Systematic Lymphadenectomy for Overall Survival in Epithelial Ovarian Cancer: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

QIN Jinchun , YANG Zhijun , XIONG Li ,  LI Li

Department of Gynecological Tumor, Affiliated Tumor Hospital, Guangxi Medical University, Nanning 530021, China;

Corresponding author：

LI Li, Email: lili@gxmu.edu.cn

Keywords：

Epithelial ovarian cancer; Systematic lymphadenectomy; Unsystematic lymphadenectomy; Meta-analysis; Systematic review; Randomized controlled trial; Observational study

DOI：

10.7507/1672-2531.20120036

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective 　To evaluate the role of systematic lymphadenectomy (SL) vs. unsystematic lymphadenectomy (USL) for improving overall survival (OS) in epithelial ovarian cancer (EOC).
Methods 　The databases such as PubMed, EMbase, The Cochrane Library, Evidence-Based Medicine Reviews (EBMR), CBM, CNKI and VIP were searched between January 1, 1995 and December 31, 2010, the randomized controlled trials (RCTs) and observational studies on SL vs. USL in treating EOC were included. Based on Cochrane handbook, the data were extracted, the methodological quality was assessed, and then meta-analyses were conducted by using RevMan 5.0 software.
Results 　The total 13 studies involving 22 796 patients were included, including 5 420 patients in the SL group, and the other 17 376 patients in the USL group. Two of the 13 studies were RCTs, and the other 11 were observational studies (including 2 studies retrieved from SEER data). The analyses on 2 RCTs showed that compared with USL, a) SL could not improve 5-PFS (OR=0.70, 95%CI 0.40 to 1.22, P=0.21) in early-stage EOC (FIGO I to II), but it did improve 5-PFS (OR=0.62, 95%CI 0.40 to 0.96, P=0.03) in advanced-stage EOC (FIGO III to IV); b) SL could not improve 5-OS in both early-stage EOC (OR=0.84; 95%CI 0.44 to1.58, P=0.58) and advanced-stage EOC (OR=0.93, 95%CI 0.64 to 1.37, P=0.73); and c) SL could not improve 5-OS in both early-stage (OR=0.84, 95%CI 0.44 to 1.58, P=0.58) and advanced-stage (OR=0.93, 95%CI 0.64 to 1.37, P=0.73) of EOC patients who had optimal tumor dubulking surgery. The analyses on observational studies showed that compared with USL, a) SL could not improve 5-PFS in both early-stage EOC (OR=0.38, 95%CI 0.08 to 1.74, P=0.21) and advanced-stage (OR=2.88, 95%CI 0.95 to 8.72, P=0.06) EOC; b) Whether SEER impacts were excluded or not, SL did improve 5-OS in both early-stage EOC (OR=0.54, 95%CI 0.46 to 0.63, P lt;0.000 01) and advanced-stage (OR=0.47, 95%CI 0.43 to 0.52, P lt;0.000 01) EOC; and c) For EOC patients who had optimal tumor dubulking surgery, SL could not improve 5-OS in early-stage (OR=0.32, 95% CI 0.02 to 6.19, P=0.45), but it did improve 5-OS in advanced-stage (OR=0.53, 95%CI 0.32 to 0.88, P=0.01).
Conclusion 　These findings suggest that maybe SL can improve 5-PFS and 5-OS in EOC. However, the efficacy of SL on 5-PFS and 5-OS is still undetermined, so more relevant studies are required for further investigating the role of SL in EOC.

Citation： QIN Jinchun,YANG Zhijun,XIONG Li,LI Li. Systematic Lymphadenectomy for Overall Survival in Epithelial Ovarian Cancer: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2012, 12(2): 224-230. doi: 10.7507/1672-2531.20120036 Copy

