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Systematic Lymphadenectomy for Survival in Epithelial Ovarian Cancer: A Meta-Analysis

Kim, Hee Seung MD*; Ju, Woong MD, PhD†; Jee, Byung Chul MD, PhD‡; Kim, Yong Beom MD, PhD‡; Park, Noh Hyun MD, PhD*; Song, Yong Sang MD, PhD*; Kim, Seung Cheol MD, PhD†; Kang, Soon-Beom MD, PhD*; Kim, Jae Weon MD, PhD*

International Journal of Gynecological Cancer: May 2010 - Volume 20 - Issue 4 - pp 520-528
doi: 10.1111/IGC.0b013e3181d6de1d
Ovarian Cancer

Background: The role of systematic lymphadenectomy (SL) remains unclear for improving overall survival (OS) in epithelial ovarian cancer (EOC). To evaluate the role of SL in EOC, we performed a meta-analysis for comparing the efficacy for OS between SL and unsystematic lymphadenectomy (USL).

Methods: After the extensive literature search between January 1995 and December 2008, we analyzed 9 studies (2 randomized controlled trials [RCTs] and 7 observational studies) with 21,919 patients with EOC who underwent staging laparotomy including SL or USL.

Results: Although SL was a favorable factor for OS compared with USL (hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.68-0.76), the efficacy of SL on increased OS could not be determined in all-stage and early-stage EOC owing to the lack of RCTs and the deviation of weight by large-scale observational studies, whereas SL improved OS in advanced-stage EOC (HR, 0.70; 95% CI, 0.67-0.75). Moreover, SL increased OS in patients with all-stage disease who underwent optimal debulking surgery (HR, 0.84; 95% CI, 0.69-0.99), whereas it could not improve OS statistically in early-stage and advanced-stage diseases. However, SL showed increased OS with marginal significance in advanced-stage EOC patients treated with optimal debulking surgery (HR, 0.82; 95% CI, 0.66-1.02).

Conclusions: These findings suggest the possibility that SL can improve OS in advanced-stage EOC. However, the efficacy of SL on OS is still unknown because of the lack of RCTs, which requires more relevant studies for investigating the role of SL in EOC.

*Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul; †Department of Obstetrics and Gynecology, Ewha Woman's University College of Medicine, Seoul; and ‡Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoungnam, Korea.

Received November 26, 2009, and in revised form January 22, 2010.

Accepted for publication January 31, 2010.

Address correspondence and reprint requests to Jae Weon Kim, MD, PhD, Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 28 Yeongeon-Dong, Jongno-Gu, Seoul 110-744, Korea. E-mail: kjwksh@snu.ac.kr.

This research was supported by World Class University program through the Korea Science and Engineering Foundation funded by the Ministry of Education, Science, and Technology.

Yong Sang Song is a major in biomodulation, World Class University, Seoul National University, Seoul, Korea.

Copyright © 2010 by IGCS and ESGO