Impact of Lymphadenectomy on Survival of Patients with Serous Advanced Ovarian Cancer After Neoadjuvant Chemotherapy: A French National Multicenter Study (FRANCOGYN)
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Group 1: Nonlymphadenectomy | Group 2: Lymphadenectomy | p-Value | |
---|---|---|---|
Number of patients | 100 | 155 | |
Age at diagnosis (years) | <0.0001 | ||
≤4/9 | 15 (20.3%) | 59 (79.7%) | <0001 |
50–69 | 43 (37.7%) | 71 (62.3%) | 0.009 |
≥70 | 42 (62.7%) | 25 (37.3%) | 0.04 |
Median (range) | 67.5 (31–83) | 59 (31–82) | |
BMI a (kg/m2) | 0.63 | ||
<25 | 38 (49.4%) | 70 (54.3%) | |
25–30 | 27 (35%) | 37 (28.7%) | |
>30 Missing | 12 (15.6%) 23 | 22 (17.1%) 26 | |
Geographic origin | 0.09 | ||
Caucasian | 74 (93.7%) | 74 (89.2%) | |
North Africa | 1 (1.3%) | 7 (8.4%) | |
Afro-Caribbean | 2 (2.5%) | 2 (2.4%) | |
Asia | 2 (2.5%) | 0 | |
South America | 0 | 0 | |
Missing | 21 | 72 | |
ASA b score | 0.03 | ||
0 | 0 | 2 (100%) | / |
1 | 15 (24.6%) | 46 (75.4%) | <0.0001 |
2 | 39 (45.9%) | 46 (54.1%) | 0.45 |
3 | 21 (47.7%) | 23 (52.3%) | 0.76 |
4 | 0 | 1 (100%) | / |
Missing | 25 | 37 | |
Charlson index | 0.003 | ||
0 | 11 (18.6%) | 48 (81.4%) | <0.0001 |
≥1 | 25 (44.6%) | 31 (55.4%) | 0.4 |
Missing | 64 | 76 | |
Gynecological-cancer history | 0.9 | ||
Personal | 3 (3%) | 5 (3%) | |
None | 97 (97%) | 150 (97%) | |
Genetic mutations | 0.19 | ||
No mutation | 2 (25%) | 7 (21.2%) | |
Known mutation | 2 (25%) | 19 (57.6%) | |
No research | 4 (50%) | 7 (21.2%) | |
Missing | 92 | 122 |
Group 1: Nonlymphadenectomy | Group 2: Lymphadenectomy | p-Value | |
---|---|---|---|
Number of patients | 100 | 155 | |
FIGO Stage | 0.4 | ||
III | 78 (78%) | 127 (81.9%) | 0.0008 |
IV | 22 (22%) | 28 (18.1%) | 0.47 |
Grade | 0.8 | ||
1–2 | 10 (17.9%) | 23 (19.3%) | |
3 | 46 (82.1%) | 96 (80.7%) | |
Missing | 44 | 36 | |
Preoperative CA125 (U/mL) | 0.36 | ||
≤1500 | 58 (65.2%) | 102 (70.8%) | |
>1500 | 31 (34.8%) | 42 (29.2%) | |
Missing | 11 | 11 | |
NAC a | |||
Number of cycles | 0.02 | ||
≤3 | 5 (5.1%) | 25 (16.7%) | |
4–6 | 74 (76.3%) | 107 (71.3%) | |
≥7 | 18 (18.6%) | 18 (12%) | |
Missing | 3 | 5 | |
Response to NAC | 0.08 | ||
Complete | 5 (27.8%) | 19 (52.8%) | 0.007 |
Partial | 13 (72.2%) | 17 (47.2%) | 0.58 |
Missing | 82 | 119 |
Group 1: Nonlymphadenectomy | Group 2: Lymphadenectomy | p-Value | |
