淋巴结清扫术对早期卵巢癌患者预后影响的回顾性队列研究

目的 评估淋巴结清扫对临床早期上皮性卵巢癌（epithelial ovarian cancer,EOC）患者预后的影响。方法 回顾性招募2008年1月至2018年12月在本院接受首次手术Ⅰ～Ⅱ期EOC患者。根据是否进行淋巴结清扫将患者分为未切除淋巴结的手术组（No-LND组）和淋巴结清扫术组（LND组），收集两组患者的人口学特征、临床病理资料以及围手术期不良事件发生情况，采用Cox比例风险回归进行生存分析。结果 共纳入279例EOC患者，其中No-LND组56例，LND组223例。LND组患者切除淋巴结中位数为25枚，包括21枚盆腔淋巴结和4枚主动脉旁淋巴结。LND组和No-LND组的5年无进展生存率分别为85.9%和81.6%,10年无进展生存率分别为81.3%和72.9%，差异有统计学意义（P=0.013）。LND组和No-LND组的5年总生存率分别为93.8%和88.7%,10年总生存率分别为86.7%和82.6%，差异有统计学意义（P=0.042）。多因素Cox回归分析显示，淋巴结清扫是预后的保护因素（HR=0.89,95%CI:0.79～0.97,P=0.041），但LND组...

A prospective study of the effect of lymph node dissection on the prognosis of patients with early ovarian cancer

Objective To evaluate the effect of lymph node dissection on the prognosis of patients with early epithelial ovarian cancer (EOC). Methods The patients with stage Ⅰ-Ⅱ EOC in our hospital from January 2008 to December 2018 were retrospectively recruited. According to whether lymph node dissection was performed, the patients were divided into an operation group without lymph node dissection (No-LND group) and a lymph node dissection group (LND group). The demographic characteristics, clinicopathological information and perioperative adverse events of the two groups were collected, and Cox proportional hazard regression was used for survival analysis. Results A total of 279 patients with EOC were enrolled, 56 cases in the No-LND group and 223 in the LND group. The median number of lymph nodes removed in the LND group was 25, including 21 pelvic lymph nodes and 4 para-aortic lymph nodes. The 5-year PFS rates of the LND group and No-LND group were 85.9% and 81.6%, respectively, and the 10-year PFS rates were 81.3% and 72.9%, respectively, with a statistically significant difference (P=0.013). The 5-year OS rates of the LND group and No-LND group were 93.8% and 88.7%, respectively, and the 10-year OS rates were 86.7% and 82.6%, respectively, with a statistically significant difference (P=0.042). Multivariable Cox regression analysis showed that lymph node dissection was a protective factor for prognosis (HR=0.89, 95%CI: 0.79-0.97, P=0.041), but the median operation time of the LND group was longer than that of No-LND group (220 min vs 155 min,  P<0.001), and the incidence of lymphatic cysts at discharge was also higher in the LND group (31.8% vs 0, P<0.001). Conclusions Lymph node dissection can improve the prognosis of patients with early EOC, but it may increase the incidence of perioperative adverse events. Therefore, the therapeutic value of lymph node dissection in the patients with early EOC still needs to be further verified by large-scale, prospective randomized controlled trials.