Stage- and Histologic Subtype-Dependent Frequency of Lymph Node Metastases in Patients with Epithelial Ovarian Cancer Undergoing Systematic Pelvic and Paraaortic Lymphadenectomy

  • Florian Heitz
  • Philipp Harter
  • Beyhan Ataseven
  • Sebastian Heikaus
  • Stephanie Schneider
  • Sonia Prader
  • Mareike Bommert
  • Anette Fisseler-Eckhoff
  • Alexander Traut
  • Andreas du Bois
Gynecologic Oncology
  • 51 Downloads

Abstract

Purpose

Tumor stage and distinct histological subtypes in epithelial ovarian cancer (EOC) show different prognostic outcome. The aim of this study is to evaluate whether the frequency of lymph node (LN) metastases in patients with different tumor stages and histological subtypes undergoing systematic pelvic and paraaortic lymphadenectomy is coincidentally divergent.

Methods

Patients with EOC treated with upfront staging or debulking surgery between January 2000 and December 2016 were included. Systematic lymphadenectomy was performed in all consecutive patients with optimal debulking and without medical contraindications.

Results

Seven hundred sixty-two patients including 27.2% with early-stage EOC were included. The median number of removed LNs was 69, and metastases to LNs were found in 54.7%. No LN metastases were found in patients with low-grade endometrioid carcinoma, independently of tumor stage. LN metastases in early-stage low-grade serous (N = 5), mucinous (N = 31), and clear cell (N = 28) EOC were found in one (20%), zero, and one (3.6%) patient, respectively. LN metastases were detected in more than 10% of patients with all other histological subtypes. On multivariate analyses, overall survival was significantly impaired in patients with LN metastases, as compared with patients without LN metastases (p = 0.001).

Conclusions

The risk of LN metastases in patients with EOC is dependent on stage and histological subtype. Patients with incidental finding of early mucinous or low-grade endometrioid EOC are at very low risk of retroperitoneal lymph node metastases. Reoperation for lymph node staging only should be discussed individually with caution.

Notes

Disclosures

No relevant commercial interest or financial support to be disclosed.

Supplementary material

10434_2018_6412_MOESM1_ESM.docx (85 kb)
Supplementary material 1 (DOCX 84 kb)
10434_2018_6412_MOESM2_ESM.docx (34 kb)
Supplementary material 2 (DOCX 34 kb)