---|---|---|---|
Number of patients | 100 | 155 | |
Interval bebulking surgery | 0.01 | ||
Laparoscopy | 15 (16.3%) | 51 (33.3%) | <0.0001 |
Laparoscopy with laparoconversion | 6 (6.5%) | 6 (4%) | 1 |
Laparotomy | 71 (77.2%) | 96 (62.7%) | 0.06 |
Missing | 8 | 2 | |
Operative time (min) | 242 (155–405) | 383 (170–660) | <0.0001 |
Number of transfused patients | 0.7 | ||
Yes | 9 (60%) | 16 (55.2%) | |
No | 6 (40%) | 13 (44.8%) | |
Missing | 85 | 126 | |
Number of transfused red-blood-cell units | 1.9 (0–6) | 2.2 (0–4) | 0.45 |
Postoperative residual disease (R) | <0.0001 | ||
0 | 50 (50%) | 137 (88.4%) | <0.0001 |
1 | 23 (23%) | 9 (5.8%) | 0.02 |
2 | 27 (27%) | 9 (5.8%) | 0.004 |
Intraoperative complications | 0.003 | ||
Yes | 6 (6.5%) | 28 (20.9%) | |
No | 86 (93.5%) | 106 (79.1%) | |
Missing | 8 | 21 | |
Postoperative complications | 0.01 | ||
Yes | 12 (12.8%) | 39 (26.7%) | |
No | 82 (87.2%) | 107 (73.3%) | |
Missing | 6 | 9 | |
Dindo–Clavien score | 0.15 | ||
0 | 81 (85.3%) | 107 (73.8%) | |
1–2 | 10 (10.5%) | 29 (20%) | |
3–4 | 4 (4.2%) | 9 (6.2%) | |
5 | 0 | 0 | |
Missing | 5 | 10 | |
Number of cycles of adjuvant chemotherapy | 6.5 (1–15) | 6.9 (2–31) | 0.2 |
Missing | 71 | 106 |
KERRYPNX | UnivariateAnalysis | MultivariateAnalysis * | ||||
---|---|---|---|---|---|---|
Variables | Hazard Ratio | 95% CI | p-Value | Hazard Ratio | 95% CI | p-Value |
Center | 0.4 | |||||
1 (ref) | 1 | |||||
2 | 1.6 | 0–123.3 | ||||
3 | 1 | 0–60.6 | ||||
4 | 0.1 | 0–1616.8 | ||||
5 | 1.5 | 0–107.8 | ||||
6 | 0 | 0 | ||||
7 | 1.8 | 0–115.6 | ||||
8 | 0.7 | 0–43 | ||||
9 | 0 | 0 | ||||
Lymphadenectomy: Number of removed lymph nodes | ||||||
0 (ref) | 1 | 1 | ||||
1–15 | 0.8 | 0.4–1.6 | 0.4 | 0.7 | 0.4–1.6 | 0.4 |
16–30 | 1.2 | 0.6–2.3 | 0.6 | 1.1 | 0.5–2.2 | 0.7 |
31–50 | 1.6 | 0.8–3.3 | 0.1 | 1.8 | 0.7–4.3 | 0.06 |
Age (years) ≤49 (ref) 50–69 ≥ 70 | ||||||
1 | ||||||
0.8 | 0.4–1.7 | 0.7 | ||||
0.8 | 0.4–1.8 | 0.7 | ||||
BMI a (kg/m2) <25 (ref) 25–30 >30 | ||||||
1 | ||||||
0.9 | 0.5–1.5 | 0.3 | ||||
1.5 | 0.7–3.3 | 0.2 | ||||
Charlson index | 0.4 | |||||
0 (ref) | 1 | |||||
≥1 | 1.3 | 0.7–2.5 | ||||
ASA | ||||||
0 (ref) | 1 | |||||
1 | 0.1 | 0–22.4 | 0.4 | |||
2 | 0.1 | 0–39.1 | 0.8 | |||
3 | 0.1 | 0–26.9 | 0.5 | |||
4 | 0 | 0 | 0 | |||
FIGO stage | ||||||
