Prognostic efficacy of systematic lymphadenectomy for ovarian cancer: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

WU Shouyuan ¹ , WANG Jianjian ¹ , LAN Hui ¹ , LIU Yafei ¹ , GUO Qiangqiang ¹ , WANG Ping ² , DONG Xiaojing ³ , XIA Lei ⁴ ,  JIANG Lei ⁵ , CHEN Yaolong ^1,2,6,7,8,9

1. School of Public Health, Lanzhou University, Lanzhou 73000, P.R.China;
2. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 73000, P.R.China;
3. Department of Gynaecology and Obstetrics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 40000, P.R.China;
4. Cancer Center, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 40000, P.R.China;
5. Department of Oncology Surgery, the First Hospital of Lanzhou University, Lanzhou 73000, P.R.China;
6. WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou 73000, P.R.China;
7. Lanzhou University Institute of Health Data Science, Lanzhou 73000, P.R.China;
8. Chinese GRADE Center, Lanzhou 73000, P.R.China;
9. Gansu Key Laboratory of Evidence-Based Medicine and Clinical Transformation, Lanzhou University, Lanzhou 73000, P.R.China;

Corresponding author：

JIANG Lei, Email: chenyaolong@vip.163.com

Keywords：

Systematic lymphadenectomy; Ovarian cancer; Systematic review; Meta-analysis; Randomized controlled trial; Cohort study

DOI：

10.7507/1672-2531.202106202

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the prognostic efficacy and safety of patients with ovarian cancer treated with systemic lymphadenectomy (SL). Methods PubMed, The Cochrane Library, Web of Science, CNKI, WanFang Data, and CBM databases were electronically searched to collect randomized controlled trials (RCTs) and cohort studies on the prognostic outcomes of patients with ovarian cancer treated with SL from inception to December 16^th, 2020. Six reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.4 software. Results A total of 5 RCTs and 23 cohort studies involving 6 166 patients were included. The results of meta-analysis showed that there were no significant differences in the 3-year survival rate, 5-year survival rate, 3-year progression-free survival rate, and 5-year progression-free survival rate between SL group and the no systemic lymphadenectomy (NSL) group. The results of the subgroup analysis showed that pelvic and para-aortic lymph node dissection combined with large omentum resection had a better prognosis for patients. Conclusions Current evidence shows that SL has no significant efficacy on survival and progression-free survival in patients with ovarian cancer. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.

Citation： WU Shouyuan, WANG Jianjian, LAN Hui, LIU Yafei, GUO Qiangqiang, WANG Ping, DONG Xiaojing, XIA Lei, JIANG Lei, CHEN Yaolong. Prognostic efficacy of systematic lymphadenectomy for ovarian cancer: a systematic review. Chinese Journal of Evidence-Based Medicine, 2021, 21(11): 1286-1292. doi: 10.7507/1672-2531.202106202 Copy

