Assessing the risk of pelvic and para-aortic nodal involvement in apparent early-stage ovarian cancer: A predictors- and nomogram-based analyses
•About 15% of early-stage ovarian cancer (EOC) are diagnosed with positive nodes.•High-grade serous and bilateral EOC are associated with occult nodal involvement.•Pelvic node involvement is more frequently detected in stage II ovarian cancer. To estimate the prevalence of lymph node involvement in...
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| Veröffentlicht in: | Gynecologic oncology 2017-10, Vol.147 (1), p.61-65 |
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| creator | Bogani, Giorgio Tagliabue, Elena Ditto, Antonino Signorelli, Mauro Martinelli, Fabio Casarin, Jvan Chiappa, Valentina Dondi, Giulia Leone Roberti Maggiore, Umberto Scaffa, Cono Borghi, Chiara Montanelli, Luca Lorusso, Domenica Raspagliesi, Francesco |
| description | •About 15% of early-stage ovarian cancer (EOC) are diagnosed with positive nodes.•High-grade serous and bilateral EOC are associated with occult nodal involvement.•Pelvic node involvement is more frequently detected in stage II ovarian cancer.
To estimate the prevalence of lymph node involvement in early-stage epithelial ovarian cancer in order to assess the prognostic value of lymph node dissection.
Data of consecutive patients undergoing staging for early-stage epithelial ovarian cancer were retrospectively evaluated. Logistic regression and a nomogram-based analysis were used to assess the risk of lymph node involvement.
Overall, 290 patients were included. All patients had lymph node dissection including pelvic and para-aortic lymphadenectomy. Forty-two (14.5%) patients were upstaged due to lymph node metastatic disease. Pelvic and para-aortic nodal metastases were observed in 22 (7.6%) and 42 (14.5%) patients. Lymph node involvement was observed in 18/95 (18.9%), 1/37 (2.7%), 4/29 (13.8%), 11/63 (17.4%), 3/41 (7.3%) and 5/24 (20.8%) patients with high-grade serous, low-grade-serous, endometrioid G1, endometrioid G2&3, clear cell and undifferentiated, histology, respectively (p=0.12, Chi-square test). We observed that high-grade serous histology was associated with an increased risk of pelvic node involvement; while, histology rather than low-grade serous and bilateral tumors were independently associated with para-aortic lymph node involvement (p |
| doi_str_mv | 10.1016/j.ygyno.2017.07.139 |
| format | Article |
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To estimate the prevalence of lymph node involvement in early-stage epithelial ovarian cancer in order to assess the prognostic value of lymph node dissection.
Data of consecutive patients undergoing staging for early-stage epithelial ovarian cancer were retrospectively evaluated. Logistic regression and a nomogram-based analysis were used to assess the risk of lymph node involvement.
Overall, 290 patients were included. All patients had lymph node dissection including pelvic and para-aortic lymphadenectomy. Forty-two (14.5%) patients were upstaged due to lymph node metastatic disease. Pelvic and para-aortic nodal metastases were observed in 22 (7.6%) and 42 (14.5%) patients. Lymph node involvement was observed in 18/95 (18.9%), 1/37 (2.7%), 4/29 (13.8%), 11/63 (17.4%), 3/41 (7.3%) and 5/24 (20.8%) patients with high-grade serous, low-grade-serous, endometrioid G1, endometrioid G2&3, clear cell and undifferentiated, histology, respectively (p=0.12, Chi-square test). We observed that high-grade serous histology was associated with an increased risk of pelvic node involvement; while, histology rather than low-grade serous and bilateral tumors were independently associated with para-aortic lymph node involvement (p<0.05). Nomograms displaying the risk of nodal involvement in the pelvic and para-aortic areas were built. High-grade serous histology and bilateral tumors are the main characteristics suggesting lymph node positivity.
