Risk factors for lymph node metastasis in ovarian cancer: Implications for systematic lymphadenectomy

• Lymphadenectomy in ovarian cancer is still controversial.
• CA-125 level is significantly associated with lymph node metastases in ovarian cancer.
• Lymphadenectomy could be avoided for patients with lower risk for lymph node metastases.

BackgroundThe purpose of this study was to assess the risk factors associated with lymph node metastases and to evaluate the role of systematic lymphadenectomy in ovarian cancer.MethodsWe retrospectively reviewed patients diagnosed with ovarian cancer between December 2004 and March 2012. Demographics, pathologic findings, and correlations with lymph node metastases were assessed.ResultsA total of 256 patients were identified. The mean number of removed lymph nodes was 20.5 (range, 2–57), and 84 patients (32.8%) had nodal metastases. The mean number of positive lymph nodes was 3 (range, 1–40) in patients with lymph node metastases. Univariate analysis showed that serous histology, histological grade 2–3, and CA-125 level at diagnosis >740 U/mL were significant risk factors for lymph node metastases. Multivariate analysis showed that serous histology (odds ratio [OR], 2.728; 95% confidence interval [CI], 1.072–6.945; p = 0.035), histological grade 2–3 (OR 1.897; 95% CI, 1.209–2.977; p = 0.005), and CA-125 level at diagnosis >740 U/mL (OR, 3.858; 95% CI 2.143–6.947; p < 0.001) remain the most important risk factors for lymph node metastases. The nodal metastasis rates for 0 to 1 risk factors were significantly lower than those of 2–3 risk factors (3.7% vs. 40.6%; p < 0.001).ConclusionsThe current study suggests that the decision making of systematic lymphadenectomy in ovarian cancer patients should be referred to the histological type, grade, and CA-125 level at diagnosis.