The impact of lymphadenectomy on survival outcomes of ovarian clear cell
carcinoma: a systematic review and meta-analysis
Abstract
Background: The treatment strategies for ovarian clear cell carcinoma
(OCCC) are the same as those for epithelial ovarian cancer. Due to the
rarity of OCCC, no prospective studies of its surgery have been
reported. Therefore, the therapeutic significance of lymphadenectomy for
OCCC needs to be further clarified. Objectives: To assess the
effectiveness of lymphadenectomy in patients with ovarian clear cell
carcinoma by a meta-analysis. Search Strategy: The Web of Science,
Scopus, PubMed, and other sources (e.g. Google Scholar) were searched
from each database’s earliest inception to June 2021. Selection
Criteria: English-language publications of observational studies that
investigated the role of lymphadenectomy in patients with OCCC were
included. Data Collection and Analysis: The pooled hazard ratio (HR) and
95% confidence interval (CI) were calculated. Main Results: The
analysis demonstrated that lymphadenectomy is associated with
significantly improved disease-specific survival (DSS) (HR=0.76;
95%CI=0.60-0.95; P=0.02; I2= 0.0%) and disease-free survival (DFS)
(HR=0.58; 95%CI=0.33-1.00; P=0.05; I2=61%), but not for overall
survival (OS) (HR=0.80; 95%CI=0.60-1.06; P=0.12; I2= 19%) and
progression-free survival (PFS) (HR=0.95; 95%CI=0.64-1.42; P=0.79; I2=
0.0%). But it is worth noting that several single studies indicated a
tendency of improved OS, PFS, DFS, DSS with lymphadenectomy.
Conclusions: Lymphadenectomy could not significantly improve OS and PFS
for OCCC, but is associated with improved DFS and DSS. Gynecologic
oncologists should tailor treatment to patients to achieve optimal
outcomes. And further studies are necessary to validate the impact of
lymphadenectomy on OCCC. Keywords: ovarian clear cell carcinoma,
lymphadenectomy, survival, systematic review, meta- analysis