Should We Abandon Systematic Pelvic and Paraaortic Lymphadenectomy in Low-Grade Serous Ovarian Cancer?
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ORIGINAL ARTICLE – GYNECOLOGIC ONCOLOGY
Should We Abandon Systematic Pelvic and Paraaortic Lymphadenectomy in Low-Grade Serous Ovarian Cancer? V. Simon, MD1, C. Ngo, MD, PhD2, E. Pujade-Lauraine, MD, PhD3,4, G. Ferron, MD, PhD4,5, C. Pomel, MD, PhD4,6, E. Leblanc, MD, PhD4,7, C. Nadeau, MD4,8, I. Ray-Cocquard, MD, PhD4,9, F. Lecuru, MD, PhD4,10,11, and H. Bonsang-Kitzis, MD, PhD2,4 1
Gynecologic and Breast Oncologic Surgical Department, Georges Pompidou European Hospital, Paris, France; Gynecological and Breast Surgery and Cancerology Center, RAMSAY-Ge´ne´rale de Sante´, Hoˆpital Prive´ des Peupliers, Paris, France; 3Medical Oncology Department, Paris Descartes University, Hoˆpital Hoˆtel-Dieu, Paris, France; 4ARCAGY – GINECO Cooperative Group, Paris, France; 5Department of Surgical Oncology, Claudius Regaud Institute, IUCT Oncopole, Toulouse, France; 6Department of Surgical Oncology, Centre Jean Perrin, Clermont-Ferrand, France; 7 Department of Surgical Oncology, Centre Oscar Lambret, Lille Cedex, France; 8Department of Surgical Oncology, CHU de Poitiers, Poitiers, France; 9Medical Oncology Department, Centre Leon Berard, Lyon, France; 10Breast, Gynecology and Reconstructive Surgical Department, Curie Institute, Paris, France; 11Universite´ de Paris, Paris, France 2
ABSTRACT Background. Low-grade serous ovarian carcinoma (LGSOC) is a rare disease that accounts for 5% of all ovarian cancers and requires surgical complete debulking. To date, the prognostic value of pelvic and paraaortic lymphadenectomy remains unclear in this population. Patients and Methods. This retrospective cohort of patients with a diagnosis of LGSOC was registered in the Tumeurs Malignes Rares Gyne´cologiques national network, between January 2000 and July 2017, at 25 centers. All LGSOC were confirmed after pathological review and operated by primary debulking surgery (PDS) or interval debulking surgery after neoadjuvant chemotherapy (NACT-IDS). Primary endpoints were overall survival (OS) and progression-free survival (PFS). Results. A total of 126 patients were included, 86.1% were stage III/IV, and 74.6% underwent lymph node dissection (LND). According to the Completeness of Cancer Resection
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-08361-5) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 11 March 2019 H. Bonsang-Kitzis, MD, PhD e-mail: [email protected]
(CCR) score, 83.7% had complete resection. Median OS was 130 months, and median PFS was 41 months. Pelvic and paraaortic LND had no significant impact on OS (p = 0.78) or DFS (p = 0.93), and this was confirmed in subgroups (advanced stages FIGO III/IV, CCR score 0/1 or 2/3, and timing of surgery PDS or NACT-IDS). Histological positive paraaortic lymph nodes had a significant negative impact on PFS in the whole population (HR 2.21, 1.18–4.39, p = 0.02) and in the CC0/CC1 population (HR, 2.28, 1.13–4.59, p = 0.02). Conclusions. Systematic pelv
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