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Publications

Journal Article Ahead of print

PubMed: 42013623 DOI: 10.1016/j.ejso.2026.111768

Advanced high-grade serous ovarian cancer treated with intensive cytoreductive surgery and chemotherapy: prognostic impact of lymph node involvement: analysis of the French national ESME-Unicancer database.

Eur J Surg Oncol 52(6):111768

Authors: Sophie Le Bars, Catherine Guerin-Charbonnel, Elodie Martin, Quentin Dominique Thomas, Hélène Costaz, Christophe Pomel, Frédéric Marchal, Fabrice Narducci, Sébastien Gouy, Enora Laas, Léa Rossi, Eric Lambaudie, Roman Rouzier, Thierry Petit, Laurence Gladieff, Thibault De La Motte Rouge, Lise Bosquet, Pierre-Emmanuel Colombo, Jean-Marc Classe, Cécile Loaec

Affiliations

  • Institut de Cancérologie de L'Ouest, Saint Herblain, France.
  • Department of Medical Oncology, Institut Du Cancer de Montpellier, France.
  • Department of Surgical Oncology, Centre Georges François Leclerc, Dijon, France.
  • Department of Surgical Oncology, Centre de Lutte Contre le Cancer Jean Perrin, Clermont Ferrand, France.
  • Department of Surgical Oncology, Institut de Cancerologie de Lorraine, Université de Lorraine, CNRS, CRAN, UMR, 7039, Nancy, France.
  • Department of Surgical Oncology, Centre Oscar Lambret, Lille, France.
  • Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France.
  • Department of Surgical Oncology, Institut Curie, Paris, France.
  • Department of Surgical Oncology Centre Leon Berard, Lyon, France.
  • Department of Surgical Oncology, Institut Paoli Calmettes, Marseille, France.
  • Department of Surgical Oncology, Centre François Baclesse, Caen, France.
  • Department of Medical Oncology, Centre Paul Strauss, Strasbourg, France.
  • Department of Medical Oncology, Oncopole CLAUDIUS REGAUD - IUCT Oncopole, Toulouse, France.
  • Department of Medical Oncology, Centre Eugène Marquis, Rennes, France.
  • Data and Partnership Department, Unicancer, Paris, France.
  • Institut de Cancérologie de L'Ouest, Saint Herblain, France.

Abstract

INTRODUCTION

Benefits on survival of retroperitoneal lymph node (LN) dissection during cytoreductive surgery (CRS) for epithelial ovarian cancer are debated. However, LN involvement may be a prognostic factor especially in case of high-grade serous ovarian cancer (HGSOC).

MATERIALS AND METHODS

In the French Epidemiological Strategy and Medical Economics - Ovarian Cancer (ESME-OC) database, we identified patients treated for advanced-stage (FIGO III-IV) HGSOC with chemotherapy and intensive CRS including retroperitoneal LN dissection. Our first objective was to identify prognostic factors in case of maximalist treatment.

RESULTS

Of 13032 patients included, 485 with advanced HGSOC diagnosed between May 29, 2006 and December 16, 2019 were analyzed. Primary CRS was performed on 279 patients (57.5%). Of them, 70.3% had LN involvement. Surgery was performed after neo-adjuvant chemotherapy (NAC) in 206 patients (42.5%). Of them, 61.2% had LN involvement. LN involvement was considered major with a Lymph Node Ratio (LNR) ≥25% for 21.1% of patients who underwent primary CRS and 15.0% after NAC. In primary CRS, when adjusted to FIGO stage and BRCA1/2 deleterious mutation, LNR ≥25% vs none indicated a poorer prognosis for both overall survival (OS) (HR = 2.46 [1.25; 4.84], p = 0.009) and progression-free survival (PFS) (HR = 2.23 [1.40; 3.57], p < 0.001). After NAC, LNR ≥25% vs none was a negative prognostic factor with a stronger negative impact on PFS (HR = 2.00 [1.12; 3.57]; p = 0.018).

CONCLUSION

LN involvement is a negative prognostic factor in advanced-stage HGSOC especially in case of primary CRS. LN involvement could be a target for developing new therapies.

MeSH

Cytoreduction Surgical Procedures, Lymph Nodes, Ovary, Neoplasms, Drug Therapy, Lymph, Ovarian Neoplasms, Therapeutics, Dissection, Prognosis, Chemotherapy