Gynecologic oncology · 2025
Impact of lymph node dissection and adjuvant chemotherapy on survival of patients with early-stage ovarian cancer: Update of a national cohort study.
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Laven Pim, Wenzel Hans H B, van der Aa Maaike A, Lambrechts Sandrina, Kruitwagen Roy F P M
Аннотация
AIM: To determine the impact of lymph node dissection and adjuvant chemotherapy on survival in patients with early-stage epithelial ovarian cancer (EOC) in an updated national cohort study.
METHODS: All patients with International Federation of Gynaecology and Obstetrics (FIGO) 2014 stage I-IIA or IIIA1 EOC, diagnosed in the Netherlands between 2000 and 2020 (8 additional years) were included. Data concerning patient, tumour and treatment characteristics and survival were extracted from the Netherlands Cancer Registry.
RESULTS: Of 5407 patients included, 2911 (53.8 %) had lymph nodes removed. Ten-year relative survival (RS) of patients with (compared to without) lymph node dissection was significantly better, also after correcting for age, stage, tumour grade and histology (83.3 % and 73.3 %, respectively; relative excess risk [RER] 0.56; 95 % confidence interval [CI]: 0.48-0.66). After adjusting for confounders, patients with 10+ lymph nodes removed had a significantly higher ten-year RS if they received adjuvant chemotherapy compared to those who did not (RER 0.64; 95 % CI 0.41-1.00, p = 0.048). This was also true for a subgroup of patients with high-risk features (stage IC and IIA and/or tumour grade 3 and/or clear cell histology) (RER 0.59; 95 % CI 0.37-0.95, p = 0.028).
CONCLUSION: For early-stage EOC patients, removing 10 or more lymph nodes and providing adjuvant chemotherapy is associated with improved RS after 10 years of follow-up. The contribution of adjuvant chemotherapy to improved RS is clinically relevant and in contrast to our previous findings reporting survival rates after only five years of follow-up.
METHODS: All patients with International Federation of Gynaecology and Obstetrics (FIGO) 2014 stage I-IIA or IIIA1 EOC, diagnosed in the Netherlands between 2000 and 2020 (8 additional years) were included. Data concerning patient, tumour and treatment characteristics and survival were extracted from the Netherlands Cancer Registry.
RESULTS: Of 5407 patients included, 2911 (53.8 %) had lymph nodes removed. Ten-year relative survival (RS) of patients with (compared to without) lymph node dissection was significantly better, also after correcting for age, stage, tumour grade and histology (83.3 % and 73.3 %, respectively; relative excess risk [RER] 0.56; 95 % confidence interval [CI]: 0.48-0.66). After adjusting for confounders, patients with 10+ lymph nodes removed had a significantly higher ten-year RS if they received adjuvant chemotherapy compared to those who did not (RER 0.64; 95 % CI 0.41-1.00, p = 0.048). This was also true for a subgroup of patients with high-risk features (stage IC and IIA and/or tumour grade 3 and/or clear cell histology) (RER 0.59; 95 % CI 0.37-0.95, p = 0.028).
CONCLUSION: For early-stage EOC patients, removing 10 or more lymph nodes and providing adjuvant chemotherapy is associated with improved RS after 10 years of follow-up. The contribution of adjuvant chemotherapy to improved RS is clinically relevant and in contrast to our previous findings reporting survival rates after only five years of follow-up.