Our data suggested that high-grade serous and bilateral early-stage epithelial ovarian cancer are at high risk of having disease harboring in the lymphatic tissues of both pelvic and para-aortic area. After receiving external validation, our data will help to identify patients deserving comprehensive retroperitoneal staging.</description><identifier>ISSN: 0090-8258</identifier><identifier>EISSN: 1095-6859</identifier><identifier>DOI: 10.1016/j.ygyno.2017.07.139</identifier><identifier>PMID: 28779965</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aged ; Carcinoma, Ovarian Epithelial ; Female ; Humans ; Logistic Models ; Lymph Nodes - pathology ; Lymphadenectomy ; Lymphatic Metastasis - pathology ; Middle Aged ; Neoplasm Staging - methods ; Neoplasms, Glandular and Epithelial - diagnosis ; Neoplasms, Glandular and Epithelial - epidemiology ; Neoplasms, Glandular and Epithelial - pathology ; Nodal involvement ; Nomogram ; Nomograms ; Ovarian cancer ; Ovarian Neoplasms - diagnosis ; Ovarian Neoplasms - epidemiology ; Ovarian Neoplasms - pathology ; Predictive Value of Tests ; Retrospective Studies ; Staging ; Young Adult</subject><ispartof>Gynecologic oncology, 2017-10, Vol.147 (1), p.61-65</ispartof><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c359t-4462f423791deecf3a172d77ef83d3e7a01f8fe020649a655a7b39cde1529e543</citedby><cites>FETCH-LOGICAL-c359t-4462f423791deecf3a172d77ef83d3e7a01f8fe020649a655a7b39cde1529e543</cites><orcidid>0000-0003-0981-0598 ; 0000-0002-8153-2599 ; 0000-0002-4863-1747</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ygyno.2017.07.139$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28779965$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bogani, Giorgio</creatorcontrib><creatorcontrib>Tagliabue, Elena</creatorcontrib><creatorcontrib>Ditto, Antonino</creatorcontrib><creatorcontrib>Signorelli, Mauro</creatorcontrib><creatorcontrib>Martinelli, Fabio</creatorcontrib><creatorcontrib>Casarin, Jvan</creatorcontrib><creatorcontrib>Chiappa, Valentina</creatorcontrib><creatorcontrib>Dondi, Giulia</creatorcontrib><creatorcontrib>Leone Roberti Maggiore, Umberto</creatorcontrib><creatorcontrib>Scaffa, Cono</creatorcontrib><creatorcontrib>Borghi, Chiara</creatorcontrib><creatorcontrib>Montanelli, Luca</creatorcontrib><creatorcontrib>Lorusso, Domenica</creatorcontrib><creatorcontrib>Raspagliesi, Francesco</creatorcontrib><title>Assessing the risk of pelvic and para-aortic nodal involvement in apparent early-stage ovarian cancer: A predictors- and nomogram-based analyses</title><title>Gynecologic oncology</title><addtitle>Gynecol Oncol</addtitle><description>•About 15% of early-stage ovarian cancer (EOC) are diagnosed with positive nodes.•High-grade serous and bilateral EOC are associated with occult nodal involvement.•Pelvic node involvement is more frequently detected in stage II ovarian cancer.
To estimate the prevalence of lymph node involvement in early-stage epithelial ovarian cancer in order to assess the prognostic value of lymph node dissection.
Data of consecutive patients undergoing staging for early-stage epithelial ovarian cancer were retrospectively evaluated. Logistic regression and a nomogram-based analysis were used to assess the risk of lymph node involvement.
Overall, 290 patients were included. All patients had lymph node dissection including pelvic and para-aortic lymphadenectomy. Forty-two (14.5%) patients were upstaged due to lymph node metastatic disease. Pelvic and para-aortic nodal metastases were observed in 22 (7.6%) and 42 (14.5%) patients. Lymph node involvement was observed in 18/95 (18.9%), 1/37 (2.7%), 4/29 (13.8%), 11/63 (17.4%), 3/41 (7.3%) and 5/24 (20.8%) patients with high-grade serous, low-grade-serous, endometrioid G1, endometrioid G2&3, clear cell and undifferentiated, histology, respectively (p=0.12, Chi-square test). We observed that high-grade serous histology was associated with an increased risk of pelvic node involvement; while, histology rather than low-grade serous and bilateral tumors were independently associated with para-aortic lymph node involvement (p<0.05). Nomograms displaying the risk of nodal involvement in the pelvic and para-aortic areas were built. High-grade serous histology and bilateral tumors are the main characteristics suggesting lymph node positivity.
