title: Role of Pelvic and Para-aortic Lymph Node Metastases in Optimally Cytoreduced Advanced Ovarian Cancer.
abstract: OBJECTIVE
  To delineate the role of pelvic and para-aortic node involvement in patients with optimally cytoreduced (R≤1 cm; R=residual tumor) stage IIIC ovarian cancer.
  
  
  METHODS
  Ninety-five consecutive optimally cytoreduced patients with primary stage IIIc ovarian cancer underwent stage-related surgery and adjuvant platinum-based chemotherapy, with a median follow-up of 53.5 months. All patients underwent systematic lymphadenectomy. On average, 24.7 pelvic and para-aortic lymph nodes were removed per patient (range=1-60 nodes); Patients were stratified into three groups to evaluate nodal involvement (ratio of affected to resected nodes): 0: no lymph node metastases; >0-0.5: >0 and fewer than 50% of involved nodes; >0.5-1: more than 50% of nodes involved. Clinical parameters were retrospectively evaluated.
  
  
  RESULTS
  Most often, serous histology, histological grade 3 and a node ratio >0-≤0.5 (61.1%) were detected. Complete cytoreduction (R=0 mm) had significant best prognostic impact compared to R>0 mm-1 cm (overall survival: p=0.047, progression-free survival: p<0.001). Nodal involvement was associated with serous histology and grade 3 tumor. Best overall survival was associated with a node ratio >0-≤0.5 (p=0.011). A solitary affection of the pelvic or rather para-aortic nodes was detected in 22.1% vs. 16.%, respectively; a combined affection of pelvic and paraaortic nodes were detected in 34.8%.
  
  
  CONCLUSIONS
  The goal is optimal cytoreduction in advanced ovarian cancer. More extensive pelvic and para-aortic lymphadenectomy seems to play an important role in providing accurate staging in optimally-cytoreduced advanced ovarian cancer and the node ratio might give prognostic information. Current prospective studies should investigate if these data have therapeutic implications and may be considered in future staging.
authors.affiliation: Department of Gynecology, University of Tübingen, Tübingen, Germany cornelia.bachmann@med.uni-tuebingen.de.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Bachmann
authors.affiliation: Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Bachmann
authors.affiliation: Department of Gynecology, University of Tübingen, Tübingen, Germany.
authors.forename: Sara Y
authors.initials: SY
authors.lastname: Brucker
authors.affiliation: Department of Pathology, University of Tübingen, Tübingen, Germany.
authors.forename: Anette
authors.initials: A
authors.lastname: Staebler
authors.affiliation: Department of Pathology, University of Tübingen, Tübingen, Germany.
authors.forename: Falko
authors.initials: F
authors.lastname: Fend
authors.affiliation: Department of Gynecology, University of Tübingen, Tübingen, Germany.
authors.forename: Eva-Maria
authors.initials: EM
authors.lastname: Grischke
authors.affiliation: Department of Gynecology, University of Tübingen, Tübingen, Germany.
authors.forename: Diethelm
authors.initials: D
authors.lastname: Wallwiener
keywords: Advanced ovarian cancer; lymphadenectomy; node metastases; node ratio; prognosis; residual tumor