Research Article

The prognostic impact of the ratio of positive lymph nodes on survival of epithelial ovarian cancer patients

  1. Haider Mahdi MD1,*,
  2. Melissa Thrall MD1,
  3. Sanjeev Kumar MD2,
  4. Rabbie Hanna MD3,
  5. Shelly Seward MD4,
  6. David Lockhart BA5,
  7. Robert T. Morris MD4,
  8. Ron Swensen MD1,
  9. Adnan R. Munkarah MD6

Article first published online: 16 JAN 2011

DOI: 10.1002/jso.21869

Issue

Journal of Surgical Oncology

Journal of Surgical Oncology

Volume 103, Issue 7, pages 724–729, 1 June 2011

Additional Information

How to Cite

Mahdi, H., Thrall, M., Kumar, S., Hanna, R., Seward, S., Lockhart, D., Morris, R. T., Swensen, R. and Munkarah, A. R. (2011), The prognostic impact of the ratio of positive lymph nodes on survival of epithelial ovarian cancer patients. J. Surg. Oncol., 103: 724–729. doi: 10.1002/jso.21869

Author Information

  1. 1

    Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington

  2. 2

    Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota

  3. 3

    Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, North Carolina

  4. 4

    Division of Gynecologic Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan

  5. 5

    Department of Biostatistics, University of Washington, Seattle, Washington

  6. 6

    Department of Women's Health Services, Henry Ford Health System, Detroit, Michigan

*Department of Obstetrics and Gynecology, University of Washington, 1959 Pacific NE, Seattle, WA. Fax: +206-543-3915.

Publication History

  1. Issue published online: 26 APR 2011
  2. Article first published online: 16 JAN 2011
  3. Manuscript Accepted: 21 DEC 2010
  4. Manuscript Received: 20 OCT 2010

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Keywords:

  • lymph node ratio;
  • positive lymph nodes;
  • ovarian cancer

Abstract

Background and Objectives

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. J. Surg. Oncol. 2011;103:724–729. © 2011 Wiley-Liss, Inc.

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