Influence of lymph node involvement or lymphadenectomy on prognosis of patients with borderline ovarian tumors: A systematic review and meta-analysis

Borderline ovarian tumors (BOTs) account for about 15% of all epithelial tumors of the ovary, and around 75% of patients are diagnosed in early stages. Although many of these patients have lymph node involvement (LNI), whether LNI decreases their survival is controversial, raising the question of wh...

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Bibliographic Details
Published in:Gynecologic oncology 2021-09, Vol.162 (3), p.797-803
Main Authors: Fan, Yu, Zhang, Yu-fei, Wang, Meng-yao, Mu, Yi, Mo, Si-ping, Li, Jin-ke
Format: Article
Language:English
Subjects:
Carcinoma, Ovarian Epithelial - mortality
Carcinoma, Ovarian Epithelial - surgery
Female
Humans
Lymph Node Excision - adverse effects
Lymphatic Metastasis
Ovarian Neoplasms - mortality
Ovarian Neoplasms - surgery
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Summary:Borderline ovarian tumors (BOTs) account for about 15% of all epithelial tumors of the ovary, and around 75% of patients are diagnosed in early stages. Although many of these patients have lymph node involvement (LNI), whether LNI decreases their survival is controversial, raising the question of whether lymphadenectomy should be performed. We conducted a systematic review and meta-analysis of these questions. We searched articles related to LNI and lymphadenectomy in patients with BOTs in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. Data on rate of LNI, recurrence and survival were pooled and meta-analyzed using a random-effects model. Heterogeneity was evaluated using the I2 test. A total of 25 studies with 12,503 patients were meta-analyzed. The overall pooled rate of LNI was 10% [95% confidence interval (CI) 0.07–0.13]. LNI was associated with a higher risk of recurrence [odds ratio (OR) 2.23, 95% CI 1.13–4.40]. However, LNI did not significantly affect cause-specific survival [hazard ratio (HR) 1.73, 95% CI 0.99–3.02] or disease-free survival (HR 1.48, 95% CI 0.56–3.92). Similarly, lymphadenectomy did not significantly affect risk of recurrence (OR 0.91, 95% CI 0.57–1.46), overall survival (HR 0.90, 95% CI 0.58–1.40), disease-free survival (HR 0.95, 95% CI 0.61–1.50) or progression-free survival (HR 0.60, 95% CI 0.24–1.49). LNI appears to increase risk of recurrence in BOT patients, but neither it nor lymphadenectomy appears to influence prognosis. Therefore, lymphadenectomy should be considered only for certain BOT patients, such as those with suspected LNI based on imaging or surgical exploration. •Lymph node involvement is related to higher risk of recurrence in patients with borderline ovarian tumors.•Neither lymph node involvement nor lymphadenectomy influences survival in patients with borderline ovarian tumors.•Lymphadenectomy should be performed only for certain patients with borderline ovarian tumors.
ISSN:0090-8258
1095-6859
DOI:10.1016/j.ygyno.2021.05.033