Guo Wen, Yin Jie, Gu Yu, Shan Yin, Wang Wei, Li Yan, Qin Meng, Chen Jiayu, Jin Ying, Pan Lingya
Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1#, Dongcheng District, Beijing, 100730, China.
BMC Cancer. 2025 May 6;25(1):832. doi: 10.1186/s12885-025-14237-2.
To investigate the prognostic impact of metastatic lymph nodes (MLNs) on advanced epithelial ovarian cancer (EOC) patients receiving neoadjuvant chemotherapy (NACT).
This was a retrospective cohort study using data from patients managed by a single gynecological team between June 2012 and June 2023. Among EOC patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC or IV disease, patients who received NACT and who underwent complete cytoreduction during interval debulking surgery were included (the NACT cohort), together with patients who received primary debulking surgery (PDS, including those with both complete and incomplete cytoreduction). Clinically suspicious lymph nodes at diagnosis and/or debulking surgeries were resected. Differences in terms of clinicopathological features, survival profiles, and recurrence patterns were analyzed between groups with different lymph node statuses.
The NACT cohort comprised 166 patients (53.6% underwent lymphadenectomy), of whom 58 presented with MLNs (the MLN group) and 108 did not (the NLN group). Among those who underwent lymphadenectomy, a median of 24 pelvic lymph nodes and 13 para-aortic lymph nodes were resected. The MLN group was significantly associated with inferior progression-free survival (PFS) and time to platinum-resistant recurrence (TTPR), even when adjusted by multivariate models. The hazard ratio (95% confidence interval) was 1.90 (1.06-3.41) for the multivariate PFS analysis and 2.50 (1.22-5.13) for the multivariate TTPR analysis. For the PDS cohort (143 patients, 68.5% underwent lymphadenectomy), a median of 25 pelvic lymph nodes and 14 para-aortic lymph nodes were resected. The MLN group (66 patients) manifested non-inferior PFS and TTPR outcomes compared to the NLN group (77 patients).
MLNs may have a negative impact on the prognosis of patients receiving NACT. For such patients, PDS is a preferred choice to delay recurrence and platinum resistance.
探讨转移性淋巴结（MLNs）对接受新辅助化疗（NACT）的晚期上皮性卵巢癌（EOC）患者预后的影响。
这是一项回顾性队列研究，使用了2012年6月至2023年6月期间由单一妇科团队管理的患者数据。在国际妇产科联盟（FIGO）IIIC期或IV期的EOC患者中，纳入接受NACT并在间隔减瘤手术期间进行了完全减瘤的患者（NACT队列），以及接受初次减瘤手术（PDS，包括完全和不完全减瘤的患者）的患者。对诊断和/或减瘤手术时临床上可疑的淋巴结进行切除。分析不同淋巴结状态组之间在临床病理特征、生存情况和复发模式方面的差异。
NACT队列包括166例患者（53.6%接受了淋巴结切除术），其中58例有MLNs（MLN组），108例没有（NLN组）。在接受淋巴结切除术的患者中，中位切除24个盆腔淋巴结和13个腹主动脉旁淋巴结。即使经多变量模型调整后，MLN组的无进展生存期（PFS）和铂耐药复发时间（TTPR）仍显著较差。多变量PFS分析的风险比（95%置信区间）为1.90（1.06 - 3.41），多变量TTPR分析为2.50（1.22 - 5.13）。对于PDS队列（143例患者，68.5%接受了淋巴结切除术），中位切除25个盆腔淋巴结和14个腹主动脉旁淋巴结。与NLN组（77例患者）相比，MLN组（66例患者）的PFS和TTPR结果无劣效性。
MLNs可能对接受NACT的患者预后产生负面影响。对于此类患者，PDS是延迟复发和铂耐药的首选。
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