Retroperitoneal Lymphadenectomy Did Not Appear to Yield Survival Benefit in Ovarian Cancer

Patients with ovarian clear cell cancer did not seem to derive additional benefit after undergoing retroperitoneal lymphadenectomy.

Retroperitoneal lymphadenectomy did not appear to provide any additional survival benefit for patients with ovarian clear cell cancer (OCCC), according to a retrospective study published in Frontiers in Oncology.

Clinically positive nodes were observed in 40 patients and negatives nodes in 119, of whom 124 underwent retroperitoneal lymphadenectomy. The estimated 2-year progression-free survival (PFS) rate was 71.4%, and the 5-year overall survival (OS) rate was 65.9% for those who received a lymphadenectomy (P = .566), compared with 72.0% and 73.7% for those who did not (P = .669).

“In this retrospective study, we found no survival benefit [from] retroperitoneal lymphadenectomy in OCCC patients, both in the entire cohort and when subgroup analysis was performed. A prospective clinical trial is needed to confirm the present results,” the study investigators wrote.

A total of 170 patients enrolled on the study, with a median age of 52 years at diagnosis. Moreover, 52.9% of patients were diagnosed with early-stage disease. Patient characteristics tended to be well balanced between the 2 groups besides residual disease. In the lymphadenectomy-free group, patients tended to undergo suboptimal surgery.

Among those who underwent peritoneal lymphadenectomy, 36 had pelvic lymph node resection, 5 had aortic lymph node resection, and 83 had both.When investigators conducted a postoperative pathology of the lymph nodes, 97 patients had negative lymph nodes, 27 had positive lymph nodes, 49 had less than 20 resected lymph nodes, and 72 had 20 or more resected lymph nodes.

In those with early-stage disease, the estimated 2-year PFS rate was 89.7% in lymphadenectomy cohort and 100.0% for no lymphadenectomy cohort (P = .256). The 5-year OS rate for early-stage population was 92.4% and 100.0% in the lymphadenectomy and no lymphadenectomy groups, respectively (P = .263). In the advanced stage population, the estimated 2-year PFS rate for the lymphadenectomy group was 50.0% and 42.5% for the no lymphadenectomy (P = .281). Moreover, the 5-year estimated OS rates were 36.9% and 46.6%, respectively (P = .351).

When analyzing retroperitoneal lymphadenectomy in those with negative nodes, investigators noted no difference between the lymphadenectomy group and the no lymphadenectomy group in terms of 2-year PFS (P = .378) and 5-year OS (P = .777).

The univariate analysis found that advanced stage venous thromboembolism (VTE), a Fagotti score of 8 or more, ascites, residual disease of 0 or more, and less than 4 cycles of therapy was associated with a shorter PFS.

The multivariate analysis showed advanced stage (HR, 3.082;), VTE (HR, 2.675), ascites (HR, 2.354), residual disease of 0 or more (HR, 8.128), and less than 4 chemotherapy cycles (HR, 1.821) were independent predictors of tumor recurrence and retroperitoneal lymphadenectomy was not.

Reference

Gao W, Shi P, Sun H, et al. Therapeutic role of retroperitoneal lymphadenectomy in 170 patients with ovarian clear cell cancer. Front Oncol. 2022;11:754149. doi:10.3389/fonc.2021.754149