BJOG : an international journal of obstetrics and gynaecology · 2016
Surgical lymph node assessment in mucinous ovarian carcinoma staging: a systematic review and meta-analysis.
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Hoogendam J P, Vlek C A, Witteveen P O, Verheijen Rhm, Zweemer R P
Аннотация
BACKGROUND: The proportion of women with mucinous ovarian carcinoma in whom nodal metastases are identified during staging remains unclear.
OBJECTIVES: To review the literature on surgical lymph node assessment during staging of women diagnosed with mucinous ovarian carcinoma.
SEARCH STRATEGY: A systematic search using synonyms of 'mucinous ovarian carcinoma' and 'lymph node assessment' was conducted in PubMed, Scopus, Embase and the Cochrane Library.
SELECTION CRITERIA: When they covered ten or more mucinous ovarian carcinoma cases, staging surgery and minimally one of the following outcomes: prevalence of metastases, stage shift or survival data.
DATA COLLECTION AND ANALYSIS: Studies were quality evaluated with the Cochrane risk-of-bias assessment tool for non-randomised studies of interventions. Outcomes were pooled using an inverse variance weighted random effects model.
MAIN RESULTS: Sixteen studies were included. In 278 women with mucinous ovarian cancer suspected to be stage I-II, a pooled proportion of 0.8% (95% CI <0.1-2.9%) had lymph node metastases and were upstaged. In those suspected of stage I (n = 184), this proportion was 0.7% (95% CI <0.1-3.8%). No difference (P = 0.287) was found in metastases between sampling at 0.0% (95% CI 0.0-3.3%) and complete pelvic and/or para-aortic lymph node dissection at 1.2% (95% CI <0.1-4.2%). One study directly compared the survival of patients staged with and without lymph node dissection and reported no significant difference.
CONCLUSIONS: Surgical lymph node assessment in women suspected of stage I-II mucinous ovarian carcinoma rarely identifies nodal metastases and consequently has no significant impact on staging.
TWEETABLE ABSTRACT: Surgical lymph node assessment in women with stage I-II mucinous ovarian cancer rarely has staging consequences.
OBJECTIVES: To review the literature on surgical lymph node assessment during staging of women diagnosed with mucinous ovarian carcinoma.
SEARCH STRATEGY: A systematic search using synonyms of 'mucinous ovarian carcinoma' and 'lymph node assessment' was conducted in PubMed, Scopus, Embase and the Cochrane Library.
SELECTION CRITERIA: When they covered ten or more mucinous ovarian carcinoma cases, staging surgery and minimally one of the following outcomes: prevalence of metastases, stage shift or survival data.
DATA COLLECTION AND ANALYSIS: Studies were quality evaluated with the Cochrane risk-of-bias assessment tool for non-randomised studies of interventions. Outcomes were pooled using an inverse variance weighted random effects model.
MAIN RESULTS: Sixteen studies were included. In 278 women with mucinous ovarian cancer suspected to be stage I-II, a pooled proportion of 0.8% (95% CI <0.1-2.9%) had lymph node metastases and were upstaged. In those suspected of stage I (n = 184), this proportion was 0.7% (95% CI <0.1-3.8%). No difference (P = 0.287) was found in metastases between sampling at 0.0% (95% CI 0.0-3.3%) and complete pelvic and/or para-aortic lymph node dissection at 1.2% (95% CI <0.1-4.2%). One study directly compared the survival of patients staged with and without lymph node dissection and reported no significant difference.
CONCLUSIONS: Surgical lymph node assessment in women suspected of stage I-II mucinous ovarian carcinoma rarely identifies nodal metastases and consequently has no significant impact on staging.
TWEETABLE ABSTRACT: Surgical lymph node assessment in women with stage I-II mucinous ovarian cancer rarely has staging consequences.