Lymphadenectomy in ovarian cancers: a meta-analysis of hazard ratios from randomized clinical trials

The debate surrounding systematic lymphadenectomy in the epithelial cancers of the ovary (EOC) was temporarily put to rest by the LION trial. However, there was a glaring disparity between the number of patients registered and the number of patients randomized suggesting inadvertent selection. A sub...

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Bibliographic Details
Published in:World journal of surgical oncology 2022-11, Vol.20 (1), p.367-367, Article 367
Main Authors: Purwar, Roli, Ranjan, Rakesh, Soni, Kishan, Pandey, Manoj, Upadhyay, Satyanshu K, Pai, Esha, Kumar, Tarun
Format: Article
Language:English
Subjects:
Aorta
Cancer
Cancer surgery
Carcinoma ovarian epithelial
Care and treatment
Clinical trials
Confidence intervals
Diagnosis
Dissection
Female
Humans
Lymph Node Excision
Lymph nodes
Lymphadenectomy
Lymphatic system
Meta-analysis
Observational studies
Ovarian cancer
Ovarian neoplasm
Ovarian Neoplasms - surgery
Progression-Free Survival
Proportional Hazards Models
Randomized Controlled Trials as Topic
Review
Surgery
Survival
Tumors
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Summary:The debate surrounding systematic lymphadenectomy in the epithelial cancers of the ovary (EOC) was temporarily put to rest by the LION trial. However, there was a glaring disparity between the number of patients registered and the number of patients randomized suggesting inadvertent selection. A subsequent meta-analysis after this trial included all types of studies in the literature (randomized, non-randomized, case series, and, retrospective cohort), thus diluting the results. We conducted a meta-analysis of hazard ratios of randomized controlled trials, to study the role of systematic para-aortic and pelvic lymph node dissection in the EOC. A detailed search of MEDLINE, Cochrane, and Embase databases was done to look for the published randomized controlled trials (RCT) comparing lymphadenectomy versus no lymphadenectomy in EOC. A meta-analysis of hazard ratios (HR) was performed for overall survival (OS) and progression-free survival (PFS) using fixed and random effect models. The quality of the RCTs was evaluated on Jadad's score, and the risk of bias was estimated by the Cochrane tool. A total of 1342 patients with EOC were included for quantitative analysis. On meta-analysis, HR for PFS was 0.9 (95% CI 0.79-1.04) favoring lymphadenectomy. HR for OS was 1 (95% CI 0.84-1.18) signifying no benefit of systematic lymphadenectomy. The results show a trend towards increased PFS which did not reach statistical significance nor translate into any meaningful benefit in OS. There is still a need for a greater number of well-conducted, suitably powered trials to convincingly answer this question.
ISSN:1477-7819
1477-7819
DOI:10.1186/s12957-022-02835-4