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Validity of complete paraaortic lymphadenectomy in apparent stage I (pTI) ovarian carcinoma
WEDNESDAY,
SEPTEMBER
6
FC3.27.04 LYMPHADENECTOMY IN PRIMARY CARCINOMA OF THE FALLOPIAN TUBE M. Klein (l), A. Rosen (2), A. Graf (3), M. Lahousen (4), (1) Dept. GYN, Hanusch Hospital, Vienna, Austria, (2) SMZ Ost., Vienna, Austria, (3) LKH Salzburg, Salzburg, Austria, (4) University Graz, Graz, Austria. Objectives: The bad prognosis of primary carcinoma of the Fallopian tube is ascribed to early lymphogenous metastasis. Due to the rarity of cases, there exist only few and divergent results on the importance of lymphnode metastasis in the relevant literature. Thus, our study aimed at detecting the incidence of lymphnode metastases and their influence on overall survival, as well as at evaluating the therapeutic effect of radical lymphadenectomy. Study Methods: We studied 109 cases in a retrospective multi-center analysis. Group I (n=38) consisted of patients who were subjected to radical pelvic and para-aortic lymphadenectomy in addition to TAH, BSO and omentectomy. The control group II (n=71) underwent the same surgical procedures but without radical lymphadnecetomy. Results: In group I 42.1% showed lymph node metastases. Lymphatic dissemination was observed only after the carcinoma had spread beyond the organ (intra-abdominal stage II); the incidence of lymphnode metastases rose significantly (p=O.O2) with growing intraperitoneal tumor masses. Pelvic and para-aortic metastases occur simultaneously. If radical lymphadenectomy is performed (group I) the median survival time increases to 43 months compared to 21 months in group II (p=O.O95). Conclusions: Correct staging is obtained only on the basis of pelvic and para-aortic lymphadenectomy. Radical lymphadenectomy in tumors of equal size may markedly prolong survival.
FC3.27.05 VALIDITY OF COMPLETE PARAAORTIC LYMPHADENECTOMY IN APPARENT STAGE I (pT1) OVARIAN CARCINOMA S. Sakurai Y. Shim@ S. Umezawa, K Shim@ T. Kate, K. Hasumi, -> Dept. of Gynecology, Cancer Institute Hospital, Tokyo, Japan. Objectives: To assess the validity of paraaortic lymphadenectomy in apparent stage I (Tl of TNM classification) ovarian carcinoma. Study Methods: Clinicopathologic analyses were made on 119 consecutive patients (pts) with pT1 ovarian carcinoma who underwent systematic pelvic and paraaortic lymphadenectomy up to the upper level of renal vessels in addition to hysterectomy, radical bilateral adnectomy, and omentectomy from January 1989 to December 1998. Results: The average number of pelvic (PLNs) plus paraaortic lymph nodes (PANS) removed was 66.5 (range: 32 to 110). The incidence of positive lymph nodes (LNs) by T subdivisions was 12.2% (7157) in pTla, 66.7% (4.6) in pTlb, 25% (14156) in pTlc, and thus 21.0% (251119) in pT1 ovarian carcinoma. The sites of LN metastasis were PANS alone in 15 pts and both PLNs and PANS in the remaining 10 pts. Thus, all of 25 LN positive pts had positive PANS. The sites of PANS involved in 25 pts were located between the bifurcation site of inferior mesenteric artery (IMA) and the renal vein. Of 25 LN positive pts 11 had a solitary LN involvement and the sites were limited to PANS superior to the IMA. The LN positive rate by histopathologic grade (G) was 1.6% (1161) in Gl, 27.0% (10145) in G2, and 66.7% (14121) in G3. The LN positive rate by histologic type was 4414% (8118) in serous, 80% (415) in transitional, 312% (1131) m endometrioid, 24.4% (10141) in clear cell, and 8.7% (2123) in mutinous carcinoma. Conclusions: The results indicate that PANS superior to the IMA is a primary site of LN involvement of ovarian carcinoma. The high positive rate of LN involvement, especially in high grade and “chemo-resistant” clear cell type, validates a complete PALA in apparent stage I ovarian carcinoma.
