| Objective: The purpose of this study is in the preoperative full abdomen CT evaluation retroperitoneal lymph node metastasis or not,on the basis of comparing late sexual ovarian epithelial tumor cells to destroy the loss retroperitoneal lymph nodes in the different treatment in patients with clinical pathological characteristics,the related parameters of perioperative outcome and survival,explore the retroperitoneal lymph node resection of advanced epithelial ovarian cancer patients survival outcome,It provides some reference for lymph node management in the initial treatment of advanced ovarian cancer.Methods: A total of 501 patients with advanced epithelial ovarian cancer who underwent tumor cytoreduction surgery in the fourth Hospital of Hebei Medical University from January 2013 to December 2017 were analyzed retrospectively,among them,119 patients with positive lymph nodes were considered by preoperative whole abdominal CT(CT positive group).The different treatment methods of intraoperative lymph nodes were statistically analyzed,and the distribution was unresectable lymph node group(group A1,n=60),selective lymphadenectomy group(group B1,n=34),and systematic lymphadenectomy group(group C1,n=25).Preoperative total abdominal CT considered lymph node negative in 382 cases(CT negative group),including unresected lymph node group(group A2,n=199),selective lymphadenectomy group(group B2,n=105)and systematic lymphadenectomy group(group C2,n=78).All patients were diagnosed as ovarian cancer by postoperative paraffin pathological examination,and re-performed surgical-pathological staging according to the International Federation of Obstetrics and Gynecology(International Federation of Gynecology and Obstetrics,FIGO)2013taging criteria,all patients with stageⅡB～ⅣB ovarian cancer.The general data and peri-operative parameters of three different lymph node operation methods in the two groups of patients with different lymph node status assessed by whole abdominal CT were compared,and their survival outcomes were compared and analyzed.SPSSR3.6.1 software was used for statistical analysis,after normality test,all the measurement data were in accordance with normal distribution,X±s described measurement data,and independent sample t-test was performed;the number and percentage of counting data were described by 2-test or Fisher exact probability method;survminer and survival packages were used to calculate the survival rate and draw the survival curve.The difference was statistically significant(P<0.05).Results:1.Comparison of general clinical data:there was no significant difference in age,basic diseases,residual cancer foci and pathological types between the two groups(P>0.05).For FIGO staging,the highest proportion of patients was stageⅢC.In both the positive and negative CT groups,the proportion ofⅡB-ⅢB in lymph node resection group was higher than that in unresectable lymph node group,and the difference was statistically significant(CT positive group:P=0.031,CT negative group:P<0.001).2.Comparison of related indexes in perioperative periodCT positive group:lymph node dissection did not increase the amount of bleeding in patients(A1、B1、C1: 505.2±504.8ml、360.6±321.2ml、391.2±397.3ml)and blood transfusion rate(A1、B1、C1: 68.3%、70.6%、56%).The same results were obtained in the CT negative group,no matter selective lymphadenectomy or systemic lymphadenectomy,there was no increase in blood loss(A2、B2、C2:453.0±408.5ml、403.5±326.6ml、349.6±297.8ml)and blood transfusion rate(A2、B2、C2:68.3%、64.8%、75.6%)compared with the unresected lymph node group.The differences were statistically significant(P<0.05).There was no significant difference in postoperative hospital stay between CT positive group and CT negative group(A1 、 B1 、C1:11.4±3.7d、11.3±3.6d、11.2±2.9d;A2、B2、C2: 12.2±5.1d、11.9±4.4d、12.9± 8.0d).In both the CT positive group and the CT negative group,the incidence of postoperative complications was similar between selective lymphadenectomy and unresected lymphadenectomy.Systematic lymphadenectomy increased the incidence of postoperative complications,with statistically significant differences(A1、B1、C1:3.3%、2.9%、8%,P=0.043;A2、B2、C2:5.0%、5.7%、15.4%,P=0.049).selective lymphadenectomy and systematic lymphadenectomy did not increased the rate of postoperative admission to ICU compared with unresected lymphadenectomy(A1、B1、C1:1.7%、2.9%、0%,P=0.157;A2、B2、C2:1.7%、2.9%、0%,P=0.479).3.Comparison of the number of intraoperative lymph node resection and the rate of postoperative lymph node metastasisAs for the number of lymph nodes