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

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Authors and Affiliations

  1. Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Essen, Germany

    Florian Heitz MD, Philipp Harter MD, PhD, Beyhan Ataseven MD, PhD, Stephanie Schneider MD, Sonia Prader MD, Mareike Bommert MD, Alexander Traut & Andreas du Bois MD, PhD

  2. Department of Gynecology and Gynecologic Oncology, Horst-Schmidt Klinik Wiesbaden, Wiesbaden, Germany

    Florian Heitz MD, Philipp Harter MD, PhD, Alexander Traut & Andreas du Bois MD, PhD

  3. Zentrum für Pathologie, Essen-Mitte, Essen, Germany

    Sebastian Heikaus MD, PhD

  4. Department of Pathology, Horst Schmidt Klinik, Wiesbaden, Germany

    Anette Fisseler-Eckhoff MD, PhD

  5. Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany

    Beyhan Ataseven MD, PhD

Authors
  1. Florian Heitz MD
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  2. Philipp Harter MD, PhD
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  3. Beyhan Ataseven MD, PhD
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  4. Sebastian Heikaus MD, PhD
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  5. Stephanie Schneider MD
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  6. Sonia Prader MD
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  7. Mareike Bommert MD
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  8. Anette Fisseler-Eckhoff MD, PhD
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  9. Alexander Traut
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  10. Andreas du Bois MD, PhD
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Corresponding author

Correspondence to Florian Heitz MD.

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Heitz, F., Harter, P., Ataseven, B. et al. Stage- and Histologic Subtype-Dependent Frequency of Lymph Node Metastases in Patients with Epithelial Ovarian Cancer Undergoing Systematic Pelvic and Paraaortic Lymphadenectomy. Ann Surg Oncol 25, 2053–2059 (2018). https://doi.org/10.1245/s10434-018-6412-y

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  • DOI: https://doi.org/10.1245/s10434-018-6412-y

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