Potential Role of Lymphadenectomy in Advanced Ovarian Cancer: A Combined Exploratory Analysis of Three Prospectively Randomized Phase III Multicenter Trials

被引:125
作者
du Bois, Andreas [1 ]
Reuss, Alexander
Harter, Philipp
Pujade-Lauraine, Eric
Ray-Coquard, Isabelle
Pfisterer, Jacobus
机构
[1] Dr Horst Schmidt Klin, Dept Gynecol, D-65199 Wiesbaden, Germany
关键词
LYMPH-NODE; 1ST-LINE TREATMENT; PARAAORTIC LYMPHADENECTOMY; SYSTEMATIC LYMPHADENECTOMY; CYTOREDUCTIVE SURGERY; INTERGROUP TRIAL; DES CANCERS; CARBOPLATIN; INVOLVEMENT; PREDICTORS;
D O I
10.1200/JCO.2009.25.3617
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose Primary surgery followed by platinum/taxane-based chemotherapy is the standard therapy in advanced ovarian cancer. The prognostic role of complete debulking has been well described; however, the impact of systematic pelvic and para-aortic lymphadenectomy and its interaction with biologic factors are still not fully defined. Methods This was an exploratory analysis of three prospective randomized trials (Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom trials 3, 5, and 7) investigating platinum/taxane-based chemotherapy regimens in advanced ovarian cancer conducted between 1995 and 2002. Results One thousand nine hundred twenty-four patients were analyzed. Lymphadenectomy was associated with superior survival in patients without gross residual disease. In patients with and without lymphadenectomy, the median survival time was 103 and 84 months, respectively, and 5-year survival rates were 67.4% and 59.2%, respectively (P = .0166); multivariate analysis confirmed a significant impact of lymphadenectomy on overall survival (OS; hazard ratio [HR] = 0.74; 95% CI, 0.59 to 0.94; P = .0123). In patients with small residual tumors up to 1 cm, the effect of lymphadenectomy on OS barely reached significance (HR = 0.85; 95% CI, 0.72 to 1.00; P = .0497). For patients with small residual tumors and clinically suspect nodes, lymphadenectomy resulted in a 16% gain in 5-year OS (log-rank test, P = .0038). Conclusion Lymphadenectomy in advanced ovarian cancer might offer benefit mainly to patients with complete intraperitoneal debulking. However, this hypothesis should be confirmed in the context of a prospectively randomized trial. J Clin Oncol 28: 1733-1739. (C) 2010 by American Society of Clinical Oncology
引用
收藏
页码:1733 / 1739
页数:7
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