References

  1. 1.
    DeSantis CE, Lin CC, Mariotto AB, Siegel RL, Stein KD, Kramer JL, Alteri R, Robbins AS, Jemal A. Cancer treatment and survivorship statistics, 2014. CA: A Cancer J Clin. 2014;64(4):252-71.Google Scholar
  2. 2.
    Heintz AP, Odicino F, Maisonneuve P, Quinn MA, Benedet JL, Creasman WT, et al. Carcinoma of the ovary. FIGO 26th annual report on the results of treatment in gynecological cancer. Int J Gynaecol Obstet. 2006;PMID: 17161157.Google Scholar
  3. 3.
    Rochon J, du Bois A. Clinical research in epithelial ovarian cancer and patients’ outcome. Ann Oncol. 2011;PMID: 22039139.Google Scholar
  4. 4.
    du Bois A, Reuss A, Pujade-Lauraine E, Harter P, Ray-Coquard I, Pfisterer J (2009) Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d’Investigateurs Nationaux Pour les Etudes des Cancers de l’Ovaire (GINECO). Cancer. 2009;115(6):1234-44.CrossRefPubMedGoogle Scholar
  5. 5.
    Malpica A, Deavers MT, Lu K, Bodurka DC, Atkinson EN, Gershenson DM, et al. Grading ovarian serous carcinoma using a two-tier system. Am J Surg Pathol. 2004;28(4):496-504.CrossRefPubMedGoogle Scholar
  6. 6.
    Shih Ie M, Kurman RJ. Ovarian tumorigenesis: a proposed model based on morphological and molecular genetic analysis. Am J Pathol. 2004;164(5):1511-8.CrossRefPubMedGoogle Scholar
  7. 7.
    Wiegand KC, Shah SP, Al-Agha OM, Zhao Y, Tse K, Zeng T, et al. ARID1A mutations in endometriosis-associated ovarian carcinomas. N Engl J Med. 2010;363(16):1532-43.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Mackay HJ, Brady MF, Oza AM, Reuss A, Pujade-Lauraine E, Swart AM, et al. Prognostic relevance of uncommon ovarian histology in women with stage III/IV epithelial ovarian cancer. Int J Gynecol Cancer. 2010;20(6):945-52.CrossRefPubMedGoogle Scholar
  9. 9.
    Heitz F, Harter P, Alesina PF, Walz MK, Lorenz D, Groeben H, et al. Pattern of and reason for postoperative residual disease in patients with advanced ovarian cancer following upfront radical debulking surgery. Gynecol Oncol. 2016;141(2):264-70.CrossRefPubMedGoogle Scholar
  10. 10.
    Fotopoulou C, El-Balat A, du Bois A, Sehouli J, Harter P, Muallem MZ, et al. Systematic pelvic and paraaortic lymphadenectomy in early high-risk or advanced endometrial cancer. Arch Gynecol Obste. 2015;292(6):1321-7.CrossRefPubMedGoogle Scholar
  11. 11.
    Harter P, Gnauert K, Hils R, Lehmann TG, Fisseler-Eckhoff A, Traut A, et al. Pattern and clinical predictors of lymph node metastases in epithelial ovarian cancer. Int J Gynecol Cancer. 2007;17(6):1238-44.CrossRefPubMedGoogle Scholar
  12. 12.
    Ataseven B, Grimm C, Harter P, Prader S, Traut A, Heitz F, et al. Prognostic value of lymph node ratio in patients with advanced epithelial ovarian cancer. Gynecol Oncol. 2014;135(3):435-40.CrossRefPubMedGoogle Scholar
  13. 13.
    Morice P, Joulie F, Camatte S, Atallah D, Rouzier R, Pautier P, et al. Lymph node involvement in epithelial ovarian cancer: analysis of 276 pelvic and paraaortic lymphadenectomies and surgical implications. J Am Coll Surg. 2003;197(2):198-205.CrossRefPubMedGoogle Scholar
  14. 14.
    Burghardt E, Girardi F, Lahousen M, Tamussino K, Stettner H. Patterns of pelvic and paraaortic lymph node involvement in ovarian cancer. Gynecol Oncol. 1991;40(2):103-6.CrossRefPubMedGoogle Scholar
  15. 15.
    Minig L, Heitz F, Cibula D, Bakkum-Gamez JN, Germanova A, Dowdy SC, et al. Patterns of lymph node metastases in apparent stage I low-grade epithelial ovarian cancer: a multicenter study. Ann Surg Oncol. 2017;24(9):2720-2726.CrossRefPubMedGoogle Scholar
  16. 16.
    Rosso M, Majem B, Devis L, Lapyckyj L, Besso MJ, Llaurado M, et al. E-cadherin: A determinant molecule associated with ovarian cancer progression, dissemination and aggressiveness. PloS One. 2017;12(9):e0184439.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Trillsch F, Kuerti S, Eulenburg C, Burandt E, Woelber L, Prieske K, et al. E-Cadherin fragments as potential mediators for peritoneal metastasis in advanced epithelial ovarian cancer. Br J Cancer. 2016;114(2):213-20.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Kommoss S, Gilks CB, du Bois A, Kommoss F. Ovarian carcinoma diagnosis: the clinical impact of 15 years of change. Br J Cancer. 2016;115(8):993-9.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Florian Heitz
    • 1
    • 2
  • Philipp Harter
    • 1
    • 2
  • Beyhan Ataseven
    • 1
    • 5
  • Sebastian Heikaus
    • 3
  • Stephanie Schneider
    • 1
  • Sonia Prader
    • 1
  • Mareike Bommert
    • 1
  • Anette Fisseler-Eckhoff
    • 4
  • Alexander Traut
    • 1
    • 2
  • Andreas du Bois
    • 1
    • 2
  1. 1.Department of Gynecology and Gynecologic OncologyKliniken Essen-Mitte, Evangelische Huyssens-StiftungEssenGermany
  2. 2.Department of Gynecology and Gynecologic OncologyHorst-Schmidt Klinik WiesbadenWiesbadenGermany
  3. 3.Zentrum für Pathologie, Essen-MitteEssenGermany
  4. 4.Department of PathologyHorst Schmidt KlinikWiesbadenGermany
  5. 5.Department of Obstetrics and GynecologyUniversity Hospital, LMU MunichMunichGermany

Personalised recommendations