Our data suggested that high-grade serous and bilateral early-stage epithelial ovarian cancer are at high risk of having disease harboring in the lymphatic tissues of both pelvic and para-aortic area. After receiving external validation, our data will help to identify patients deserving comprehensive retroperitoneal staging.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Carcinoma, Ovarian Epithelial</subject><subject>Female</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Lymph Nodes - pathology</subject><subject>Lymphadenectomy</subject><subject>Lymphatic Metastasis - pathology</subject><subject>Middle Aged</subject><subject>Neoplasm Staging - methods</subject><subject>Neoplasms, Glandular and Epithelial - diagnosis</subject><subject>Neoplasms, Glandular and Epithelial - epidemiology</subject><subject>Neoplasms, Glandular and Epithelial - pathology</subject><subject>Nodal involvement</subject><subject>Nomogram</subject><subject>Nomograms</subject><subject>Ovarian cancer</subject><subject>Ovarian Neoplasms - diagnosis</subject><subject>Ovarian Neoplasms - epidemiology</subject><subject>Ovarian Neoplasms - pathology</subject><subject>Predictive Value of Tests</subject><subject>Retrospective Studies</subject><subject>Staging</subject><subject>Young Adult</subject><issn>0090-8258</issn><issn>1095-6859</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kctu1DAUhi0EokPhCZCQl2wy-BLHMRKLUQW0UiU2sLbO2CeDhyQOdiZS3oJHrqdTWLI6F33n-hPylrMtZ7z5cNyuh3WMW8G43jK95dI8IxvOjKqaVpnnZMOYYVUrVHtFXuV8ZIxJxsVLciVarY1p1Ib82eWMOYfxQOefSFPIv2js6IT9EhyF0dMJElQQ01ziMXroaRiX2C844DgXn8JUkLOPkPq1yjMckMYFUoCROhgdpo90R6eEPrg5plw99h3jEA8JhmoPGX1JQb-WVV6TFx30Gd882Wvy48vn7ze31f23r3c3u_vKSWXmqq4b0dVCasM9ouskcC281ti10kvUwHjXdsgEa2oDjVKg99I4j1wJg6qW1-T9pe-U4u8T5tkOITvsexgxnrLlRjSmZUqpgsoL6lLMOWFnpxQGSKvlzJ6lsEf7KIU9S2GZtkWKUvXuacBpP6D_V_P39wX4dAGwnLkETDa7gOVdPiR0s_Ux_HfAA9eXnkg</recordid><startdate>201710</startdate><enddate>201710</enddate><creator>Bogani, Giorgio</creator><creator>Tagliabue, Elena</creator><creator>Ditto, Antonino</creator><creator>Signorelli, Mauro</creator><creator>Martinelli, Fabio</creator><creator>Casarin, Jvan</creator><creator>Chiappa, Valentina</creator><creator>Dondi, Giulia</creator><creator>Leone Roberti Maggiore, Umberto</creator><creator>Scaffa, Cono</creator><creator>Borghi, Chiara</creator><creator>Montanelli, Luca</creator><creator>Lorusso, Domenica</creator><creator>Raspagliesi, Francesco</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0981-0598</orcidid><orcidid>https://orcid.org/0000-0002-8153-2599</orcidid><orcidid>https://orcid.org/0000-0002-4863-1747</orcidid></search><sort><creationdate>201710</creationdate><title>Assessing the risk of pelvic and para-aortic nodal involvement in apparent early-stage ovarian cancer: A predictors- and nomogram-based analyses</title><author>Bogani, Giorgio ; Tagliabue, Elena ; Ditto, Antonino ; Signorelli, Mauro ; Martinelli, Fabio ; Casarin, Jvan ; Chiappa, Valentina ; Dondi, Giulia ; Leone Roberti Maggiore, Umberto ; Scaffa, Cono ; Borghi, Chiara ; Montanelli, Luca ; Lorusso, Domenica ; Raspagliesi, Francesco</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c359t-4462f423791deecf3a172d77ef83d3e7a01f8fe020649a655a7b39cde1529e543</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Carcinoma, Ovarian Epithelial</topic><topic>Female</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Lymph Nodes - pathology</topic><topic>Lymphadenectomy</topic><topic>Lymphatic Metastasis - pathology</topic><topic>Middle Aged</topic><topic>Neoplasm Staging - methods</topic><topic>Neoplasms, Glandular and Epithelial - diagnosis</topic><topic>Neoplasms, Glandular and Epithelial - epidemiology</topic><topic>Neoplasms, Glandular and Epithelial - pathology</topic><topic>Nodal involvement</topic><topic>Nomogram</topic><topic>Nomograms</topic><topic>Ovarian cancer</topic><topic>Ovarian Neoplasms - diagnosis</topic><topic>Ovarian Neoplasms - epidemiology</topic><topic>Ovarian Neoplasms - pathology</topic><topic>Predictive Value of Tests</topic><topic>Retrospective Studies</topic><topic>Staging</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bogani, Giorgio</creatorcontrib><creatorcontrib>Tagliabue, Elena</creatorcontrib><creatorcontrib>Ditto, Antonino</creatorcontrib><creatorcontrib>Signorelli, Mauro</creatorcontrib><creatorcontrib>Martinelli, Fabio</creatorcontrib><creatorcontrib>Casarin, Jvan</creatorcontrib><creatorcontrib>Chiappa, Valentina</creatorcontrib><creatorcontrib>Dondi, Giulia</creatorcontrib><creatorcontrib>Leone