Staging Lymphadenectomy in Patients With Clear Cell Carcinoma of the Ovary.
OBJECTIVE
The purpose of this study was to assess the rate of lymph node (LN) metastasis in comprehensively staged ovarian clear cell carcinoma (OCCC) clinically confined to the ovary and determine factors associated with LN metastasis.


METHODS
We identified all cases of OCCC treated at 4 institutions from January 1994 through December 2011. We included cases with disease grossly confined to the ovary that had surgical staging performed, including at least 10 LNs sampled. Clinical and pathologic data were abstracted from electronic medical records, and a deidentified data set was compiled and processed at a single institution. Factors potentially associated with LN metastasis were tested. Appropriate statistical tests were performed.


RESULTS
We identified 145 eligible cases that met the criteria for this analysis. Median age was 52.9 years (range, 30-81 years), and median total LN count was 19 (range, 10-74). Seven (4.8%) of 145 comprehensively staged cases had LN metastasis; 6 of these cases (4.1%) were isolated metastasis. Cytologic washings, peritoneal, omental, and fallopian tube involvement were not associated with nodal metastasis. Cases with ovarian surface involvement and positive cytology had a 37.5% incidence of LN positivity, which was statistically meaningful when compared with all other cases (P = 0.003).


CONCLUSIONS
Women who underwent comprehensive staging for clinical stage I OCCC had an LN metastasis rate of 4.8%. The subgroup of cases with both ovarian surface involvement and positive cytology had the highest incidence of LN metastasis. This may influence clinical decision making on whether to perform lymphadenectomy in patients with incidental OCCC found after salpingo-oophorectomy.
*Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; †Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cedars-Sinai Medical Center, Los Angeles, CA; ‡University of Oklahoma Health Sciences Center, Oklahoma City, OK; §Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL; ∥Department of Obstetrics and Gynecology, Weill Cornell Medical Center, New York, NY; ¶Department of Medicine, Weill Cornell Medical Center, New York, NY; #Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY; and **Department of Pathology and Laboratory Medicine, Weill Cornell Medical Center, New York, NY.
Jennifer J
JJ
Mueller
Marie
M
Holzapfel
Chan H
CH
Han
Kevin
K
Santos
Camille
C
Gunderson
Kathleen
K
Moore
Britt
B
Erickson
Charles A
CA
Leath
Elena
E
Diaz
Christine
C
Walsh
Stephanie L
SL
Wethington
Sheila Z
SZ
Dejbakhsh
Richard R
RR
Barakat
Ginger J
GJ
Gardner
David M
DM
Hyman
Robert A
RA
Soslow
Mario M
MM
Leitao
D018262:Adenocarcinoma, Clear Cell / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077216:Carcinoma, Ovarian Epithelial; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000601:surgery*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D010052:Ovariectomy; D011379:Prognosis; D012189:Retrospective Studies