Ray M D, Gaur Manish Kumar
Department of Surgical Oncology, DR BRA-IRCH, All India Institute of Medical Sciences, New Delhi, India.
J Egypt Natl Canc Inst. 2025 Apr 11;37(1):17. doi: 10.1186/s43046-025-00256-4.
The nodal positivity in advanced ovarian cancers is approximately 68-70% histopathologically. Even after neoadjuvant chemotherapy (NACT) chance of nodal positivity is around 50-80%. In the prevailing literature, the nodal burden is a neglected entity in both assessment and documentation and complete clearance during the CRS. We aim to highlight the importance of nodal dissection and propose a Nodal Cancer Index (NCI) like PCI for ovarian cancers based on our experience of 105 cases.
We included 105 patients with advanced ovarian cancers who underwent CRS. Retroperitoneal lymph nodes and bilateral pelvic lymph node dissection were routinely done in all the cases. For Nodal Cancer Index calculation, the abdomen is divided into 13 zones, zones 1-6 for retroperitoneum, zones 1-6 for Pelvic nodes, and zone 0 for extra-abdominal nodes. Furthermore, a Nodal size score ranging from 1 to 3 has been proposed so that the Nodal Cancer Index ranges from 13 to 39.
The median age of the patients was 51 years (range 19-71) and the most significant patients were in stage III (65.7%), and 34.3% had stage IV disease at presentation. The lymph nodes were found to be positive in 62 patients (59%), and the positivity rate was higher in patients who underwent upfront surgery 36 (58.1%) as compared to 26 (41.9%) in those who received NACT. The majority of the patients (56.6%) had positive lymph nodes in both the pelvic and retroperitoneal groups, whereas 19.3% had only pelvic nodes positive, and 24.2% had only retroperitoneal nodes positive. The probability of overall survival at 5 years in our patients was 48.9% (95% CI = 35.5-61).
The results of our analytic observation confirm that systemic lymphadenectomy of all 13 zones proposed by our study should be an integral part of optimal CRS in the advanced carcinoma ovary and this will help us manage these advanced cases in a better objective manner.
晚期卵巢癌的淋巴结阳性率在组织病理学上约为68%-70%。即使经过新辅助化疗（NACT），淋巴结阳性的几率仍在50%-80%左右。在现有文献中，淋巴结负荷在评估和记录以及CRS期间的完全清除方面都是一个被忽视的实体。我们旨在强调淋巴结清扫的重要性，并根据我们105例病例的经验，为卵巢癌提出一种类似PCI的淋巴结癌指数（NCI）。
我们纳入了105例接受CRS的晚期卵巢癌患者。所有病例均常规进行腹膜后淋巴结和双侧盆腔淋巴结清扫。为了计算淋巴结癌指数，将腹部分为13个区域，区域1-6为腹膜后，区域1-6为盆腔淋巴结，区域0为腹外淋巴结。此外，还提出了一个范围从1到3的淋巴结大小评分，使得淋巴结癌指数范围从13到39。
患者的中位年龄为51岁（范围19-71岁），最主要的患者处于III期（65.7%），34.3%的患者初诊时为IV期。62例患者（59%）的淋巴结呈阳性，接受 upfront 手术的患者阳性率较高，为36例（58.1%），而接受NACT的患者为26例（41.9%）。大多数患者（56.6%）的盆腔和腹膜后组淋巴结均为阳性，而19.3%的患者仅盆腔淋巴结阳性，24.2%的患者仅腹膜后淋巴结阳性。我们患者5年的总生存率为48.9%（95%CI = 35.5-61）。
我们的分析观察结果证实，我们研究提出的所有13个区域的系统性淋巴结清扫术应成为晚期卵巢癌最佳CRS的一个组成部分，这将有助于我们以更好的客观方式管理这些晚期病例。