FC3.27.06 REVIEW OF OVARIAN CANCER IN TEHRAN, IRAN M. Ashrafi R. Alaghehbandan, S. Tavajjohi, Dept. OBIGYN, Iran -> University of Medical Sciences, P.O. Box 19395-4644, Tehran, Iran Objectives: Epithelial ovarian cancer is the most lethal of gynecologic malignancies. Although the incidence of ovarian cancer has remained
67
stable over the last three decades in developed countries, increasing incidence has been reported in developing countries. The aim of this study was to determine the frequency of epidemiological risk factors among epithelial ovarian cancer patients. Study Methods: The records of 203 patients with epithelial ovarian cancer who were treated at four gynecologic oncology centers in Tehran, during the 10 year period from 1989-1998 were reviewed. Demographic data and associated risk factors were investigated. Results: The median age of diagnosis was 47 years (range, 17-81 years). 61% of patients (1241203) were in the 30-60 age group. 46.3% of patients (941203) were diagnosed as having serous tumors, 22.1% (451203) had mutinous tumors, 20% (401203) had unclassified adenocarcinomas, and 4% (81203) had endometrioid carcinoma. The median parity was 3, and 15.7% of patients (321203) were nulliparous women. 88% of patients (1791203) did not use oral contraceptives. The most common blood group was group 0 (35%), followed by group A (31%) and group B (19%). The rate of tubal ligation was 3% (61203). In 11.3% of patients positive family history for gynecologic malignancies were found. The most common presenting symptoms were abdominal pain (43%), abdominal swelling (21%), palpable mass (14%), and vaginal bleeding (13%). Conclusions: Our study showed that the median age of the patients to be lower comparing to the most various reports. Also it seems that the rate of factors associated with decreasing in risk is relatively low. However, further investigation through large epidemiological studies is required.
FC3.27.07 PREDICTIVE VALUES OF SERUM TETRANECTIN AND CA125 IN OVARIAN CANCER. C. H0ndall’,5, E. HOgdallz,“, .I. Blaakae?, L. Christenser?, E. Gludz, .I. Vuust“, B. Norgaard-Pederser?, J. Bock’ and S. Kriiger Kjaer’*. Dept. Gyn/obst, Rigshospitalet, Copenhagen’ Institute of Cancer Epidemiology, Danish Cancer Society, Copenhager?, Dept. Gyniobst, Aarhus University Hospital, Skejby3, Lab. Mol. Biology4 & Dept. Clin. Biochemistry, Statens Serum Institute, Copenhagen, Denmark5 (‘Principal investigator). Objectives: The aim of the study was to evaluate the predictive values of serum tetranectin (TN), CA125 and a mathematical index, based on the two serum markers, in a possible screening setting for ovarian cancer (OC) Study methods: In the MALOVA study blood samples were collected from 1331 healthy control women and pre-operatively from 124 patients with a borderline ovarian tumor, 106 with a FIG0 stage I OC, 39 stage II OC, 225 stage III OC and 58 with a stage IV OC. The stage related distributions of TN and CA125 were examined by Mann-Whitney and the Spearman’s correlation tests. Sensitivities and specificities were evaluated by receiver operator cmves (ROC). Results: Significant differences were found between respectively the TN and CA125 levels in every of the above mentioned tested subgroups (median controls: TN 12.7 mg/l, CA125 8.7 U/ml; Borderline: TN 11.2 mg/l, CA125 24.8 U/ml; Stage I: TN 9.6 mg/l, CA125 46 U/ml; Stage II: TN 8.8 mg/l, CA125 269 U/ml; Stage III: TN 8.0 mg/l, CA125 569 U/ml; Stage IV: TN 6.3 mg/l, CA125 622 U/ml. Highly significant correlations were found between TN, CA125 and stage. In the ROC analyses TN and CA125 supplemented each other in all stages. For stage I an increase in sensitivity was found from 30% for CA125 alone to 43% for the index at a specificity of 99.8%. Conclusions: TN is highly correlated to the stage of OC. TN and CA125 supplement each other, resulting in an increase in sensitivity without any decrease in specificity, when the variables are used in a mathematical index. TN may be valuable in a panel of tumor markers for OC screening.
