Speculation on optimal numbers of examined lymph node for early-stage epithelial ovarian cancer from the perspective of stage migration

Yuan Li; Jiashan Ding; Huimin Zheng; Lijiang Xu; Weiru Li; Minshan Zhu; Xiaolu Zhang; Cong Ma; Fangying Zhang; Peiwen Zhong; Dong Liang; Yubin Han; Siyou Zhang; Linsheng He; Jiaqi Li

doi:10.3389/fonc.2023.1265631

Speculation on optimal numbers of examined lymph node for early-stage epithelial ovarian cancer from the perspective of stage migration

Front Oncol. 2023 Sep 22:13:1265631. doi: 10.3389/fonc.2023.1265631. eCollection 2023.

Authors

Yuan Li¹, Jiashan Ding², Huimin Zheng¹, Lijiang Xu¹, Weiru Li¹, Minshan Zhu¹, Xiaolu Zhang¹, Cong Ma¹, Fangying Zhang¹, Peiwen Zhong¹, Dong Liang¹, Yubin Han¹, Siyou Zhang¹, Linsheng He³, Jiaqi Li³

Affiliations

¹ Department of Obstetrics and Gynecology, First People's Hospital of Foshan, Foshan, Guangdong, China.
² Department of Gynecological Oncology, Xiangya Hospital Central South University, Central South University, Changsha, Hunan, China.
³ Department of Gynecologic Oncology, Jiangxi Maternal and Child Health Hospital, Nanchang Medical College, Nanchang, Jiangxi, China.

Abstract

Introduction: In early-stage epithelial ovarian cancer (EOC), how to perform lymphadenectomy to avoid stage migration and achieve reliable targeted excision has not been explored in depth. This study comprehensively considered the stage migration and survival to determine appropriate numbers of examined lymph node (ELN) for early-stage EOC and high-grade serous ovarian cancer (HGSOC).

Methods: From the Surveillance, Epidemiology, and End Results database, we obtained 10372 EOC cases with stage T1M0 and ELN ≥ 2, including 2849 HGSOC cases. Generalized linear models with multivariable adjustment were used to analyze associations between ELN numbers and lymph node stage migration, survival and positive lymph node (PLN). LOESS regression characterized dynamic trends of above associations followed by Chow test to determine structural breakpoints of ELN numbers. Survival curves were plotted using Kaplan-Meier method.

Results: More ELNs were associated with more node-positive diseases, more PLNs and better prognosis. ELN structural breakpoints were different in subgroups of early-stage EOC, which for node stage migration or PLN were more than those for improving outcomes. The meaning of ELN structural breakpoint varied with its location and the morphology of LOESS curve. To avoid stage migration, the optimal ELN for early-stage EOC was 29 and the minimal ELN for HGSOC was 24. For better survival, appropriate ELN number were 13 and 8 respectively. More ELNs explained better prognosis only at a certain range.

Discussion: Neither too many nor too few numbers of ELN were ideal for early-stage EOC and HGSOC. Excision with appropriate numbers of lymph node draining the affected ovary may be more reasonable than traditional sentinel lymph node resection and systematic lymphadenectomy.

Keywords: early-stage; epithelial ovarian cancer; examined lymph node; stage migration; structural breakpoint; survival.

Grants and funding

Guangdong Basic and Applied Basic Research Foundation (2021A1515111176); National Natural Science Foundation of China (82260534); Natural Science Foundation of Jiangxi Province (20202BBGL73110); Foshan Science and Technology Innovation Project (2020001005206).