Lymph-node metastasis in stage I and II sex cord stromal and malignant germ cell tumours of the ovary: A systematic review

• The incidence of lymph node metastasis in clinical stage I and II sex cord stromal tumours is very rare.
• The incidence of lymph node metastasis in patients with clinical stage I–II germ cell tumours is considerable.
• Despite of limited data, the need for lymphadenectomy or lymph node sampling in sex cord stromal tumours should be reassessed.

ObjectivesThe aim of this systematic review is to determine the incidence of lymph-node metastasis in clinical stage I and II sex cord stromal tumours and germ cell tumours of the ovary.MethodsRelevant articles were identified from MEDLINE and EMBASE and supplemented with citations from the reference lists of the primary studies. Eligibility was determined by two authors. Included studies were prospective or retrospective cohort and cross-sectional studies analysing at least ten patients with clinical early-stage non-epithelial ovarian cancer who underwent lymphadenectomy or lymph-node sampling as part of a staging laparotomy.ResultsFor sex cord stromal tumours, five articles including 578 patients were analysed and lymph-node metastasis was not detected in the 86 patients who underwent lymph-node removal. The median number of removed lymph nodes was 13 (range 9–29).For malignant germ cell tumours, three articles were eligible including 2436 patients of whom 946 patients underwent lymph-node resection. The mean number of removed nodes was 10 (range 2–14) with a mean incidence of lymph-node metastasis of 10.9% (range 10.5–11.8%).ConclusionsThe incidence of lymph-node metastasis in patients with clinical stage I and II sex cord stromal tumours is low, whereas the incidence in patients with clinical stage I–II germ cell tumours is considerable, although limited data are available.