Shimada Yoshifumi, Nishino Koji, Hasegawa Junki, Nakano Masato, Nakano Mae, Matsumoto Akio, Yamai Daisuke, Ozeki Hikaru, Minamikawa Takahiro, Kudo Risa, Suzuki Miho, Yachida Nozomi, Kobayashi Akiko, Adachi Sosuke, Yoshihara Kosuke, Wakai Toshifumi
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Ann Surg Oncol. 2025 Jul 12. doi: 10.1245/s10434-025-17779-8.
Mesenteric lymph node (MLN) involvement is frequently observed in patients undergoing cytoreductive surgery for ovarian cancer (OC) with rectosigmoid invasion. However, MLN detection methods are not standardized, and the clinical significance of MLN involvement remains controversial. This study aimed to investigate the clinical significance of MLN involvement in patients with OC using a standardized detection method.
The study included 171 patients with stage II, III, or IV OC who underwent cytoreductive surgery. The analysis detected MLN in patients who underwent rectosigmoid resection in the same manner as for colorectal cancer: systematic regional lymph node dissection followed by systematic extraction and histopathologic examination of MLN.
Of the 171 patients, 57 underwent rectosigmoid resection. In 56 patients (98.2 %), MLNs were detected, with a median of nine (range, 0-51) dissected nodes. Histopathologic examination confirmed MLN involvement in 30 of these 57 patients. The independent prognostic factors for progression-free survival identified by multivariate analysis were residual tumor status (P = 0.002), ascitic cytology (P = 0.034), and MLN involvement (P = 0.010). Among the 86 patients who underwent complete cytoreductive surgery, MLN involvement was significantly associated with worse prognosis (P < 0.001). However, for the 85 patients who underwent optimal or suboptimal cytoreductive surgery, MLN involvement was not a significant prognostic factor.
In patients with OC, MLN involvement is an important prognostic factor, particularly for those undergoing complete cytoreductive surgery. Evaluation of MLNs using a standardized detection method in the same manner as for colorectal cancer may help identify patients at higher risk for a poor prognosis.
在接受细胞减灭术治疗的卵巢癌（OC）合并直肠乙状结肠侵犯患者中，常观察到肠系膜淋巴结（MLN）受累。然而，MLN检测方法并不标准化，且MLN受累的临床意义仍存在争议。本研究旨在使用标准化检测方法探讨MLN受累在OC患者中的临床意义。
本研究纳入了171例接受细胞减灭术的II、III或IV期OC患者。分析对接受直肠乙状结肠切除术的患者检测MLN，其方式与结直肠癌相同：进行系统性区域淋巴结清扫，随后系统性提取并对MLN进行组织病理学检查。
171例患者中，57例接受了直肠乙状结肠切除术。56例患者（98.2%）检测到MLN，中位切除淋巴结数为9个（范围为0 - 51个）。组织病理学检查证实这57例患者中有30例存在MLN受累。多因素分析确定的无进展生存独立预后因素为残留肿瘤状态（P = 0.002）、腹水细胞学（P = 0.034）和MLN受累（P = 0.010）。在86例接受了完全细胞减灭术的患者中，MLN受累与较差的预后显著相关（P < 0.001）。然而，对于85例接受了最佳或次优细胞减灭术的患者，MLN受累并非显著的预后因素。
在OC患者中，MLN受累是一个重要的预后因素，尤其是对于那些接受完全细胞减灭术的患者。以与结直肠癌相同的方式使用标准化检测方法评估MLN，可能有助于识别预后较差风险较高的患者。
