title: Prognostic impact of lymphadenectomy in clinically early stage malignant germ cell tumour of the ovary.
abstract: BACKGROUND
  The aim of this study was to determine the impact of lymphadenectomy and nodal metastasis on survival in clinical stage I malignant ovarian germ cell tumour (OGCT).
  
  
  METHODS
  Data were obtained from the National Cancer Institute registry from 1988 to 2006. Analyses were performed using Student's t-test, Kaplan-Meier and Cox proportional hazard methods.
  
  
  RESULTS
  In all, 1083 patients with OGCT who have undergone surgical treatment and deemed at time of the surgery to have disease clinically confined to the ovary were included 590 (54.48%) had no lymphadenectomy (LND-1) and 493 (45.52%) had lymphadenectomy. Of the 493 patients who had lymphadenectomy, 441 (89.5%) were FIGO surgical stage I (LND+1) and 52 (10.5%) were upstaged to FIGO stage IIIC due to nodal metastasis (LND+3C). The 5-year survival was 96.9% for LND-1, 97.7% for LND+1 and 93.4% for LND+3C (P=0.5). On multivariate analysis, lymphadenectomy was not an independent predictor of survival when controlling for age, histology and race (HR: 1.26, 95% CI: 0.62-2.58, P=0.5). Moreover, the presence of lymph node metastasis had no significant effect on survival (HR: 2.7, 95% CI: 0.67-10.96, P=0.16).
  
  
  CONCLUSIONS
  Neither lymphadenectomy nor lymph node metastasis was an independent predictor of survival in patients with OGCT confined to the ovary. This probably reflects the highly chemosensitive nature of these tumours.
authors.affiliation: Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA 98195, USA.
authors.forename: H
authors.initials: H
authors.lastname: Mahdi
authors.forename: R E
authors.initials: RE
authors.lastname: Swensen
authors.forename: R
authors.initials: R
authors.lastname: Hanna
authors.forename: S
authors.initials: S
authors.lastname: Kumar
authors.forename: R
authors.initials: R
authors.lastname: Ali-Fehmi
authors.forename: A
authors.initials: A
authors.lastname: Semaan
authors.forename: H
authors.initials: H
authors.lastname: Tamimi
authors.forename: R T
authors.initials: RT
authors.lastname: Morris
authors.forename: A R
authors.initials: AR
authors.lastname: Munkarah
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015999:Multivariate Analysis; D054547:National Cancer Institute (U.S.); D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States