İleri Evre (Evre IIIC ve IV) Epitelial Over Kanserli Hastalarda Lenf Nodu Diseksiyonunun Sağkalıma Etkisi

Yıl 2020, Cilt: 7 Sayı: 1, 40 - 44, 28.04.2020

Ece Öcal Süleyman Cemil Oğlak

Öz

Bu çalışmanın amacı, ileri evre (evre IIIC ve IV) primer epitelyal over kanseri nedeni ile primer sitoredüktif cerrahi uygulanan hastalarda sistematik retroperitoneal lenf nodu diseksiyonunun sağkalıma olan etkisini incelemektir. 1 Ocak 2003 ile 31 Aralık 2012 tarihleri arasında İzmir Tepecik Eğitim ve Araştırma Hastanesi Jinekolojik Onkoloji Kliniği'nde ileri evre primer epitelyal over kanseri tanısıyla primer sitoredüktif cerrahi uygulanmış 326 hastanın dosyası retrospektif olarak incelendi. Çalışmaya alınma kriterlerine uygun olan 208 hasta, primer sitoredüktif cerrahi ile eş zamanlı retroperitoneal lenf nodu diseksiyonu yapılmayanlar ve yapılanlar olmak üzere iki gruba ayrıldı. Hastaların genel ve hastalıksız dönem sağkalım süreleri incelendi. Lenfadenektomi yapılan grupta genel sağkalım süresinin daha yüksek olduğu bulundu. Ancak her iki grup arasında hastalıksız dönem sağkalım süreleri açısından anlamlı bir farklılık yoktu. Sistematik lenfadenektominin ileri evre over kanserli hastaların sağkalımına etkisi halen net olarak belirlenememiştir. Çalışmaların çoğunluğunda optimal debulkinge retroperitoneal lenfadenektomi eklenmesinin genel sağkalım süresini arttırdığı görülmesine rağmen bu bulguların prospektif çalışmalarla desteklenmesi gerekmektedir.

Anahtar Kelimeler

Genel Sağkalım Süresi, İleri Evre Over Kanseri, Lenfadenektomi

The Effect of Lymph Node Dissection on Survival in Patients with Advanced Stage (Stage IIIC and IV) Ovarian Cancer

Öz

The aim of this study was to investigate the effect of systematic retroperitoneal lymph node dissection on survival in patients underwent primary cytoreductive surgery for advanced stage (stage IIIC and IV) primary epithelial ovarian cancer. The records of 326 patients who underwent primary cytoreductive surgery for advanced stage primary epithelial ovarian cancer between 01.01.2003 and 31.12.2012 in Gynecologic Oncology Clinic of Izmir Tepecik Training and Research Hospital were reviewed retrospectively. 208 patients, who met the inclusion criteria were divided into two groups as those performed with and without retroperitoneal lymph node dissection in addition to primary cytoreductive surgery. The overall survival and progression-free survival of the patients were evaluated. Overall survival was higher in the lymphadenectomy group. However, there was no significant difference between the two groups in terms of progression-free survival. The effect of systematic lymphadenectomy on survival of patients with advanced ovarian cancer remains unclear. Although the addition of retroperitoneal lymphadenectomy to the optimal debulking increases the overall survival in the majority of studies, these findings should be supported by prospective studies.

