Assessing the risk of pelvic and para-aortic nodal involvement in apparent early-stage ovarian cancer

A predictors- and nomogram-based analyses

Giorgio Bogani, Elena Tagliabue, Antonino Ditto, Mauro Signorelli, Fabio Martinelli, Jvan Casarin, Valentina Chiappa, Giulia Dondi, Umberto Leone Roberti Maggiore, Cono Scaffa, Chiara Borghi, Luca Montanelli, Domenica Lorusso, Francesco Raspagliesi

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective To estimate the prevalence of lymph node involvement in early-stage epithelial ovarian cancer in order to assess the prognostic value of lymph node dissection. Methods Data of consecutive patients undergoing staging for early-stage epithelial ovarian cancer were retrospectively evaluated. Logistic regression and a nomogram-based analysis were used to assess the risk of lymph node involvement. Results Overall, 290 patients were included. All patients had lymph node dissection including pelvic and para-aortic lymphadenectomy. Forty-two (14.5%) patients were upstaged due to lymph node metastatic disease. Pelvic and para-aortic nodal metastases were observed in 22 (7.6%) and 42 (14.5%) patients. Lymph node involvement was observed in 18/95 (18.9%), 1/37 (2.7%), 4/29 (13.8%), 11/63 (17.4%), 3/41 (7.3%) and 5/24 (20.8%) patients with high-grade serous, low-grade-serous, endometrioid G1, endometrioid G2&3, clear cell and undifferentiated, histology, respectively (p = 0.12, Chi-square test). We observed that high-grade serous histology was associated with an increased risk of pelvic node involvement; while, histology rather than low-grade serous and bilateral tumors were independently associated with para-aortic lymph node involvement (p < 0.05). Nomograms displaying the risk of nodal involvement in the pelvic and para-aortic areas were built. High-grade serous histology and bilateral tumors are the main characteristics suggesting lymph node positivity. Conclusions Our data suggested that high-grade serous and bilateral early-stage epithelial ovarian cancer are at high risk of having disease harboring in the lymphatic tissues of both pelvic and para-aortic area. After receiving external validation, our data will help to identify patients deserving comprehensive retroperitoneal staging.

Original languageEnglish
Pages (from-to)61-65
Number of pages5
JournalGynecologic Oncology
Volume147
Issue number1
DOIs
Publication statusPublished - Oct 1 2017

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Nomograms
Ovarian Neoplasms
Lymph Nodes
Histology
Lymph Node Excision
Lymphoid Tissue
Chi-Square Distribution
Neoplasms
Logistic Models
Neoplasm Metastasis
Ovarian epithelial cancer

Keywords

  • Lymphadenectomy
  • Nodal involvement
  • Nomogram
  • Ovarian cancer
  • Staging

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynaecology

Cite this

Assessing the risk of pelvic and para-aortic nodal involvement in apparent early-stage ovarian cancer : A predictors- and nomogram-based analyses. / Bogani, Giorgio; Tagliabue, Elena; Ditto, Antonino; Signorelli, Mauro; Martinelli, Fabio; Casarin, Jvan; Chiappa, Valentina; Dondi, Giulia; Leone Roberti Maggiore, Umberto; Scaffa, Cono; Borghi, Chiara; Montanelli, Luca; Lorusso, Domenica; Raspagliesi, Francesco.

In: Gynecologic Oncology, Vol. 147, No. 1, 01.10.2017, p. 61-65.

Research output: Contribution to journalArticle

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abstract = "Objective To estimate the prevalence of lymph node involvement in early-stage epithelial ovarian cancer in order to assess the prognostic value of lymph node dissection. Methods Data of consecutive patients undergoing staging for early-stage epithelial ovarian cancer were retrospectively evaluated. Logistic regression and a nomogram-based analysis were used to assess the risk of lymph node involvement. Results Overall, 290 patients were included. All patients had lymph node dissection including pelvic and para-aortic lymphadenectomy. Forty-two (14.5{\%}) patients were upstaged due to lymph node metastatic disease. Pelvic and para-aortic nodal metastases were observed in 22 (7.6{\%}) and 42 (14.5{\%}) patients. Lymph node involvement was observed in 18/95 (18.9{\%}), 1/37 (2.7{\%}), 4/29 (13.8{\%}), 11/63 (17.4{\%}), 3/41 (7.3{\%}) and 5/24 (20.8{\%}) patients with high-grade serous, low-grade-serous, endometrioid G1, endometrioid G2&3, clear cell and undifferentiated, histology, respectively (p = 0.12, Chi-square test). We observed that high-grade serous histology was associated with an increased risk of pelvic node involvement; while, histology rather than low-grade serous and bilateral tumors were independently associated with para-aortic lymph node involvement (p < 0.05). Nomograms displaying the risk of nodal involvement in the pelvic and para-aortic areas were built. High-grade serous histology and bilateral tumors are the main characteristics suggesting lymph node positivity. Conclusions Our data suggested that high-grade serous and bilateral early-stage epithelial ovarian cancer are at high risk of having disease harboring in the lymphatic tissues of both pelvic and para-aortic area. After receiving external validation, our data will help to identify patients deserving comprehensive retroperitoneal staging.",
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AU - Tagliabue, Elena

AU - Ditto, Antonino

AU - Signorelli, Mauro

AU - Martinelli, Fabio

AU - Casarin, Jvan

AU - Chiappa, Valentina

AU - Dondi, Giulia

AU - Leone Roberti Maggiore, Umberto

AU - Scaffa, Cono

AU - Borghi, Chiara

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AU - Lorusso, Domenica

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AB - Objective To estimate the prevalence of lymph node involvement in early-stage epithelial ovarian cancer in order to assess the prognostic value of lymph node dissection. Methods Data of consecutive patients undergoing staging for early-stage epithelial ovarian cancer were retrospectively evaluated. Logistic regression and a nomogram-based analysis were used to assess the risk of lymph node involvement. Results Overall, 290 patients were included. All patients had lymph node dissection including pelvic and para-aortic lymphadenectomy. Forty-two (14.5%) patients were upstaged due to lymph node metastatic disease. Pelvic and para-aortic nodal metastases were observed in 22 (7.6%) and 42 (14.5%) patients. Lymph node involvement was observed in 18/95 (18.9%), 1/37 (2.7%), 4/29 (13.8%), 11/63 (17.4%), 3/41 (7.3%) and 5/24 (20.8%) patients with high-grade serous, low-grade-serous, endometrioid G1, endometrioid G2&3, clear cell and undifferentiated, histology, respectively (p = 0.12, Chi-square test). We observed that high-grade serous histology was associated with an increased risk of pelvic node involvement; while, histology rather than low-grade serous and bilateral tumors were independently associated with para-aortic lymph node involvement (p < 0.05). Nomograms displaying the risk of nodal involvement in the pelvic and para-aortic areas were built. High-grade serous histology and bilateral tumors are the main characteristics suggesting lymph node positivity. Conclusions Our data suggested that high-grade serous and bilateral early-stage epithelial ovarian cancer are at high risk of having disease harboring in the lymphatic tissues of both pelvic and para-aortic area. After receiving external validation, our data will help to identify patients deserving comprehensive retroperitoneal staging.

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