Role of lymphadenectomy for apparent early-stage low-grade serous ovarian carcinoma

Investigate the prevalence of lymph node metastasis and impact of lymphadenectomy on the survival of patients with apparent early-stage low-grade serous ovarian carcinoma.

Patients with apparent early-stage low-grade serous ovarian carcinoma diagnosed between 2004 and 2015 were identified in the National Cancer Database. The performance of lymphadenectomy and incidence of lymph node metastasis were assessed from pathology report. Overall survival was compared with the log-rank test, and a Cox model was constructed to control for a priori selected confounders.

A total of 977 patients were identified. The rate of lymphadenectomy was 65.9%, whereas the median number of lymph nodes removed was 12. There were no differences between patients who did and did not undergo lymphadenectomy in terms of patient age, race, insurance status, apparent disease stage, and type of treatment facility. The rate of adjuvant chemotherapy use was higher in patients who underwent lymphadenectomy (33.5% vs 26.4%, p = .024). The overall incidence of lymphadenectomy metastasis was 7.5%, which was higher in patients with stage IC (10.1%) than in those with stage IA disease (5.6%), p = .031. Patients who underwent lymphadenectomy had better overall survival than those who had did not, p < .001; the 5-year overall survival rates were 91.6% and 83.3%, respectively. After controlling for confounders, performance of lymphadenectomy was associated with better overall survival (HR 0.67, 95% CI 0.48-0.93).

The incidence of lymph node metastases among apparent early-stage low-grade serous ovarian carcinoma is not negligible, especially in patients with apparent stage IC disease. Performance of lymphadenectomy may be associated with a survival benefit likely secondary to stage migration.