Introduction: Benefits on survival of retroperitoneal lymph node (LN) dissection during cytoreductive surgery (CRS) for epithelial ovarian cancer are debated. However, LN involvement may be a prognostic factor especially in case of high-grade serous ovarian cancer (HGSOC).Materials and methods: In the French Epidemiological Strategy and Medical Economics - Ovarian Cancer (ESME-OC) database, we identified patients treated for advanced-stage (FIGO III-IV) HGSOC with chemotherapy and intensive CRS including retroperitoneal LN dissection. Our first objective was to identify prognostic factors in case of maximalist treatment.Results: Of 13032 patients included, 485 with advanced HGSOC diagnosed between May 29, 2006 and December 16, 2019 were analyzed. Primary CRS was performed on 279 patients (57.5%). Of them, 70.3% had LN involvement. Surgery was performed after neo-adjuvant chemotherapy (NAC) in 206 patients (42.5%). Of them, 61.2% had LN involvement. LN involvement was considered major with a Lymph Node Ratio (LNR) ≥25% for 21.1% of patients who underwent primary CRS and 15.0% after NAC. In primary CRS, when adjusted to FIGO stage and BRCA1/2 deleterious mutation, LNR ≥25% vs none indicated a poorer prognosis for both overall survival (OS) (HR = 2.46 [1.25; 4.84], p = 0.009) and progression-free survival (PFS) (HR = 2.23 [1.40; 3.57], p < 0.001). After NAC, LNR ≥25% vs none was a negative prognostic factor with a stronger negative impact on PFS (HR = 2.00 [1.12; 3.57]; p = 0.018).Conclusion: LN involvement is a negative prognostic factor in advanced-stage HGSOC especially in case of primary CRS. LN involvement could be a target for developing new therapies.
- Advanced high-grade serous ovarian cancer treated with intensive cytoreductive surgery and chemotherapy: prognostic impact of lymph node involvement: analysis of the French national ESME-Unicancer database
- Sophie Le Bars - Institut de Cancérologie de l'OuestCatherine Guerin-Charbonnel - Institut de Cancérologie de l'OuestElodie Martin - Institut de Cancérologie de l'OuestQuentin Dominique Thomas - Université de Montpellier, IRCM - Institut de Recherche en Cancérologie de MontpellierHélène Costaz - Centre Georges François LeclercChristophe Pomel - Centre Jean PerrinFrédéric Marchal - Centre National de la Recherche ScientifiqueFabrice Narducci - Centre Oscar LambretSébastien Gouy - Institut Gustave RoussyEnora Laas - Institut CurieLéa RossiEric Lambaudie - Institut Paoli-CalmettesRoman Rouzier - Centre François BaclesseThierry Petit - Institut de Cancérologie de Strasbourg EuropeLaurence Gladieff - Institut Claudius RegaudThibault de la Motte Rouge - Centre Eugène MarquisLise Bosquet - UniCancer GroupPierre-Emmanuel Colombo - Université de Montpellier, IRCM - Institut de Recherche en Cancérologie de MontpellierJean-Marc Classe - Institut de Cancérologie de l'OuestCécile Loaec - Institut de Cancérologie de l'Ouest
- EJSO - European Journal of Surgical Oncology, Vol.52(6)
- 99283008609311
- IRCM - Institut de Recherche en Cancérologie de Montpellier
- English
- Journal article
- hal-05694086