FC3.27.08 MALIGNOMAS OF FALLOPIAN TUBE R. J. Popovic-Lazic, R. Maglic, E. Garalejic, N. Antic, B. Stanimirovic, B. Terzic, J. Milosevic, Dept. of Pathology, University of Belgrade, OB/GYN Clinic “Narodni Front”, Belgrade, Serbia, Yugoslavia. Objectives: The aim of this study is to analyze the frequency the primary-malignomas of the fallopian tube.
and type of
SEPTEMBER
6
FC3.27.04 LYMPHADENECTOMY IN PRIMARY CARCINOMA OF THE FALLOPIAN TUBE M. Klein (l), A. Rosen (2), A. Graf (3), M. Lahousen (4), (1) Dept. GYN, Hanusch Hospital, Vienna, Austria, (2) SMZ Ost., Vienna, Austria, (3) LKH Salzburg, Salzburg, Austria, (4) University Graz, Graz, Austria. Objectives: The bad prognosis of primary carcinoma of the Fallopian tube is ascribed to early lymphogenous metastasis. Due to the rarity of cases, there exist only few and divergent results on the importance of lymphnode metastasis in the relevant literature. Thus, our study aimed at detecting the incidence of lymphnode metastases and their influence on overall survival, as well as at evaluating the therapeutic effect of radical lymphadenectomy. Study Methods: We studied 109 cases in a retrospective multi-center analysis. Group I (n=38) consisted of patients who were subjected to radical pelvic and para-aortic lymphadenectomy in addition to TAH, BSO and omentectomy. The control group II (n=71) underwent the same surgical procedures but without radical lymphadnecetomy. Results: In group I 42.1% showed lymph node metastases. Lymphatic dissemination was observed only after the carcinoma had spread beyond the organ (intra-abdominal stage II); the incidence of lymphnode metastases rose significantly (p=O.O2) with growing intraperitoneal tumor masses. Pelvic and para-aortic metastases occur simultaneously. If radical lymphadenectomy is performed (group I) the median survival time increases to 43 months compared to 21 months in group II (p=O.O95). Conclusions: Correct staging is obtained only on the basis of pelvic and para-aortic lymphadenectomy. Radical lymphadenectomy in tumors of equal size may markedly prolong survival.
FC3.27.05 VALIDITY OF COMPLETE PARAAORTIC LYMPHADENECTOMY IN APPARENT STAGE I (pT1) OVARIAN CARCINOMA S. Sakurai Y. Shim@ S. Umezawa, K Shim@ T. Kate, K. Hasumi, -> Dept. of Gynecology, Cancer Institute Hospital, Tokyo, Japan. Objectives: To assess the validity of paraaortic lymphadenectomy in apparent stage I (Tl of TNM classification) ovarian carcinoma. Study Methods: Clinicopathologic analyses were made on 119 consecutive patients (pts) with pT1 ovarian carcinoma who underwent systematic pelvic and paraaortic lymphadenectomy up to the upper level of renal vessels in addition to hysterectomy, radical bilateral adnectomy, and omentectomy from January 1989 to December 1998. Results: The average number of pelvic (PLNs) plus paraaortic lymph nodes (PANS) removed was 66.5 (range: 32 to 110). The incidence of positive lymph nodes (LNs) by T subdivisions was 12.2% (7157) in pTla, 66.7% (4.6) in pTlb, 25% (14156) in pTlc, and thus 21.0% (251119) in pT1 ovarian carcinoma. The sites of LN metastasis were PANS alone in 15 pts and both PLNs and PANS in the remaining 10 pts. Thus, all of 25 LN positive pts had positive PANS. The sites of PANS involved in 25 pts were located between the bifurcation site of inferior mesenteric artery (IMA) and the renal vein. Of 25 LN positive pts 11 had a solitary LN involvement and the sites were limited to PANS superior to the IMA. The LN positive rate by histopathologic grade (G) was 1.6% (1161) in Gl, 27.0% (10145) in G2, and 66.7% (14121) in G3. The LN positive rate by histologic type was 4414% (8118) in serous, 80% (415) in transitional, 312% (1131) m endometrioid, 24.4% (10141) in clear cell, and 8.7% (2123) in mutinous carcinoma. Conclusions: The results indicate that PANS superior to the IMA is a primary site of LN involvement of ovarian carcinoma. The high positive rate of LN involvement, especially in high grade and “chemo-resistant” clear cell type, validates a complete PALA in apparent stage I ovarian carcinoma.
