Prognostic value of systematic lymphadenectomy in patients with ovarian
cancer: A systematic review and meta-analysis
Abstract
Background: Standard management of ovarian cancer is surgical debulking
and adjuvant chemotherapy. The role of systematic lymphadenectomy, as a
part of debulking, has been controversial. Objective: To assess
prognostic value of systematic lymphadenectomy in women with ovarian
cancer based on stage, control group and type of chemotherapy Search
strategy: A literature search was conducted on SCOPUS, PUBMED, COCHRANE,
MEDLINE, and WEB OF SCIENCE databases. Selection criteria: All
comparative studies that assess outcomes of systematic lymphadenectomy
in patients with ovarian cancer were eligible. Data Collection and
Analysis: overall survival was analyzed by pooling log hazard ratio (HR)
and standard error of multivariable Cox regression models. MOGGE
Meta-analysis Matrix is a novel illustration tool that was used to
demonstrate multiple subgroup analyses of included studies. Main
results: Twenty-two studies were eligible. Systematic lymphadenectomy
was associated with better overall survival, that was close to
significance, compared to control group (HR 0.93, 95%CI 0.86-1.00).
Among women treated with adjuvant chemotherapy, overall survival
improved in women with stage IIB-IV who underwent systematic
lymphadenectomy (HR 0.91, 95%CI 0.84-0.99) and was most significant
among patients with III to IV (HR 0.85, 95%CI 0.73-0.99). Systematic
lymphadenectomy did not improve survival in women who received
neoadjuvant chemotherapy (HR 0.97, 95%CI 0.73-1.29). Systematic
lymphadenectomy was associated with improved progress-free survival
compared to control group (HR 0.88, 95%CI 0.79-0.99). Conclusion: Data
from clinical trials do not support role of systematic lymphadenectomy
in advanced ovarian cancer. However, further studies may be warranted to
assess substage-specific survival outcomes in women with advanced
stages.