III (ref) | 1 | |||||
IV | 1.2 | 0.8–2 | 0.4 | |||
Grade | 0.8 | |||||
1–2 (ref) | 1 | |||||
3 | 0.9 | 0.4–1.9 | ||||
Preoperative CA125 (U/mL) | 0.07 | 0.01 | ||||
≤1500 | 1 | 1 | ||||
>1500 | 1.5 | 1–2.4 | 1.9 | 1.1–3.1 | ||
Number of cycles | ||||||
≤3 | 1 | |||||
4–6 | 0.9 | 0.4–2 | 0.3 | |||
≥7 | 1.3 | 0.5–3.4 | 0.3 | |||
NAC b response | ||||||
Complete (ref) | 1 | |||||
Partial | 1.5 | 0.5–4.5 | 0.4 | |||
Surgery debulking | ||||||
Laparoscopy (ref) | 1 | |||||
Laparoscopy with laparoconversion | 1.7 | 0.2–12.6 | 0.5 | |||
Laparotomy | 0.6 | 0.4–1.1 | 0.2 | |||
Postoperative residual disease | ||||||
R0 (ref) | 1 | 1 | ||||
R1 | 1.6 | 0.9–2.8 | 0.09 | 1.8 | 0.9–3.4 | 0.07 |
R2 | 1 | 0.6–1.6 | 0.3 | 1 | 0.6–1.9 | 0.4 |
Number of invaded lymph nodes | ||||||
0–5 (ref) | 1 | 1 | ||||
6–10 | 1.2 | 0.1–21.1 | 0.4 | 1.3 | 0.1–25 | 0.5 |
11–20 | 6.4 | 0.2–199 | 0.1 | 9.6 | 0.3–320.7 | 0.06 |
21–30 | 1.1 | 0–33.8 | 0.6 | 0.9 | 0–28.9 | 0.4 |
≥31 | 0 | / | / | 0 | / | / |
Univariate Analysis | Multivariate Analysis * | |||||
---|---|---|---|---|---|---|
Variables | Hazard Ratio | 95% CI | p-Value | Hazard Ratio | 95% CI | p-Value |
Center | 0.8 | |||||
1 (ref) | 1 | |||||
2 | 1.6 | 0.1–36.9 | ||||
3 | 0.6 | 0–11.2 | ||||
4 | 0.2 | 0–2282.7 | ||||
5 | 0.7 | 0–16.3 | ||||
6 | 0.5 | 0–14.1 | ||||
7 | 0.7 | 0–13.3 | ||||
8 | 0.7 | 0–13.5 | ||||
9 | 0 | 0 | ||||
Lymphadenectomy: Number of removed lymph nodes | ||||||
0 (ref) | 1 | 1 | ||||
1–15 | 1.2 | 0.7–2 | 0.2 | 0.2 | 0.06–0.7 | 0.01 |
16–30 | 0.9 | 0.6–1.4 | 0.7 | 0.2 | 0.05–0.8 | 0.03 |
31–50 | 0.6 | 0.4–1.1 | 0.1 | 0.03 | 0.04–0.2 | 0.0005 |
Age (years) | ||||||
≤49 (ref) | 1 | |||||
50–69 | 0.8 | 0.5–1.4 | 0.5 | |||
≥70 | 0.9 | 0.5–1.6 | 0.9 | |||
BMI a (kg/m2) | ||||||
<25 (ref) | 1 | |||||
25–30 | 1.2 | 0.8–1.8 | 0.4 | |||
>30 | 1 | 0.6–1.7 | 0.7 | |||
Charlson index | 0.3 | |||||
0 (ref) | 1 | |||||
≥1 | 0.8 | 0.5–1.2 | ||||
ASA | ||||||
0 (ref) | 1 | |||||
1 | 3.4 | 0–951.4 | 0.7 | |||
2 | 2.9 | 0–801.9 | 0.9 | |||
3 | 3.9 | 0–1103.6 | 0.7 | |||
4 | 0 | 0 | 0 | |||
FIGO stage | ||||||
III (ref) | 1 | |||||
IV | 1.1 | 0.8–1.7 | 0.5 | |||
Grade | 0.7 | |||||
1–2 (ref) | 1 | |||||
3 | 1.1 | 0.7–1.8 | ||||
Preoperative CA125 (U/mL) | 0.1 | 0.1 | ||||
≤1500 | 1 | 1 | ||||
>1500 | 1.3 | 0.9–1.8 | 2.8 | 0.8–9.9 | ||
