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  3. Incidence and impact of low-volume lymph node metastasis in apparent early-stage ovarian cancer: MICR-OVARY study

Incidence and impact of low-volume lymph node metastasis in apparent early-stage ovarian cancer: MICR-OVARY study

Fecha de publicación:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Bizzarri N.
  • Agusti N.
  • Uccella S.
  • Buda A.
  • Torrent A.
  • Perrone A.M.
  • Calderaro-Di Ruggiero F.
  • Sadeghi R.
  • Taskiran C.
  • Lambrechts S.
  • Cosentino F.
  • Vizzielli G.
  • Giannarelli D.
  • Di Berardino S.
  • Nero C.
  • Díaz-Feijoo B.
  • Fagotti A.

Grupos

Abstract

Objective: Sentinel lymph node (SLN) biopsy is an emerging technique in apparent early-stage ovarian cancer, with the potential to detect low-volume lymph node metastases. However, the prognostic value of low-volume metastases is still unknown. This study aimed to assess the incidence and the prognosis of low-volume metastases detected in patients with apparent early-stage ovarian cancer undergoing SLN biopsy as part of a clinical trial. Methods: Retrospective, multi-center, international study. Inclusion criteria were apparent International Federation of Gynecology and Obstetrics 2014 stage I to II epithelial ovarian cancer, undergoing SLN biopsy with systematic bilateral pelvic and para-aortic lymphadenectomy, and complete peritoneal surgical staging, from October 2012 to December 2023. In the absence of lymph-node macro-metastasis, at least 4-level ultra-staging at the SLN was performed. Fertility-sparing surgery or no SLN detection were exclusion criteria. Low-volume metastases were defined as any tumor deposit =2 mm (isolated tumor cells as <0.2mm, micro-metastasis as 0.2-2 mm). Descriptive statistics and survival analyses, including multi-variable Cox regression, were performed. Results: SLN mapping was attempted in 260 patients. At least 1 SLN was detected in 199 (76.5%) patients, and low-volume metastases were found in 14/199 (7.0%), including 7 (3.5%) isolated tumor cells and 7 (3.5%) micro-metastases. Macro-metastases were identified in 18/199 (9.0%) patients. Among patients with lymph node metastases, 29/32 (90.6%) received adjuvant chemotherapy, including 11/14 (78.6%) with low-volume metastases. Median follow-up was 37 months (95% confidence interval [CI] 34.5 to 39.5). Three-year disease-free survival was 89.9% in node-negative patients, 100.0% in patients with low-volume metastasis, and 64.2% in patients with macro-metastasis (p < .001). Three-year overall survival was 98.2%, 100.0%, and 87.8%, respectively (p < .001). Lymph node macro-metastasis was the only factor independently associated with worse disease-free survival (hazard ratio 1.532, 95% CI 1.111 to 2.112, p = .009) and overall survival (hazard ratio 1.894, 95% CI 1.091 to 3.286, p = .001). Conclusions: Lymph node low-volume metastases in apparent early-stage ovarian cancer were present in 7% of patients, and none of these patients experienced recurrence or death. Lymph node macro-metastasis independently impaired disease-free and overall survival. © 2026 The Authors. Published by Elsevier Inc. on behalf of European Society of Gynaecological Oncology and the International Gynecologic Cancer Society. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/

Datos de la publicación

ISSN/ISSNe:
1048-891X, 1525-1438

INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER  ELSEVIER

Tipo:
Article
Páginas:
-
PubMed:
41968027
Enlace a otro recurso:
www.scopus.com
Factor de Impacto:
0,854 SCImago ℠
Cuartil:
Q1 SCImago ℠

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Keywords

  • Incidence; Isolated Tumor Cells; Ovarian Cancer; Sentinel Lymph Node Micro-Metastasis; Survival

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