Roberti Maggiore, Umberto</creatorcontrib><creatorcontrib>Scaffa, Cono</creatorcontrib><creatorcontrib>Borghi, Chiara</creatorcontrib><creatorcontrib>Montanelli, Luca</creatorcontrib><creatorcontrib>Lorusso, Domenica</creatorcontrib><creatorcontrib>Raspagliesi, Francesco</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Gynecologic oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bogani, Giorgio</au><au>Tagliabue, Elena</au><au>Ditto, Antonino</au><au>Signorelli, Mauro</au><au>Martinelli, Fabio</au><au>Casarin, Jvan</au><au>Chiappa, Valentina</au><au>Dondi, Giulia</au><au>Leone Roberti Maggiore, Umberto</au><au>Scaffa, Cono</au><au>Borghi, Chiara</au><au>Montanelli, Luca</au><au>Lorusso, Domenica</au><au>Raspagliesi, Francesco</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessing the risk of pelvic and para-aortic nodal involvement in apparent early-stage ovarian cancer: A predictors- and nomogram-based analyses</atitle><jtitle>Gynecologic oncology</jtitle><addtitle>Gynecol Oncol</addtitle><date>2017-10</date><risdate>2017</risdate><volume>147</volume><issue>1</issue><spage>61</spage><epage>65</epage><pages>61-65</pages><issn>0090-8258</issn><eissn>1095-6859</eissn><abstract>•About 15% of early-stage ovarian cancer (EOC) are diagnosed with positive nodes.•High-grade serous and bilateral EOC are associated with occult nodal involvement.•Pelvic node involvement is more frequently detected in stage II ovarian cancer.
To estimate the prevalence of lymph node involvement in early-stage epithelial ovarian cancer in order to assess the prognostic value of lymph node dissection.
Data of consecutive patients undergoing staging for early-stage epithelial ovarian cancer were retrospectively evaluated. Logistic regression and a nomogram-based analysis were used to assess the risk of lymph node involvement.
Overall, 290 patients were included. All patients had lymph node dissection including pelvic and para-aortic lymphadenectomy. Forty-two (14.5%) patients were upstaged due to lymph node metastatic disease. Pelvic and para-aortic nodal metastases were observed in 22 (7.6%) and 42 (14.5%) patients. Lymph node involvement was observed in 18/95 (18.9%), 1/37 (2.7%), 4/29 (13.8%), 11/63 (17.4%), 3/41 (7.3%) and 5/24 (20.8%) patients with high-grade serous, low-grade-serous, endometrioid G1, endometrioid G2&3, clear cell and undifferentiated, histology, respectively (p=0.12, Chi-square test). We observed that high-grade serous histology was associated with an increased risk of pelvic node involvement; while, histology rather than low-grade serous and bilateral tumors were independently associated with para-aortic lymph node involvement (p<0.05). Nomograms displaying the risk of nodal involvement in the pelvic and para-aortic areas were built. High-grade serous histology and bilateral tumors are the main characteristics suggesting lymph node positivity.
Our data suggested that high-grade serous and bilateral early-stage epithelial ovarian cancer are at high risk of having disease harboring in the lymphatic tissues of both pelvic and para-aortic area. After receiving external validation, our data will help to identify patients deserving comprehensive retroperitoneal staging.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28779965</pmid><doi>10.1016/j.ygyno.2017.07.139</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0003-0981-0598</orcidid><orcidid>https://orcid.org/0000-0002-8153-2599</orcidid><orcidid>https://orcid.org/0000-0002-4863-1747</orcidid></addata></record> |
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| subjects | Adolescent Adult Aged Carcinoma, Ovarian Epithelial Female Humans Logistic Models Lymph Nodes - pathology Lymphadenectomy Lymphatic Metastasis - pathology Middle Aged Neoplasm Staging - methods Neoplasms, Glandular and Epithelial - diagnosis Neoplasms, Glandular and Epithelial - epidemiology Neoplasms, Glandular and Epithelial - pathology Nodal involvement Nomogram Nomograms Ovarian cancer Ovarian Neoplasms - diagnosis Ovarian Neoplasms - epidemiology Ovarian Neoplasms - pathology Predictive Value of Tests Retrospective Studies Staging Young Adult |
| title | Assessing the risk of pelvic and para-aortic nodal involvement in apparent early-stage ovarian cancer: A predictors- and nomogram-based analyses |
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