Surgical treatment of patients with lymph node involvement in recurrent ovarian cancer: immediate and long-term results

Abstract

Objective: analysis of the immediate and long-term results of surgical treatment of patients with lymph node (Ln) involvement in recurrent ovarian cancer (OC), as well as the search for prognostic factors for progression-free survival (PfS) and overall survival (OS).Materials and methods. The retrospective analysis included patients under the age of 75 who underwent surgery for recurrence of OC with Ln involvement at n.n. Blokhin national medical Research Center of Oncology in the period from 2005 to 2020. All patients had previously received combined treatment due to a primary diagnosis of OC. Exclusion criteria: the presence of concomitant pathology in the decompensation phase, primary multiple malignant tumors and recurrences of non-epithelial ovarian tumors. The analysis of the main operational characteristics, the frequency of postoperative complications according to Clavien–Dindo within 30 days after surgery, PfS, OS, as well as parameters affecting the long-term results of treatment were performed.Results. The study included 123 patients: a cohort of isolated lesions of the Ln (n = 65) and a group of combined recurrence in the Ln and other anatomical locations (n = 58). The frequency of complete cytoreduction was significantly higher in the group of patients with isolated recurrence in the Ln: 86.62 % versus 53.4 % in patients with combined relapse, p <0.0001. The median duration of the operation was also significantly higher in patients with combined recurrence: 245 min versus 180 min in a cohort of patients with isolated recurrence in the Ln, p <0.0001. Postoperative complications of grade III B were more often observed in the group of combined recurrence: 6.8 % versus 1.5 % in the group of isolated recurrence in the Ln, p = 0.148. none of the patients in the group of isolated recurrence in the Ln had postoperative mortality, while in the group of combined recurrence 2 (3.4 %) patients died after surgery from developed complications. In patients with isolated recurrence in the Ln and combined recurrence of OC, the median PfS was significantly higher when complete cytoreduction was achieved: 31.0 months and 18.0 months versus 10.0 months and 9.0 months with incomplete repeated cytoreduction, p <0.0001. In patients with isolated recurrence in the Ln and combined recurrence of OC, the median OS was identically significantly higher when complete repeated cytoreduction was achieved: 97.0 months and 60.0 months versus 34.0 months and 27.0 months with incomplete cytoreduction, p <0.0001.Conclusion. Surgical treatment of recurrence of OC is justified only if it is possible to achieve complete cytoreduction and platinum-sensitive type of recurrence of OC. Low grade tumor, platinum-sensitive type of recurrence, absence of marker recurrence of OC, isolated recurrence in Ln, complete repeated cytoreduction and lymphodissection were identified as predictors of PfS in multivariate analysis. The following factors had an independent favorable effect on OS in multivariate analysis: low tumor grade, platinum-sensitive type of recurrence, satisfactory overall status on the ECOg scale (0–1 points) at the time of detection of relapse, isolated recurrence in the Ln and complete repeated cytoreduction.

Keywords

• isolated recurrence in the lymph nodes
• repeated cytoreduction
• para-aortic lymph node dissection
• pelvic lymph node dissection
• platinum-sensitive recurrence
• platinum-resistant recurrence