Mets Linfaticas

Prevalence of Lymph Node Metastasis in Primary Mucinous Carcinoma of the Ovary
Kathleen M. Schmeler, MD, Xia Tao, MD, Michael Frumovitz, MD, MPH, Michael T. Deavers, Charlotte C. Sun, DrPH, Anil K. Sood, MD, Jubilee Brown, MD, David M. Gershenson, MD, and Pedro T. Ramirez, MD
OBJECTIVE: To estimate the prevalence of lymph node involvement in women with primary mucinous ovarian carcinomas.METHODS: A retrospective study was performed of patients with primary mucinous ovarian carcinomas evaluated at a single institution between 1985 and 2007. A gynecologic oncology pathologist evaluated all cases. Patients with tumors of low malignant potential and mucinous carcinomas metastatic to the ovary from other primary sites were excluded. RESULTS: Patients with primary mucinous ovarian carcinomaswere identified (n 107). All patients underwent primary surgery. At time of surgery, 93 patients (87%) had tumors that grossly appeared to be confined to the ovary, and 14 patients (13%) had evidence of extraovarian disease. Of the 93 patients with tumors that grossly appeared to be confined to the ovary at surgical exploration, 51 (55%) underwent lymphadenectomy (n 27 pelvic and paraaortic, n 19pelvic only, n 5 paraaortic only). Of these 51 patients, none had metastatic disease to the pelvic or paraaortic lymph nodes. In addition, there were no significant differences in progression-free survival and overall survival rates between the patients who underwent lymphadenectomy and those who did not. CONCLUSION: There were no cases of isolated lymph node metastases among women with primarymucinous carcinoma grossly confined to the ovary, suggesting that routine lymphadenectomy may be omitted in these patients. LEVEL OF EVIDENCE: III
(Obstet Gynecol 2010;116:269–73)
From the Departments of Gynecologic Oncology, Pathology, and Cancer Biology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas. Corresponding author: Kathleen M. Schmeler, MD, Department of GynecologicOncology, The University of Texas M.D. Anderson Cancer Center, P.O. Box 301439, Houston, TX 77230-1439; e-mail: kschmele@mdanderson.org. Financial Disclosure The authors did not report any potential conflicts of interest. © 2010 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins. ISSN: 0029-7844/10

MD,

rimary mucinous carcinomas of the ovaryaccount for less than 5% of all invasive epithelial ovarian cancers.1,2 When compared with serous carcinomas of the ovary, mucinous carcinomas have a distinct presentation, clinical course, and response to therapy.2– 4 The majority of mucinous ovarian carcinomas are well or moderately differentiated and are confined to the ovary at the time of diagnosis. These early-stage mucinous ovarian carcinomashave significantly higher survival rates when compared with early-stage serous ovarian carcinomas.3 However, patients with advanced stage mucinous ovarian carcinomas have been shown to have a lower response rate to platinum-based chemotherapy and a poorer prognosis when compared with serous tumors.2,4 – 6 Although comprehensive surgical staging is recommended for all epithelial ovarian cancers,little is known about the patterns of metastasis of primary mucinous carcinomas of the ovary. In serous carcinomas of the ovary, approximately 10% to 20% of apparent stage I tumors will have occult nodal metastasis.7,8 However, recent data suggest that in patients with mucinous tumors that appear to be confined to the ovary on surgical exploration lymph node involvement is exceedingly low.7,9 Ittherefore remains unclear if complete staging with systematic lymphadenectomy and its associated morbidity is beneficial in this group of patients. To further explore this issue, we estimated the prevalence of lymph node involvement in patients with primary mucinous carcinoma of the ovary. In addition, we compared recurrence rates and survival between patients undergoing lymphadenectomy and those who...