Lymph node involvement in clinically apparent early ovarian cancer: a prospective study

Purpose: The objective of this study was to identify the lymph node involvement in apparently early ovarian cancer (OC) Materials and Methods: Patients with clinically apparent early OC who underwent staging surgery between August 2012 and August 2015 were prospectively identified. Patients’ characteristics and tumor histopathology were evaluated. Results: Twenty consecutive patients were operated for grossly apparent early ovarian carcinoma. All patients were surgically staged and underwent a systematic pelvic and paraaortic lymphadenectomy. There were eight patients (40%) with lymph node involvement. One of the eight lymph node metastasis was solely in para-aortic node, three patients had both positive-pelvic and aortic nodes, and the other metastasis was in ipsilateral pelvic lymph node. Positive lymph node involvement was significantly higher among patients with poorly differentiated tumor grade (62.5%) (p = 0.02). Conclusion: All patients diagnosed with early OC macroscopically confined to the ovaries should be considered for comprehensive staging surgery including pelvic and para-aortic lymphadenectomy.

Ovarian cancer; Pelvic and para-aortic lymphadenectomy.

[1] Jemal A., Siegel R., Ward E., Murray T., Xu J., Thun M.: “Cancer statistics, 2007”. CA Cancer J. Clin., 2007, 57, 43–66.

[2] Hirsawa A; Masuda K, Akhane T, Ueki A, Yokota M, Tsuruta T, et al.: “Family history and BRCA1/BRCA2 status among Japanese ovarian cancer patients and occult cancer in a BRCA1 mutant case”. Jpn J Clin Oncol, 2011, 44, 49-56.

[3] Xu Y., Liu Y., Zhou R., Meng F., Gao Y., Yang S., et al.: “LAPTM4B polymorphisms is associated with ovarian cancer susceptibility and its prognosis”. Jpn. J. Clin. Oncol., 2012, 42, 413.

[4] “FIGO stages – 1998 Revision”. Gynecol. Oncol, 1998, 35, 125.

[5] Subak L.L., Hricak H., Powell C.B., Azizi L., Stern J.L.: “Cervical carcinoma: Computed tomography and magnetic resonance imaging for preoperative staging”. Obstet. Gynecol., 1995, 26, 43.

[6] Panici P.B., Maneschi F., Cutillo G.: “Pelvic and aortic lymphadenectomy”. Sur. Clin. North Am., 2001, 81, 841.

[7] Creasman W.T, DeGeest K., Disaia P.J., Zaimo R.J.: “Significance of true pathologic staging: A gynecologic oncology group study”. Am. J. Obstet. Gynecol., 1999, 8, 31.

[8] Mariani A., Webb M.J., Rao S.K., Lesnick T.G., Podratz K.C.: “Significance of pathologic patterns of pelvic lymph node metastases in endometrial cancer”. Gynecol. Oncol., 2001, 80, 113.

[9] Benedetti-Panici P., Greggi S., Maneschi F., Scambia G., Amoroso M., Rabitti C., Mancuso S.: “Anatomical and pathological study of retroperitoneal nodes in endometrial cancer”. Gynecol. Cancer, 1993, 51, 150.

[10] Otsuka I., Kubota T., Aso T.: “Lymphadenectomy and adjuvant therapy in endometrial carcinoma: role of adjuvant therapy“. Br. J. Cancer, 2002, 87, 377.

[11] Benedetti-Panici P., Scambia G., Baiocchi G., Greggi S., Mancuso S.: “Technique and feasibility of radical para aortic and pelvic lymphadenectomy for gynecologic malignancies: A prospective study”. Int. J. Gynecol. Cancer, 1991, 1, 133.

[12] Michel G., Morice P., Castaigne D., Leblanc M., Reg A., Duvillard P.: “Lymphatic spread of stage IB / II cervical carcinoma: anatomy and surgical implications”. Obstet. Gynecol.,1998, 91, 360.

[13] Levesque R.: “SPSS programming and data aanagement: a guide for SPSS and SAS users”. 4thed. Chicago: SPSS Inc., 2007.

[14] Desteli G.A, Gultekin M., Usubutun A., Yuce K., Ayhan A.: “ Lymph node metastasis in grossly apparent clinical stage Ia epithelial ovarian cancer: Hacettepe experience and review of literature”. World J. Surg. Oncol., 2010, 8, 106.