1.	Chan JK, Cheung MK, Husain A, et al. Patterns and progress in ovarian cancer over 14 years. Obstet Gynecol, 2006, 108(3Pt1): 521-528.
2.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
3.	Torre LA, Trabert B, DeSantis CE, et al. Ovarian cancer statistics, 2018. CA Cancer J Clin, 2018, 68(4): 284-296.
4.	Ayhan A, Ozkan NT, Sarı ME, et al. Impact of lymph node ratio on survival in stage Ⅲ ovarian high-grade serous cancer: a turkish gynecologic oncology group study. J Gynecol Oncol, 2018, 29(1): e12.
5.	佟晓晶, 王纯雁. 腹膜后淋巴结清扫术在妇科恶性肿瘤治疗中的演变. 中国肿瘤, 2015, 24(9): 747-751.
6.	Scarabelli C, Gallo A, Zarrelli A, et al. Systematic pelvic and para-aortic lymphadenectomy during cytoreductive surgery in advanced ovarian cancer: potential benefit on survival. Gynecol Oncol, 1995, 56(3): 328-337.
7.	Morgan RJ, Armstrong DK, Alvarez RD, et al. Ovarian cancer, version 1. 2016, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2016, 14(9): 1134-1163.
8.	Harter P, Sehouli J, Lorusso D, et al. A randomized trial of lymphadenectomy in patients with advanced ovarian neoplasms. N Engl J Med, 2019, 380(9): 822-832.
9.	Armstrong DK, Alvarez RD, Bakkum-Gamez JN, et al. NCCN guidelines insights: ovarian cancer, version 1. 2019. J Natl Compr Canc Netw, 2019, 17(8): 896-909.
10.	周琦, 吴小华, 刘继红, 等. 卵巢恶性肿瘤诊断与治疗指南(第四版). 中国实用妇科与产科杂志, 2018, 34(7): 739-749.
11.	Wang Y, Ren F, Song Z, et al. Prognostic significance of systematic lymphadenectomy in patients with optimally debulked advanced ovarian cancer: a meta-analysis. Front Oncol, 2020, 10: 86.
12.	Chiyoda T, Sakurai M, Satoh T, et al. Lymphadenectomy for primary ovarian cancer: a systematic review and meta-analysis. J Gynecol Oncol, 2020, 31(5): e67.
13.	Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 2021, 372: n71.
14.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (Version 5. 1. 0). The Cochrane Collaboration, 2011, Availableat: //www.cochrane-handbook.org.
15.	Savović J, Jones HE, Altman DG, et al. Influence of reported study design characteristics on intervention effect estimates from randomized, controlled trials. Ann Intern Med, 2012, 157(6): 429-438.
16.	Wells GA, Shea BO, Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Available at:http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
17.	Timmermans L, de Goede B, van Dijk SM, et al. Meta-analysis of sublay versus onlay mesh repair in incisional hernia surgery. Am J Surg, 2014, 207(6): 980-988.
18.	张天嵩. 经典Meta分析统计模型的合理选择. 中国循证医学杂志, 2020, 20(12): 1477-1481.
19.	Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336(7650): 924-926.
20.	Kigawa J, Minagawa Y, Itamochi H, et al. Retroperitoneal lymphadenectomy, including the para-aortic nodes in patients with stage III ovarian cancer. Am J Clin Oncol, 1994, 17(3): 230-233.
21.	di Re F, Baiocchi G, Fontanelli R, et al. Systematic pelvic and paraaortic lymphadenectomy for advanced ovarian cancer: prognostic significance of node metastases. Gynecol Oncol, 1996, 62(3): 360-365.
22.	王文福. Ⅰ期卵巢上皮性癌合理治疗模式的探讨. 中华妇产科杂志, 1996, 31(7): 387-389.
23.	Allen DG, Coulter J. Survival of patients with epithelial ovarian cancer and the effect of lymphadenectomy in those with stage 3 disease. Aust N Z J Obstet Gynaecol, 1999, 39(4): 420-424.
24.	赵文翠, 陈爱平, 祁秀娟, 等. 卵巢癌患者盆腔淋巴结清除术与预后关系的探讨. 中华实用医学, 2002, 4(8): 11-12.
25.	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生存率分析. 四川大学学报(医学版), 2004, 35(3): 449-450.
26.	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.
27.	Maggioni A, Benedetti Panici P, Dell'Anna T, et al. Randomised study of systematic lymphadenectomy in patients with epithelial ovarian cancer macroscopically confined to the pelvis. Br J Cancer, 2006, 95(6): 699-704.
28.	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.
29.	马珂, 温宏武, 廖秦平. 腹膜后淋巴结切除术在术中肉眼观察临床Ⅰ期卵巢上皮性癌中的意义. 中国妇产科临床杂志, 2010, 11(2): 105-108.
30.	Chang SJ, Bristow RE, Ryu HS. Prognostic significance of systematic lymphadenectomy as part of primary debulking surgery in patients with advanced ovarian cancer. Gynecol Oncol, 2012, 126(3): 381-386.
