Removal of Lymph Nodes Improves Progression-Free Survival

Removal of Lymph Nodes Improves Progression-Free Survival but Not Overall Survival in Advanced Ovarian Cancer

According to results recently published in the Journal of the National Cancer Institute, the removal of lymph nodes of the abdomen (aortic) and pelvis improves progression-free survival, but not overall survival at 5 years in patients with advanced ovarian cancer.

Ovarian cancer is a malignancy that arises from various different cells within the ovaries. Approximately 25,000 new cases of ovarian cancer are diagnosed in the United States each year. Patients with stages IIIB-C or stage IV ovarian cancer are considered to have advanced disease, as cancer has spread from the ovaries to distant sites in the body. Standard treatment for advanced ovarian cancer involves the surgical removal of as much cancer as possible if a patient is eligible for surgery, as well as chemotherapy and/or radiation therapy. The role of the removal of lymph nodes from the pelvis and abdomen in patients who are able to have surgery has remained controversial in patients with advanced ovarian cancer.

Researchers from Europe recently conducted a clinical trial to evaluate the effectiveness of the surgical removal of pelvic and aortic lymph nodes in patients with advanced ovarian cancer. This trial included 427 patients with stages IIIB-C or stage IV ovarian cancer. All patients underwent the surgical removal of their cancer as well as nearby lymph nodes that were enlarged (bulky) due to cancer. Approximately half of the patients had their pelvic and aortic lymph nodes removed, while the other half did not have them removed. At approximately 5 years, the risk of a death or a cancer recurrence was reduced by 25% in patients with the removal of pelvic/aortic lymph nodes. Progression-free survival was 31.2% for patients with lymph nodes removed, compared to 21.6% for those without lymph node removal. However, overall survival at 5 years was not significantly different between the two groups of patients (48.5% for those with lymph node removal and 47% for those without lymph node removal).

The researchers concluded that the surgical removal of pelvic and aortic lymph nodes appear to improve progression-free survival at 5 years in patients with advanced ovarian cancer; however, the removal of these lymph nodes did not improve overall survival in these patients. Patients with advanced ovarian cancer may wish to speak with their physician regarding their individual risks and benefits of the surgical removal of their pelvic or aortic lymph nodes.

Reference: Panici P, Maggioni A, Hacker N, et al. Systematic Aortic and Pelvic Lymphadenectomy Versus Resection of Bulky Nodes Only in Optimally Debulked Advanced Ovarian Cancer: A Randomized Clinical Trial. Journal of the National Cancer Institute. 2005; 97: 560-566.

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