resected during operation,in CT positive group,the number of para-aortic lymph nodes and pelvic lymph nodes in B1 group was 2.83.6,7.9±5.4,respectively,and that in C1 group was7.15.6,29.7±9.3,respectively.The difference was statistically significant(P<0.001).In CT negative group,the number of para-aortic lymph nodes and pelvic lymph nodes in B2 group was 4.5±5.2,11.5± 6.3,respectively,which was 8.9±6.9,29.4±9.3 in C2 group(P<0.001).For the postoperative lymph node metastasis rate,in CT positive group,the postoperative lymph node metastasis rate in B1 group and C1 group was73.5%and 72% respectively,and there was no significant difference between group B2 and group C2(P>0.05).In);in CT negative group,the postoperative lymph node metastasis rate in B2 group and C2 group was 44.8%and 50%respectively,and the difference was not statistically significant(P>0.05).4.Comparison of living conditionsIn the CT positive group:after the end of follow-up,the recurrence rates of A1,B1 and C1 groups were 85%,80%and 73.5%,respectively.There was no significant difference(P>0.05).In the CT negative group:after the end of follow-up,the recurrence rates in A2,B2 and C2 groups were 85.9%,67.9%and69.5%,respectively,with statistically significant differences(P<0.001).The recurrence rate in group B2 was similar to that in group C2 and significantly lower than that in group A2.For the median progression-free survival((PFS),in CT positive group,the patients in A1,B1 and C1 groups were 12.9 months,18.9 months and 23.8months respectively,and there was no significant difference among the three groups(P>0.05).In CT negative group,the patients in A2,B2 and C2 groups were 14.2 months,25.1 months and 23.6 months respectively,and there was significant difference among the three groups(P<0.001).Selective lymphadenectomy or systematic lymphadenectomy did not improve preoperative CT evaluation of lymph node positive advanced ovarian cancer patients with PFS,improved preoperative CT evaluation of lymph node negative PFS.The median overall survival time of patients in groups A1,B1 and C1with(OS),CT positive were 29.0 months,39.0 months and 43.0 months,respectively.And in CT negative group,the patients in A2,B2 and C2 groups were 34.3 months,41.5 months and 39.7 months,respectively.Statistical analysis showed that there was significant difference both in CT positive and negative group(P<0.05).Selective lymphadenectomy or systematic lymphadenectomy can improve the OS of patients with positive and negative lymph node status before operation.Statistical analysis showed that the 1-year survival rate of group C1 was higher than that of group A1 and group B1 in CT positive group,but that of group B1 was slightly lower than that of group A1.Statistical analysis showed that there was no significant difference between the two groups(P>0.05).The3-year survival rate in group A1,group B1 and group C1 increased gradually,and the difference was statistically significant(P<0.05).In CT negative group,the 1-year survival rate of B2 group was higher than that of A2 group and C2 group,the statistical analysis showed that there was no significant difference(P>0.05).The 3-year survival rate in group A2,group B2 and group C2 increased gradually,and the difference was statistically significant(P<0.05).5.The predictive CT positive group of CT for lymph node metastasis59 cases were resected,of which 43 cases were pathologically positive and 16 cases were negative,while in CT negative group,183 cases were resected,86 cases were pathologically positive and 97 cases were negative.The sensitivity of whole abdominal CT scan plus enhancement in the diagnosis of pelvic and abdominal lymph node metastasis was not high(33.33%),and the specificity was high(85.84%).The positive predictive value was 72.88%,and the negative predictive value was 53.01%.Conclusions:1.Whole abdominal plain scan plus enhanced CT has a high speci-ficity for the diagnosis of retroperitoneal lymph node metastasis of ovarian malignant tumors,which can provide some reference for the preoperative evaluation of lymph node status of ovarian malignant tumors.2.For the patients with advanced epithelial ovarian cancer,tumors or suspected lymph node resection should be performed if the lymph node is positive on preoperative CT.For patients with negative lymph nodes on preoperative CT,the peritoneum should be strictly explored after opening intraoperatively.Selective lymph node resection can bring survival benefit without increasing the incidence of complications. |
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