31.	Dell' Anna T, Signorelli M, Benedetti-Panici P, et al. Systematic lymphadenectomy in ovarian cancer at second-look surgery: a randomised clinical trial. Br J Cancer, 2012, 107(5): 785-792.
32.	Sakai K, Kajiyama H, Umezu T, et al. Is there any association between retroperitoneal lymphadenectomy and survival benefit in advanced stage epithelial ovarian carcinoma patients. J Obstet Gynaecol Res, 2012, 38(7): 1018-1023.
33.	Oshita T, Itamochi H, Nishimura R, et al. Clinical impact of systematic pelvic and para-aortic lymphadenectomy for pT1 and pT2 ovarian cancer: a retrospective survey by the Sankai gynecology study group. Int J Clin Oncol, 2013, 18(6): 1107-1113.
34.	许冬娣, 汪艳. 晚期上皮性卵巢癌腹膜后淋巴结清扫的临床价值. 实用临床医药杂志, 2013, 17(9): 156-158.
35.	Li X, Xing H, Li L, et al. Clinical significance of para-aortic lymph node dissection and prognosis in ovarian cancer. Front Med, 2014, 8(1): 96-100.
36.	Svolgaard O, Lidegaard O, Nielsen ML, et al. Lymphadenectomy in surgical stage I epithelial ovarian cancer. Acta Obstet Gynecol Scand, 2014, 93(3): 256-260.
37.	汤岭梅. 腹膜后淋巴结切除术在早期卵巢上皮性癌的临床应用价值分析. 中国现代手术学杂志, 2014, 18(4): 301-304.
38.	Schwartz L, Schrot-Sanyan S, Brigand C, et al. Impact of pelvic and para-aortic lymphadenectomy in advanced ovarian cancer after neoadjuvant chemotherapy. Anticancer Res, 2015, 35(10): 5503-5509.
39.	黄伟容, 李雪, 赵仁峰. 初次手术中行盆腔淋巴结清扫对Ⅲc期上皮性卵巢癌的临床价值. 中国医药, 2015, 10(9): 1350-1354.
40.	Paik ES, Shim M, Choi HJ, et al. Impact of lymphadenectomy on survival after recurrence in patients with advanced ovarian cancer without suspected lymph node metastasis. Gynecol Oncol, 2016, 143(2): 252-257.
41.	顾海风, 黄绮丹, 涂画. 初次肿瘤细胞减灭术中行系统性腹膜后淋巴结清扫对晚期卵巢癌预后的影响. 实用医学杂志, 2016, 32(10): 1623-1627.
42.	Qin B, Xu W, Li Y. The impact of lymphadenectomy on prognosis and survival of clinically apparent early-stage malignant ovarian germ cell tumors. Jpn J Clin Oncol, 2020, 50(3): 282-287.
43.	Bund V, Lecointre L, Velten M, et al. Impact of lymphadenectomy on survival of patients with serous advanced ovarian cancer after neoadjuvant chemotherapy: a French national multicenter study (FRANCOGYN). J Clin Med, 2020, 9(8): 2427.
44.	Fang C, Zhang Y, Zhao L, et al. The relationship between retroperitoneal lymphadenectomy and survival in advanced ovarian cancer patients. BMC Cancer, 2020, 20(1): 654.
45.	Kajiyama H, Suzuki S, Yoshikawa N, et al. The impact of systematic retroperitoneal lymphadenectomy on long-term oncologic outcome of women with advanced ovarian clear-cell carcinoma. J Gynecol Oncol, 2020, 31(4): e47.
46.	陈艳, 胡卫平, 吴大保, 等. 腹膜后淋巴结清扫术对早期卵巢恶性生殖细胞肿瘤患者生存及预后的影响. 中国临床保健杂志, 2020, 23(4): 499-504.
47.	Armstrong DK, Alvarez RD, Bakkum-Gamez JN, et al. Ovarian cancer, version 2. 2020, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2021, 19(2): 191-226.
48.	Petrillo M, Fagotti A, Ferrandina G, et al. Ovarian cancer patients with localized relapse: clinical outcome and prognostic factors. Gynecol Oncol, 2013, 131(1): 36-41.
49.	Iwase H, Takada T, Iitsuka C, et al. Clinical features of long-term survivors of recurrent epithelial ovarian cancer. Int J Clin Oncol, 2015, 20(1): 143-149.
50.	Xu D, Xue J, Rozan R, et al. The role systematic lymphadenectomy plays in determining the survival outcome for advanced ovarian cancer patients: a meta-analysis. Ann Palliat Med, 2020, 9(3): 912-920.
51.	卢淮武, 林荣春, 林仲秋. 2017 NCCN《卵巢癌临床实践指南(第一版)》解读. 中国实用妇科与产科杂志, 2017, 33(5): 485-493.
52.	卢淮武, 林仲秋. 《2018 NCCN卵巢癌包括输卵管癌及原发性腹膜癌临床实践指南》解读. 中国实用妇科与产科杂志, 2018, 34(5): 526-536.
53.	Jiang L, Yang KH, Chen Y, et al. Systematic review and meta-analysis of the effectiveness and safety of extended lymphadenectomy in patients with resectable gastric cancer. Br J Surg, 2014, 101(6): 595-604.
54.	Gmyrek LJ, Jonska-Gmyrek J, Sobiczewski P, et al. Evaluation of intraoperative and postoperative complications related to lymphadenectomy in ovarian cancer patients. Oncol Lett, 2011, 2(3): 537-541.