[15] Baek S.J, Park J.Y., Kim D.Y., Kim J.H., Kim Y.M., Kim Y.T., et al.: “Stage IIIC epithelial ovarian cancer classified solely by lymph node metastasis has a more favorable prognosis than other types of stage IIIC epithelial ovarian cancer”. J. Gynecol. Oncol., 2008, 19, 223.

[16] Fujimoto T., Fukuda J., Tanka T.: “R ole of complete para-aortic lymphadenectomy in endometrial cancer”. Curr. Opin. Obstet. Gynecol., 2009, 21, 10.

[17] Muscicollo V., Amadio G., Lo Russo D., Raimondo I., Giordano A., Scambia G.: “Controversies in the management of endometrial cancer”. Obstet. Gynecol Int., 2010, 2010, 638165.

[18] May K., Brayant A., Dickinson H.O., Kehoe S., Morrison J.: “Lymphadenectomy for the management of endometrial cancer”. Cochrane Database Syst Rev., 2010, 1, CD007585.

[19] Petru E., Lahousen M., Tamussino K., Pickel H., Stranzl H., Stettner H., Winter R.: “Lymphadenectomy in stage I ovarian cancer”. Am. J. Obstet. Gynecol., 1994, 170, 656.

[20] Walter A.J, Magrina J.F.: “Contralateral pelvic and aortic lymph node metastasis in clinical stage I epithelial ovarian cancer”. Gynecol. Oncol., 1999, 74, 128.

[21] Cass I., Runowicz C.D., Fields A., Goldberg G.L., Leuchter R.S., Lagasse L.D., Karlan B.Y.: “Pattern of lymph node metastases in clinically unilateral stage I invasive epithelial ovarian carcinomas”. Gynecol. Oncol., 2001, 80, 56.

[22] Negishi H., Takeda M., Fujimoto T., Todo Y., Ebina Y., Watari H., et al.: “Lymphatic mapping and sentinel node identification as related to the primary sites of lymph node metastasis in early stage ovarian cancer”. Gynecol. Oncol., 2004, 94, 161.

[23] Sakuragi N., Yamada H., Oikawa M., Okuyama K., Fujino T., Sagawa T., Fujimoto S.: “Prognostic significance of lymph node metastasis and clear cell histology in ovarian carcinoma limited to the pelvis (pT1M0 and pT2M0)”. Gynecol. Oncol., 2000, 79, 251.

[24] 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, 198.

[25] Harter P., Gnauert K., Hils R., Lehmann T.G., Fisseler-Eckhoff A., Traut A., du Bois A.: “Pattern and clinical predictors of lymph node metastases in epithelial ovarian cancer”. Int. J. Gynecol. Cancer, 2007, 17, 1238.

[26] Suzuki M., Ohwada M., Yamada T., Kohno T., Sekiguchi I., Sato I.: “Lymph node metasis in stage I epithelial ovarian cancer”. Gynecol. Oncol., 2000, 79, 305.

[27] Benedetti-Panici P., Greggi S., Maneschi F., Scambia G., Amoroso M., Rabitti C., Mancuso S.: “Anatomical and pathological study of retroperitoneal nodes in epithelial ovarian cancer”. Gynecol. Oncol., 1993, 51, 150.

[28] Onda T., Yoshikava H., Yasugi T., Taketani Y.: “Assessment of metastases to aortic and pelvic lymph nodes in epithelial ovarian carcinoma. A proposal for essential sites for lymph node biopsy”. Cancer , 1996, 78, 803.

[29] Sakai K., Kamura T., Hirakawa T., Saito T., Kaku T., Nakano H.: “Relationship between pelvic lymph node involvement and other disease sites in patients with ovarian cancer”. Gynecol. Oncol., 1997, 65, 164.

[30] Maggioni A., Benedetti Panici P., Dell’ Anna T., Landoni F., Lissoni A., Pellegrino A., et al.: “Randomised study of systematic lymphadenectomy in patients with epithelial ovarian cancer macroscopically confined to the pelvis”. Br. J. Cancer, 2006, 95, 699.

[31] Kanazawa K., Suzuki T., Tokashiki M.: “The validity and significance of substage IIIC by node involvement in epithelial ovarian cancer: impact of nodal metastasis on patient survival”. Gynecol. Oncol., 1999, 73, 237.

[32] Di Re F., Baiocchi G., Fontanelli R., Grosso G., Cobellis L., Raspagliesi F., Re E.D.: “Systematic pelvic and para-aortic lymphadenectomy for advanced ovarian cancer: Prognostic significance of node metastases”. Gynecol. Oncol., 1996, 62, 360.