Anahtar Kelimeler

vanced Stage Ovarian Cancer, Lymphadenectomy, Overall Survival

Kaynakça

• 1. Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol. 2002;20(5):1248-59.
• 2. Harter P, du Bois A, Hahmann M, et al. Surgery in recurrent ovarian cancer: the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR trial. Ann Surg Oncol. 2006;13(12):1702-10.
• 3. di Re F, Baiocchi G, Fontanelli R, et al. Systematic pelvic and paraaortic lymphadenectomy for advanced ovarian cancer: prognostic significance of node metastases. Gynecol Oncol. 1996;62(3):362-5.
• 4. Morice P, Joulie F, Rey A, et al. Are nodal metastases in ovarian cancer chemoresistant lesions? Analysis of nodal involvement in 105 patients treated with preoperative chemotherapy. Eur J Gynaecol Oncol. 2004;25(2):169-74.
• 5. Eoh KJ, Yoon JW, Lee I, et al. The efficacy of systematic lymph node dissection in advanced epithelial ovarian cancer during interval debulking surgery performed after neoadjuvant chemotherapy. J Surg Oncol. 2017;116(3):329-36.
• 6. Ushijima K. Management of retroperitoneal lymph nodes in the treatment of ovarian cancer. Int J Clin Oncol. 2007;12(3):181-6.
• 7. Pereira A, Magrina JF, Rey V, Cortes M, Magtibay PM. Pelvic and aortic lymph node metastasis in epithelial ovarian cancer. Gynecol Oncol. 2007;105(3):604-8.
• 8. Panici PB, Maggioni A, Hacker N, et al. Systematic aortic and pelvic lymphadenectomy versus resection of bulky nodes only in optimally debulked advanced ovarian cancer: a randomized clinical trial. J Natl Cancer Inst. 2005;97(8):560-6.
• 9. Angioli R, Plotti F, Palaia I, et al. Update on lymphadenectomy in early and advanced ovarian cancer. Curr Opin Obstet Gynecol. 2008;20(1):34-9.
• 10. Morice P, Joulie F, Camatte S, et al. Lymph node involvement in epithelial ovarian cancer: analysis of 276 pelvic and paraaortic lymphadenectomies and surgical implications. J Am Coll Surg. 2003;197(2):198-205.
• 11. Wimberger P, Lehmann N, Kimmig R, Burges A, Meier W, Du BoisA. Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group Prognostic factors for complete debulking in advanced ovarian cancer, its impact on survival. An exploratory analysis of a prospectively randomized phase III study of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group (AGO-OVAR). Gynecol Oncol. 2007;106(1):69-74.
• 12. Abe A, Furumoto H, Irahara M, et al. The impact of systematic para-aortic and pelvic lymphadenectomy on survival in patients with optimally debulked ovarian cancer. J Obstet Gynaecol Res. 2010;36(5):1023-30.
• 13. du Bois A, Reuss A, Pujade-Lauraine E, Harter P, Ray-Coquard I, Pfisterer J. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d'Investigateurs Nationaux Pour les Etudes des Cancers de l'Ovaire (GINECO). Cancer. 2009;115(6):1234-44.
• 14. Saygili U, Guclu S, Uslu T, Erten O, Dogan E. The effect of ascites, mass volume, and peritoneal carcinomatosis on serum CA125 levels in patients with ovarian carcinoma. Int J Gynecol Cancer. 2002;12(5):438-42.
• 15. Aletti GD, Dowdy S, Podratz KC, Cliby WA. Role of lymphadenectomy in the management of grossly apparent advanced stage epithelial ovarian cancer. Am J Obstet Gynecol. 2006;195(6):1862-8.
• 16. Rouzier R, Bergzoll C, Brun JL, et al. The role of lymph node resection in ovarian cancer: analysis of the Surveillance, Epidemiology, and End Results (SEER) database. BJOG. 2010;117(12):1451-8.
• 17. Mahdi H, Thrall M, Kumar S, et al. The prognostic impact of the ratio of positive lymph nodes on survival of epithelial ovarian cancer patients. J Surg Oncol. 2011;103(7):724-9.
• 18. Kim HS, Ju W, Jee BC, et al. Systematic lymphadenectomy for survival in epithelial ovarian cancer: a meta-analysis. Int J Gynecol Cancer. 2010;20(4):520-8.
• 19. du Bois A, Reuss A, Harter P, Pujade-Lauraine E, Ray-Coquard I, Pfisterer J. Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom; Groupe d'Investigateurs Nationaux pour I'Etude des Cancers Ovariens. Potential role of lymphadenectomy in advanced ovarian cancer: a combined exploratory analysis of three prospectively randomized phase III multicenter trials. J Clin Oncol 2010;28(10):1733-9.
• 20. Bachmann C, Bachmann S, Fehm T, et al. Nodal status-its impact on prognosis in advanced ovarian cancer. J Cancer Res Clin Oncol. 2012;138(2):261-7.
• 21. Iwase H, Takada T, Iitsuka C, et al. Clinical significance of systematic retroperitoneal lymphadenectomy during interval debulking surgery in advanced ovarian cancer patients. J Gynecol Oncol. 2015;26(4):303-10.
• 22. Gu HF, Zhou Y, Li YX, Ou YL, Liu HJ. Prognostic significance of systematic retroperitoneal lymphadenectomy in patients with epithelial ovarian cancer: a Meta-analysis. Zhonghua Yi Xue Za Zhi. 2016;96(37):3020-5.