1. Chan JK, Cheung MK, Husain A, et al. Patterns and progress in ovarian cancer over 14 years. Obstet Gynecol, 2006, 108(3Pt1): 521-528.
2. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
3. Torre LA, Trabert B, DeSantis CE, et al. Ovarian cancer statistics, 2018. CA Cancer J Clin, 2018, 68(4): 284-296.
4. Ayhan A, Ozkan NT, Sarı ME, et al. Impact of lymph node ratio on survival in stage Ⅲ ovarian high-grade serous cancer: a turkish gynecologic oncology group study. J Gynecol Oncol, 2018, 29(1): e12.
5. 佟晓晶, 王纯雁. 腹膜后淋巴结清扫术在妇科恶性肿瘤治疗中的演变. 中国肿瘤, 2015, 24(9): 747-751.
6. Scarabelli C, Gallo A, Zarrelli A, et al. Systematic pelvic and para-aortic lymphadenectomy during cytoreductive surgery in advanced ovarian cancer: potential benefit on survival. Gynecol Oncol, 1995, 56(3): 328-337.
7. Morgan RJ, Armstrong DK, Alvarez RD, et al. Ovarian cancer, version 1. 2016, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2016, 14(9): 1134-1163.
8. Harter P, Sehouli J, Lorusso D, et al. A randomized trial of lymphadenectomy in patients with advanced ovarian neoplasms. N Engl J Med, 2019, 380(9): 822-832.
9. Armstrong DK, Alvarez RD, Bakkum-Gamez JN, et al. NCCN guidelines insights: ovarian cancer, version 1. 2019. J Natl Compr Canc Netw, 2019, 17(8): 896-909.
10. 周琦, 吴小华, 刘继红, 等. 卵巢恶性肿瘤诊断与治疗指南(第四版). 中国实用妇科与产科杂志, 2018, 34(7): 739-749.
11. Wang Y, Ren F, Song Z, et al. Prognostic significance of systematic lymphadenectomy in patients with optimally debulked advanced ovarian cancer: a meta-analysis. Front Oncol, 2020, 10: 86.
12. Chiyoda T, Sakurai M, Satoh T, et al. Lymphadenectomy for primary ovarian cancer: a systematic review and meta-analysis. J Gynecol Oncol, 2020, 31(5): e67.
13. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 2021, 372: n71.
14. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (Version 5. 1. 0). The Cochrane Collaboration, 2011, Availableat: //www.cochrane-handbook.org.
15. Savović J, Jones HE, Altman DG, et al. Influence of reported study design characteristics on intervention effect estimates from randomized, controlled trials. Ann Intern Med, 2012, 157(6): 429-438.
16. Wells GA, Shea BO, Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Available at:http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
17. Timmermans L, de Goede B, van Dijk SM, et al. Meta-analysis of sublay versus onlay mesh repair in incisional hernia surgery. Am J Surg, 2014, 207(6): 980-988.
18. 张天嵩. 经典Meta分析统计模型的合理选择. 中国循证医学杂志, 2020, 20(12): 1477-1481.
19. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336(7650): 924-926.
20. Kigawa J, Minagawa Y, Itamochi H, et al. Retroperitoneal lymphadenectomy, including the para-aortic nodes in patients with stage III ovarian cancer. Am J Clin Oncol, 1994, 17(3): 230-233.