1.	曹泽毅. 中华妇产科学. 北京: 人民卫生出版社, 2004: 2154.
2.	Chan JK, Cheung MK, HusainA, et al. Patterns and progress in ovarian cancer over 14 years. Obstet Gynecol, 2006, 108(3 Pt 1): 521-528.
3.	Pereira A, Magrina JF, Rey V, et al. Pelvic and aortic lymph node metastasis in epithelial ovarian cancer. Gynecol Oncol, 2007, 105(3): 604-608.
4.	Onda T, Yoshikawa H, Yokota H, et al. 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(4): 803-808.
5.	Chan JK, Urban R, Hu JM, et al. The potential therapeutic role of lymph node resection in epithelial ovarian cancer: a study of 13918 patients. Br J Cancer, 2007, 96(12): 1817-1822.
6.	Chan JK, Munro EG, Cheung MK, et al. Association of lymphadenectomy and survival in stage I ovarian cancer patients. Obstet Gynecol, 2007, 109(1): 12-19.
7.	Maggioni A, Benedetti Panici P, Dell’Anna T, et al. Randomized study of systematic lymphadenectomy in patients with epithelial ovarian cancer macroscopically confined to the pelvis. Br J Cancer, 2006, 95(6): 699-704.
8.	Panici PB, Maggioni A, Hacker N, et al. Systematic aortic and pelvic lymphadenectomy versus resection of bulky nodes only in optimally debulked advanced ovarian cancer: a randomized clinical trial. J Natl Cancer Inst, 2005, 97(8): 560-566.
9.	Cohen J. A coefficient of agreement for nominal scales. Ednc Psychol Measure, 1960, 20(1): 37-46.
10.	Allen DG, Coulter J. Survival of patients with epithelial ovarian cancer and the effect of lymphadenectomy in those with stage Ⅲ disease. Aust N Z J Obstet Gynaecol, 1999, 39(4): 420-424.
11.	王荣业. 腹膜后淋巴结清除在卵巢上皮癌治疗中的地位. 中国肿瘤临床, 2001, 28(3): 192-194.
12.	Saygili U, Guclu S, Uslu T, et al. Does systematic lymphadenectomy have a benefit on survival of suboptimally debulked patients with stage III ovarian carcinoma? A DEGOG* Study. J Surg Oncol, 2002, 81(3): 132-137.
13.	熊宙芳, 王泽华, 王世宣. 卵巢上皮性癌的腹膜后淋巴结切除对预后的影响. 中华妇产科杂志, 2003, 38(2): 77-80.
14.	郄明蓉, 杨小芸, 郑艾, 等. 盆腔及腹主动脉旁淋巴结清扫术与卵巢上皮性癌OS分析. 四川大学学报, 2004, 35(3): 449-450.
15.	Isonishi S, Niimi S, Sasaki H, et al. Drug sensitivity-related benefit of systematic lymphadenectomy during cytoreductive surgery in optimally debulked stages IIIc and IV ovarian cancer. Gynecol Oncol, 2004, 93(3): 647-652.
16.	余冬青, 李力. 腹膜后淋巴结清扫在卵巢上皮癌治疗中的作用. 广东医学, 2007, 28(9): 1489-1491.
17.	Suzuki S, Kajiyama H, Shibata K, et al. Is there any association between retroperitoneal lymphadenectomy and survival benefit in ovarian clear cell carcinoma patients? Ann Oncol, 2008, 19(7): 1284-1287.
18.	Abe A, Furumoto H, Irahara M, et al. The impact of systematic para-aortic and pelvic lymphadenectomy on survival in patients with optimally debulked ovarian cancer. J Obstet Gynaecol Res, 2010, 36(5): 1023-1030.
19.	Kim HS, Ju W, Jee BC, et al. Systematic lymphadenectomy for survival in epithelial ovarian cancer: a meta-analysis. Int J Gynecol Cancer, 2010, 20(4): 520-528.
20.	Baek SJ, Park JY, Kim DY, 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(4): 223-228.
21.	Onda T, Yoshikawa H, Yokota H, et al. 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(4): 803-808.
22.	Soper JT, Johnson P, Johnson V, et al. Comprehensive restaging laparotomy in women with apparent early ovarian carcinoma. Obstet Gynecol, 1992, 80(6): 949-953.
23.	Cliby WA, Aletti GD, Wilson TO, et al. Is it justified to classify patients to Stage IIIC epithelial ovarian cancer based on nodal involvement only? Gynecol Oncol, 2006, 103(3): 797-801.
24.	Eisenkop SM, Spirtos NM. The clinical significance of occult macroscopically positive retroperitoneal nodes in patients with epithelial ovarian cancer. Gynecol Oncol, 2001, 82(1): 143-149.

