期上皮性卵巢癌（AEOC）患者，淋巴结切除术是细胞减灭术的一部分。本研究旨在开发和验证一种术前影像学评分，以预测接受细胞减灭术的 AEOC 患者的盆腔和/或腹主动脉旁淋巴结转移（LNM）。
我们进行了一项多中心回顾性研究。构建样本由在两个转诊中心接受手术的 53 例患者组成。验证样本由在第三个转诊中心接受手术的 39 例患者组成。该评分采用内部验证的 bootstrap 逻辑回归模型构建。
计算机断层扫描（CT）和/或正电子发射断层扫描（PET/CT）上有两个变量与预测盆腔和/或腹主动脉旁 LNM 相关：“腹主动脉旁淋巴结受累”（调整诊断比值比）（aDOR）=8.77 95CI [1.42-54.09]，p=0.02）和“结肠受累”（aDOR=7.97 95CI [1.28-49.58]，p=0.03）。bootstrap 过程表明模型稳定。该 2 分 LNM 术前影像学评分来自这两个影像学变量，确定了一个高风险组，评分≥1：盆腔和/或腹主动脉旁 LNM 的概率为 76%，特异性为 85.7% 95CI [67.3-96.0]，阳性似然比为 3.6 95CI [1.4-9.7]。在验证样本中，评分≥1 的特异性为 78.3%，LR+为 1.2。
LNM 术前影像学评分可帮助外科医生决定对接受细胞减灭术的 AEOC 患者行盆腔和腹主动脉旁淋巴结切除术。
该研究方案获得了妇产科伦理委员会（CEROG 2016-GYN 1003）的批准。