21. di Re F, Baiocchi G, Fontanelli R, et al. Systematic pelvic and paraaortic lymphadenectomy for advanced ovarian cancer: prognostic significance of node metastases. Gynecol Oncol, 1996, 62(3): 360-365.
22. 王文福. Ⅰ期卵巢上皮性癌合理治疗模式的探讨. 中华妇产科杂志, 1996, 31(7): 387-389.
23. Allen DG, Coulter J. Survival of patients with epithelial ovarian cancer and the effect of lymphadenectomy in those with stage 3 disease. Aust N Z J Obstet Gynaecol, 1999, 39(4): 420-424.
24. 赵文翠, 陈爱平, 祁秀娟, 等. 卵巢癌患者盆腔淋巴结清除术与预后关系的探讨. 中华实用医学, 2002, 4(8): 11-12.
25. 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生存率分析. 四川大学学报(医学版), 2004, 35(3): 449-450.
26. 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.
27. Maggioni A, Benedetti Panici P, Dell'Anna T, et al. Randomised study of systematic lymphadenectomy in patients with epithelial ovarian cancer macroscopically confined to the pelvis. Br J Cancer, 2006, 95(6): 699-704.
28. 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.
29. 马珂, 温宏武, 廖秦平. 腹膜后淋巴结切除术在术中肉眼观察临床Ⅰ期卵巢上皮性癌中的意义. 中国妇产科临床杂志, 2010, 11(2): 105-108.
30. Chang SJ, Bristow RE, Ryu HS. Prognostic significance of systematic lymphadenectomy as part of primary debulking surgery in patients with advanced ovarian cancer. Gynecol Oncol, 2012, 126(3): 381-386.
31. Dell' Anna T, Signorelli M, Benedetti-Panici P, et al. Systematic lymphadenectomy in ovarian cancer at second-look surgery: a randomised clinical trial. Br J Cancer, 2012, 107(5): 785-792.
32. Sakai K, Kajiyama H, Umezu T, et al. Is there any association between retroperitoneal lymphadenectomy and survival benefit in advanced stage epithelial ovarian carcinoma patients. J Obstet Gynaecol Res, 2012, 38(7): 1018-1023.
33. Oshita T, Itamochi H, Nishimura R, et al. Clinical impact of systematic pelvic and para-aortic lymphadenectomy for pT1 and pT2 ovarian cancer: a retrospective survey by the Sankai gynecology study group. Int J Clin Oncol, 2013, 18(6): 1107-1113.
34. 许冬娣, 汪艳. 晚期上皮性卵巢癌腹膜后淋巴结清扫的临床价值. 实用临床医药杂志, 2013, 17(9): 156-158.
35. Li X, Xing H, Li L, et al. Clinical significance of para-aortic lymph node dissection and prognosis in ovarian cancer. Front Med, 2014, 8(1): 96-100.
36. Svolgaard O, Lidegaard O, Nielsen ML, et al. Lymphadenectomy in surgical stage I epithelial ovarian cancer. Acta Obstet Gynecol Scand, 2014, 93(3): 256-260.
37. 汤岭梅. 腹膜后淋巴结切除术在早期卵巢上皮性癌的临床应用价值分析. 中国现代手术学杂志, 2014, 18(4): 301-304.
38. Schwartz L, Schrot-Sanyan S, Brigand C, et al. Impact of pelvic and para-aortic lymphadenectomy in advanced ovarian cancer after neoadjuvant chemotherapy. Anticancer Res, 2015, 35(10): 5503-5509.
39. 黄伟容, 李雪, 赵仁峰. 初次手术中行盆腔淋巴结清扫对Ⅲc期上皮性卵巢癌的临床价值. 中国医药, 2015, 10(9): 1350-1354.