1. 曹泽毅. 中华妇产科学. 北京: 人民卫生出版社, 2004: 2154.
2. Chan JK, Cheung MK, HusainA, et al. Patterns and progress in ovarian cancer over 14 years. Obstet Gynecol, 2006, 108(3 Pt 1): 521-528.
3. Pereira A, Magrina JF, Rey V, et al. Pelvic and aortic lymph node metastasis in epithelial ovarian cancer. Gynecol Oncol, 2007, 105(3): 604-608.
4. Onda T, Yoshikawa H, Yokota H, et al. 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(4): 803-808.
5. Chan JK, Urban R, Hu JM, et al. The potential therapeutic role of lymph node resection in epithelial ovarian cancer: a study of 13918 patients. Br J Cancer, 2007, 96(12): 1817-1822.
6. Chan JK, Munro EG, Cheung MK, et al. Association of lymphadenectomy and survival in stage I ovarian cancer patients. Obstet Gynecol, 2007, 109(1): 12-19.
7. Maggioni A, Benedetti Panici P, Dell’Anna T, et al. Randomized study of systematic lymphadenectomy in patients with epithelial ovarian cancer macroscopically confined to the pelvis. Br J Cancer, 2006, 95(6): 699-704.
8. Panici PB, Maggioni A, Hacker N, et al. Systematic aortic and pelvic lymphadenectomy versus resection of bulky nodes only in optimally debulked advanced ovarian cancer: a randomized clinical trial. J Natl Cancer Inst, 2005, 97(8): 560-566.
9. Cohen J. A coefficient of agreement for nominal scales. Ednc Psychol Measure, 1960, 20(1): 37-46.
10. Allen DG, Coulter J. Survival of patients with epithelial ovarian cancer and the effect of lymphadenectomy in those with stage Ⅲ disease. Aust N Z J Obstet Gynaecol, 1999, 39(4): 420-424.
11. 王荣业. 腹膜后淋巴结清除在卵巢上皮癌治疗中的地位. 中国肿瘤临床, 2001, 28(3): 192-194.
12. Saygili U, Guclu S, Uslu T, et al. Does systematic lymphadenectomy have a benefit on survival of suboptimally debulked patients with stage III ovarian carcinoma? A DEGOG* Study. J Surg Oncol, 2002, 81(3): 132-137.
13. 熊宙芳, 王泽华, 王世宣. 卵巢上皮性癌的腹膜后淋巴结切除对预后的影响. 中华妇产科杂志, 2003, 38(2): 77-80.
14. 郄明蓉, 杨小芸, 郑艾, 等. 盆腔及腹主动脉旁淋巴结清扫术与卵巢上皮性癌OS分析. 四川大学学报, 2004, 35(3): 449-450.
15. Isonishi S, Niimi S, Sasaki H, et al. Drug sensitivity-related benefit of systematic lymphadenectomy during cytoreductive surgery in optimally debulked stages IIIc and IV ovarian cancer. Gynecol Oncol, 2004, 93(3): 647-652.
16. 余冬青, 李力. 腹膜后淋巴结清扫在卵巢上皮癌治疗中的作用. 广东医学, 2007, 28(9): 1489-1491.
17. Suzuki S, Kajiyama H, Shibata K, et al. Is there any association between retroperitoneal lymphadenectomy and survival benefit in ovarian clear cell carcinoma patients? Ann Oncol, 2008, 19(7): 1284-1287.
18. Abe A, Furumoto H, Irahara M, et al. The impact of systematic para-aortic and pelvic lymphadenectomy on survival in patients with optimally debulked ovarian cancer. J Obstet Gynaecol Res, 2010, 36(5): 1023-1030.
19. Kim HS, Ju W, Jee BC, et al. Systematic lymphadenectomy for survival in epithelial ovarian cancer: a meta-analysis. Int J Gynecol Cancer, 2010, 20(4): 520-528.
20. Baek SJ, Park JY, Kim DY, 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(4): 223-228.
21. Onda T, Yoshikawa H, Yokota H, et al. 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(4): 803-808.
22. Soper JT, Johnson P, Johnson V, et al. Comprehensive restaging laparotomy in women with apparent early ovarian carcinoma. Obstet Gynecol, 1992, 80(6): 949-953.
23. Cliby WA, Aletti GD, Wilson TO, et al. Is it justified to classify patients to Stage IIIC epithelial ovarian cancer based on nodal involvement only? Gynecol Oncol, 2006, 103(3): 797-801.
24. Eisenkop SM, Spirtos NM. The clinical significance of occult macroscopically positive retroperitoneal nodes in patients with epithelial ovarian cancer. Gynecol Oncol, 2001, 82(1): 143-149.

Previous Article
Proton Pump Inhibitors and the Risk of Bone Fractures: A Systematic Review
Next Article
Multivariate Random Effects Model in Meta-Analysis of Diagnostic Tests and Its SAS Programs

Chinese Journal of Evidence-Based Medicine

Systematic Lymphadenectomy for Overall Survival in Epithelial Ovarian Cancer: A Meta-Analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content