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Lymphadenectomy During Interval Debulking Surgery in Advanced Epithelial Ovarian Cancer: A Multicenter Real-World
Xingyu Liu1,2, Yiyang Shen1,2, Yingjun Zhao1,2
1Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Objective:
To investigate the controversial impact of lymphadenectomy on prognosis and postoperative complications in patients with advanced epithelial ovarian cancer (AEOC) receiving neoadjuvant chemotherapy followed by interval debulking surgery (IDS).
Methods:
This retrospective real-world study analyzed 1068 patients with AEOC undergoing IDS at seven tertiary centers in China between 2006 and 2021. Endpoints included progression-free survival (PFS), overall survival (OS), and postoperative complications. Propensity score matching (PSM) and overlapping weight (OW) analyses were employed to minimize selection bias.
Results:
Of the cohort, 528 patients (49.4%) underwent lymphadenectomy. After adjustment, 960 patients were matched in the propensity score matching cohort (480 per group), and 1068 patients were included in the overlapping weight cohort. Lymphadenectomy was consistently associated with improved PFS in the unadjusted (HR, 0.77; 95% CI, 0.67-0.90; P = 0.001), PSM (HR, 0.77; 95% CI, 0.66-0.90; P = 0.001), and OW cohorts (HR, 0.76; 95% CI, 0.65-0.89; P = 0.001). However, lymphadenectomy had no impact on OS from the unadjusted analysis (HR, 0.85; 95% CI, 0.70-1.02; P = 0.084), PSM adjusted analysis (HR, 0.86; 95% CI, 0.70-1.05; P = 0.129), and OW adjusted analysis (HR, 0.85; 95% CI, 0.70-1.03; P = 0.098). Lymphadenectomy was not associated with an increased incidence of overall or severe postoperative complications across all models (All P > 0.05).
Conclusion:
In this multicenter retrospective cohort study, lymphadenectomy during IDS was associated with improved PFS but not OS after adjustment. No increased risk of postoperative complications was observed. Given the retrospective design, prospective studies are needed to validate these findings and clarify the role of lymphadenectomy.