40. Paik ES, Shim M, Choi HJ, et al. Impact of lymphadenectomy on survival after recurrence in patients with advanced ovarian cancer without suspected lymph node metastasis. Gynecol Oncol, 2016, 143(2): 252-257.
41. 顾海风, 黄绮丹, 涂画. 初次肿瘤细胞减灭术中行系统性腹膜后淋巴结清扫对晚期卵巢癌预后的影响. 实用医学杂志, 2016, 32(10): 1623-1627.
42. Qin B, Xu W, Li Y. The impact of lymphadenectomy on prognosis and survival of clinically apparent early-stage malignant ovarian germ cell tumors. Jpn J Clin Oncol, 2020, 50(3): 282-287.
43. Bund V, Lecointre L, Velten M, et al. Impact of lymphadenectomy on survival of patients with serous advanced ovarian cancer after neoadjuvant chemotherapy: a French national multicenter study (FRANCOGYN). J Clin Med, 2020, 9(8): 2427.
44. Fang C, Zhang Y, Zhao L, et al. The relationship between retroperitoneal lymphadenectomy and survival in advanced ovarian cancer patients. BMC Cancer, 2020, 20(1): 654.
45. Kajiyama H, Suzuki S, Yoshikawa N, et al. The impact of systematic retroperitoneal lymphadenectomy on long-term oncologic outcome of women with advanced ovarian clear-cell carcinoma. J Gynecol Oncol, 2020, 31(4): e47.
46. 陈艳, 胡卫平, 吴大保, 等. 腹膜后淋巴结清扫术对早期卵巢恶性生殖细胞肿瘤患者生存及预后的影响. 中国临床保健杂志, 2020, 23(4): 499-504.
47. Armstrong DK, Alvarez RD, Bakkum-Gamez JN, et al. Ovarian cancer, version 2. 2020, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2021, 19(2): 191-226.
48. Petrillo M, Fagotti A, Ferrandina G, et al. Ovarian cancer patients with localized relapse: clinical outcome and prognostic factors. Gynecol Oncol, 2013, 131(1): 36-41.
49. Iwase H, Takada T, Iitsuka C, et al. Clinical features of long-term survivors of recurrent epithelial ovarian cancer. Int J Clin Oncol, 2015, 20(1): 143-149.
50. Xu D, Xue J, Rozan R, et al. The role systematic lymphadenectomy plays in determining the survival outcome for advanced ovarian cancer patients: a meta-analysis. Ann Palliat Med, 2020, 9(3): 912-920.
51. 卢淮武, 林荣春, 林仲秋. 2017 NCCN《卵巢癌临床实践指南(第一版)》解读. 中国实用妇科与产科杂志, 2017, 33(5): 485-493.
52. 卢淮武, 林仲秋. 《2018 NCCN卵巢癌包括输卵管癌及原发性腹膜癌临床实践指南》解读. 中国实用妇科与产科杂志, 2018, 34(5): 526-536.
53. Jiang L, Yang KH, Chen Y, et al. Systematic review and meta-analysis of the effectiveness and safety of extended lymphadenectomy in patients with resectable gastric cancer. Br J Surg, 2014, 101(6): 595-604.
54. Gmyrek LJ, Jonska-Gmyrek J, Sobiczewski P, et al. Evaluation of intraoperative and postoperative complications related to lymphadenectomy in ovarian cancer patients. Oncol Lett, 2011, 2(3): 537-541.

Chinese Journal of Evidence-Based Medicine

Prognostic efficacy of systematic lymphadenectomy for ovarian cancer: a systematic review

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