The prognostic impact of the ratio of positive lymph nodes on survival of epithelial ovarian cancer patients.
OBJECTIVE
To study the prognostic significance of ratio of positive to examined lymph nodes (LNR) on survival of patients with node positive epithelial ovarian cancer (NPEOC).


METHODS
Data were obtained from Surveillance, Epidemiology, and End Results Program (SEER) from 1988 to 2006, and analyzed using Kaplan-Meier survival and Cox regression proportional hazard methods. Patients were divided into: stage IIIC group 1 (no macroscopic peritoneal disease), stage IIIC group 2 (macroscopic peritoneal disease), and stage IV.


RESULTS
A total of 6,310 women were included. The 5-year survival for stage IIIC groups 1, 2, and stage IV was 55.4%, 35.5%, and 20.3%, respectively (P < 0.001). Increasing LNR (<10%, 10-50%, and >50%) was associated with decreased survival from 51.5% to 38.1% to 27.0%, respectively, (P < 0.001). On multivariate analysis, LNR was an independent prognostic factor for survival after adjusting for extent of peritoneal disease, stage, grade, race, age, extent of lymphadenectomy and absolute number of positive nodes.


CONCLUSIONS
The impact of increasing LNR was strongly related to survival, especially in patients with no macroscopic peritoneal disease. Stratification of this subpopulation of node positive EOC based on nodal burden provides a significant prognostic value that may be considered in future staging and aid in management decisions.
Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA. mahdih@uw.edu
Haider
H
Mahdi
Melissa
M
Thrall
Sanjeev
S
Kumar
Rabbie
R
Hanna
Shelly
S
Seward
David
D
Lockhart
Robert T
RT
Morris
Ron
R
Swensen
Adnan R
AR
Munkarah
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015999:Multivariate Analysis; D009375:Neoplasms, Glandular and Epithelial / Q000401:mortality* / Q000473:pathology*; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000473:pathology*; D011379:Prognosis; D018426:SEER Program