Assessment of survival and clinicopathologic characteristics associated with lymph node isolated tumor cells in epithelial ovarian cancer.

OBJECTIVE

To assess reported incidences, characteristics, and survival associated with isolated tumor cells (ITCs) in epithelial ovarian cancer.

METHODS

This retrospective cohort study queried the Commission-on-Cancer's National Cancer Database. The study population included 15,484 patients with epithelial ovarian cancer and American Joint Committee on Cancer classification T1-T3 / N0-N0(i+) / M0 who had lymph node evaluation at primary anti-cancer surgery from 2018 to 2023. Multivariable Cox proportional hazards regression model was created to assess overall survival (OS) associated with ITCs, adjusting for preoperative and intraoperative factors-derived propensity score and further postoperative chemotherapy.

RESULTS

A total of 157 (1.0%) patients had ITCs in regional lymph nodes, corresponding to one in 100 patients. Higher T classification was associated with higher incidence rate of ITCs (0.5%, 1.2%, and 2.6% for T1, T2, and T3 classification, respectively; adjusted-odd ratio [aOR] for T2 vs T1, 1.90, 95% confidence interval [CI] 1.21 to 3.00; and aOR for T3 vs T1 3.45, 95%Cl 2.29 to 5.20). Reported incidence rates of ITCs were higher for low-grade serous carcinoma compared to high-grade serous carcinoma (4.0% vs 1.5%, aOR 2.68, 95%Cl 1.66 to 4.31). In multivariable analysis, ITCs were statistically not associated with OS (4-year rates, 81.0% and 86.7%, adjusted-hazard ratio 0.94, 95%Cl 0.58 to 1.52). Results were similar in several subgroups (age < 60, age ≥ 60, T1, T2, and T3 classifications, high-grade serous, and low-grade serous) in exploratory analysis. This included adjusted-hazard ratio of 1.26 (95%CI 0.40 to 3.93) for T1 classification.

CONCLUSION

The results of this cohort study suggest that ITCs in the regional lymph node may not be a prognostic factor for short-term survival in epithelial ovarian cancer.