1. What can we learn from the 10 mm lymph node size cut-off on the CT in advanced ovarian cancer at the time of interval debulking surgery?
- Author
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Benoit L, Zerbib J, Koual M, Nguyen-Xuan HT, Delanoy N, Le Frère-Belda MA, Bentivegna E, Bats AS, Fournier L, and Azaïs H
- Subjects
- Aged, Carcinoma, Ovarian Epithelial mortality, Carcinoma, Ovarian Epithelial surgery, Cytoreduction Surgical Procedures methods, Female, Humans, Lymph Node Excision methods, Lymph Nodes diagnostic imaging, Middle Aged, Ovarian Neoplasms mortality, Ovarian Neoplasms surgery, Predictive Value of Tests, Retrospective Studies, Tomography, X-Ray Computed, Carcinoma, Ovarian Epithelial pathology, Lymph Node Excision statistics & numerical data, Lymph Nodes pathology, Ovarian Neoplasms pathology
- Abstract
Introduction: The benefit of a systematic lymphadenectomy is still debated in patients undergoing neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) in ovarian cancer (OC). The objective of this study was to evaluate the predictive value of the pre-NACT and post-NACT CT in predicting definitive histological lymph node involvement. The prognostic value of a positive node on the CT was also assessed., Materiel and Methods: A retrospective, unicentric cohort study was performed including all patients with ovarian cancer who underwent NACT and IDS with a lymphadenectomy between 2005 and 2018. CT were analyzed blinded to pathology, and nodes with small axis ≥ 10 mm on CT were considered positive. Sensitivity (Se), specificity (Sp), and negative (NPV) and positive predictive values (PPV) and their CI95% were calculated. The 2-year recurrence free survival (RFS) and 5-year overall survival (OS) was compared., Results: 158 patients were included, among which 92 (58%) had histologically positive lymph nodes. CT had a Se, Sp, NPV and PPV of 35%, 82%, 47% and 73% before NACT and 20%, 97%, 47% and 91% after NACT, respectively. Patients with nodes considered positive had a non-significant lower 2-year RFS and 5-year OS on the pre-NACT and post-NACT CT. Patients at 'high risk' (nodes stayed positive on the CT or became positive after NACT) also had a non-significant lower 2-year RFS and 5-year OS., Conclusion: Presence of enlarged lymph nodes on CT is a weak indicator of lymph node involvement in patients with advanced ovarian cancer undergoing NACT. However, it could be used to assess prognosis., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Published
- 2021
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