Number of cycles | ||||||
≤3 | 1 | |||||
4–6 | 1.2 | 0.7–2.1 | 0.4 | |||
≥7 | 1.1 | 0.6–2 | 0.9 | |||
NAC response | 0.03 | 0.7 | ||||
Complete (ref) | 1 | 2 | ||||
Partial | 2.3 | 1.1–5 | 1.3 | 0.3–4.7 | ||
Surgery debulking | ||||||
Laparoscopy (ref) | 1 | 1 | ||||
Laparoscopy with laparoconversion | 2.4 | 0.9–6.4 | 0.07 | 154.8 | 5.4–441.1 | 0.003 |
Laparotomy | 1.1 | 0.7–1.6 | 0.2 | 1.4 | 0.4–4.6 | 0.5 |
Postoperative residual disease | ||||||
R0 (ref) | 1 | 1 | ||||
R1 | 1.7 | 1.05–2.8 | 0.1 | 0.8 | 0.2–4.4 | 0.8 |
R2 | 1.3 | 0.8–2.1 | 0.9 | 1.3 | 0.1–10.1 | 0.8 |
Number of invaded lymph nodes | ||||||
0–5 (ref) | 1 | |||||
6–10 | 0.9 | 0.5–1.7 | 0.4 | |||
11–20 | 1.5 | 0.5–4.6 | 0.7 | |||
21–30 | 1.9 | 0.4–7.6 | 0.5 | |||
≥31 | 1.0 | 0.1–7.4 | 0.8 |
Group 1: Nonlymphadenectomy | Group 2: Lymphadenectomy | p-Value | |
---|---|---|---|
Recurrence | |||
Pelvic | 0 | 0 | |
Intraperitoneal | 25 (44%) | 36 (61%) | 0.2 |
Retroperitoneal | 10 (15%) | 13 (22%) | 0.67 |
Remote metastasis | 23 (41%) | 20 (34%) | 0.76 |
Missing | 42 | 86 |
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Bund, V.; Lecointre, L.; Velten, M.; Ouldamer, L.; Bendifallah, S.; Koskas, M.; Bolze, P.-A.; Collinet, P.; Canlorbe, G.; Touboul, C.; et al. Impact of Lymphadenectomy on Survival of Patients with Serous Advanced Ovarian Cancer After Neoadjuvant Chemotherapy: A French National Multicenter Study (FRANCOGYN). J. Clin. Med. 2020, 9, 2427. https://doi.org/10.3390/jcm9082427
Bund V, Lecointre L, Velten M, Ouldamer L, Bendifallah S, Koskas M, Bolze P-A, Collinet P, Canlorbe G, Touboul C, et al. Impact of Lymphadenectomy on Survival of Patients with Serous Advanced Ovarian Cancer After Neoadjuvant Chemotherapy: A French National Multicenter Study (FRANCOGYN). Journal of Clinical Medicine. 2020; 9(8):2427. https://doi.org/10.3390/jcm9082427
Chicago/Turabian StyleBund, Virginie, Lise Lecointre, Michel Velten, Lobna Ouldamer, Sofiane Bendifallah, Martin Koskas, Pierre-Adrien Bolze, Pierre Collinet, Geoffroy Canlorbe, Cyril Touboul, and et al. 2020. "Impact of Lymphadenectomy on Survival of Patients with Serous Advanced Ovarian Cancer After Neoadjuvant Chemotherapy: A French National Multicenter Study (FRANCOGYN)" Journal of Clinical Medicine 9, no. 8: 2427. https://doi.org/10.3390/jcm9082427