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  • br Results br The median age of the patients was

    2020-08-14


    Results
    The median age of the patients was 52 years (range 16-89), median PFS was 25 months and median OS was 75 months. Five-year OS rate was 55%, 78%, 35% for all stages, stage 1I-II, stage III-IV, respectively. Median follow-up duration was 39 months (range 2-146). In all patients, the median number of SP13786 nodes removed was 10 (range 0-100). In the group that at least 1 lymph node was removed, the median number of removed lymph nodes was 19 (range 1-100), the ratio of metastatic lymph node was 22% (Table 1). The patients in the group without lymphadenectomy were older. There was a difference in the stage, ECOG PS (Table 2).
    In univariate model, the age of the patient (≤65, >65), the stage of the disease (1-2, 3-4), the grade of the disease (I-II, III), the status of lymph node dissection (yes/no), the number of lymph nodes removed (1-10, >10), the region of removed lymph nodes (pelvic, pelvic plus paraaortic), ECOG-PS (0, ≥1) had significant effects on survival time (P < 0.05). Effect of the stage of the disease, the age of the patients and the number of lymph nodes removed on survival was demonstrated with multivariate analysis (Table 4).
    We examined 2 separate groups as stage I-II and stage III-IV. Progression-free survival time did not differ significantly between groups with respect to dissection of lymph node (P > 0.05). PFS differed significantly with respect to the number of lymph nodes removed (>10 vs 1-10) (stage I-II; P = 0.05, stage III-IV; P = 0.006). Stage III-IV patients who underwent lymphadenec-tomy had significantly improved OS (37 vs 57 months, P = 0.021). Survival was found to be longer in stage III-IV patients with pelvic and paraaortic lymph node dissection compared to
    Table 1
    Follow-up and treatment characteristics.
    Min - Max Median n %
    Status
    Died
    Alive
    222 58.7 Progression-free survival
    Relapse or progression
    No
    Yes
    Nonlymphadenectomy
    Lymphadenectomy
    Number of lymph nodes
    69 18.3 Lymphadenectomy region
    Pelvic
    Pelvic + Paraaortic
    Metastatic lymph nodes
    No
    Yes
    patients with only pelvic lymph node dissection (P = 0.013), but that was not the case in stage I-II patients.
    In evaluation that we did by dividing the patients into 5 groups according to number of lymph nodes removed as 0, 1-5, 6-10, 11-20, and >20, the increase in number of lymph nodes removed improved progression-free survival (P = 0.001). Moreover, in stage III-IV of the disease, improvement in survival was also shown and this effect was supported by multivariate analy-sis (HR = 0.74; 95% CI, 0.58-0.95; P = 0.02). There was no correlation between number of lymph nodes removed and number of metastatic lymph nodes (r = 0,068/P = 0.326). In stage IIIC pa-tients having metastatic lymph nodes, when patients were divided into 2 groups as having 1-3 positive lymph nodes and ≥4 lymph nodes, there were no difference in progression-free survival and OS.
    Discussion
    EOC is the genital cancer in which lymphatic spread is seen most frequently. Lymphatic metastasis and lymphadenectomy are the most analyzed issues in EOC during the last 2 decades.4,14
    There are 3 meta-analysis in the literature which indicate the survival effect of lymphadenec-tomy. In 2016, J Zhou et al conducted a meta-analysis of 556 patients (3 randomized controlled trials and 11 retrospective studies).15 In this meta-analysis, lymphadenectomy was associated with more progression-free survival in randomized clinical trials, but not retrospective trials. Lymphadenectomy was associated with a 5-year overall survival in patients with both early and advanced stage cancer, but only with progression-free survival and a lower recurrence rate in patients with advanced stage cancer. In the 2 previous meta-analyses, lymphadenectomy was shown to increase 5-year OS in patients with advanced stage cancer, but not in early stage pa-tients.16,17
    In our study, 474 (stage I-IV) patients with EOC, PFS, and OS were significantly better in pa-tients with lymphadenectomy compared to those without lymphadenectomy. Multivariate anal-ysis was performed to analyze the impact of the number of lymph nodes removed (1-10 or ˃10) on survival. There were differences in the clinopathologic features of patients with and with-out lymphadenectomy. Patients without lymphadenectomy had higher median age and stage IV
    Table 2
    Clinicopathological data of all stage epithelial ovarian cancer patients (with or without lymphadenectomy).
    Non-
    lymphadenectomy Lymphadenectomy All patients
    Grade
    ECOG-PS
    Adjuvant therapy
    paclitaxel
    Adjuvant therapy