FC3.27.06 REVIEW OF OVARIAN CANCER IN TEHRAN, IRAN M. Ashrafi R. Alaghehbandan, S. Tavajjohi, Dept. OBIGYN, Iran -> University of Medical Sciences, P.O. Box 19395-4644, Tehran, Iran Objectives: Epithelial ovarian cancer is the most lethal of gynecologic malignancies. Although the incidence of ovarian cancer has remained
67
stable over the last three decades in developed countries, increasing incidence has been reported in developing countries. The aim of this study was to determine the frequency of epidemiological risk factors among epithelial ovarian cancer patients. Study Methods: The records of 203 patients with epithelial ovarian cancer who were treated at four gynecologic oncology centers in Tehran, during the 10 year period from 1989-1998 were reviewed. Demographic data and associated risk factors were investigated. Results: The median age of diagnosis was 47 years (range, 17-81 years). 61% of patients (1241203) were in the 30-60 age group. 46.3% of patients (941203) were diagnosed as having serous tumors, 22.1% (451203) had mutinous tumors, 20% (401203) had unclassified adenocarcinomas, and 4% (81203) had endometrioid carcinoma. The median parity was 3, and 15.7% of patients (321203) were nulliparous women. 88% of patients (1791203) did not use oral contraceptives. The most common blood group was group 0 (35%), followed by group A (31%) and group B (19%). The rate of tubal ligation was 3% (61203). In 11.3% of patients positive family history for gynecologic malignancies were found. The most common presenting symptoms were abdominal pain (43%), abdominal swelling (21%), palpable mass (14%), and vaginal bleeding (13%). Conclusions: Our study showed that the median age of the patients to be lower comparing to the most various reports. Also it seems that the rate of factors associated with decreasing in risk is relatively low. However, further investigation through large epidemiological studies is required.
FC3.27.07 PREDICTIVE VALUES OF SERUM TETRANECTIN AND CA125 IN OVARIAN CANCER. C. H0ndall’,5, E. HOgdallz,“, .I. Blaakae?, L. Christenser?, E. Gludz, .I. Vuust“, B. Norgaard-Pederser?, J. Bock’ and S. Kriiger Kjaer’*. Dept. Gyn/obst, Rigshospitalet, Copenhagen’ Institute of Cancer Epidemiology, Danish Cancer Society, Copenhager?, Dept. Gyniobst, Aarhus University Hospital, Skejby3, Lab. Mol. Biology4 & Dept. Clin. Biochemistry, Statens Serum Institute, Copenhagen, Denmark5 (‘Principal investigator). Objectives: The aim of the study was to evaluate the predictive values of serum tetranectin (TN), CA125 and a mathematical index, based on the two serum markers, in a possible screening setting for ovarian cancer (OC) Study methods: In the MALOVA study blood samples were collected from 1331 healthy control women and pre-operatively from 124 patients with a borderline ovarian tumor, 106 with a FIG0 stage I OC, 39 stage II OC, 225 stage III OC and 58 with a stage IV OC. The stage related distributions of TN and CA125 were examined by Mann-Whitney and the Spearman’s correlation tests. Sensitivities and specificities were evaluated by receiver operator cmves (ROC). Results: Significant differences were found between respectively the TN and CA125 levels in every of the above mentioned tested subgroups (median controls: TN 12.7 mg/l, CA125 8.7 U/ml; Borderline: TN 11.2 mg/l, CA125 24.8 U/ml; Stage I: TN 9.6 mg/l, CA125 46 U/ml; Stage II: TN 8.8 mg/l, CA125 269 U/ml; Stage III: TN 8.0 mg/l, CA125 569 U/ml; Stage IV: TN 6.3 mg/l, CA125 622 U/ml. Highly significant correlations were found between TN, CA125 and stage. In the ROC analyses TN and CA125 supplemented each other in all stages. For stage I an increase in sensitivity was found from 30% for CA125 alone to 43% for the index at a specificity of 99.8%. Conclusions: TN is highly correlated to the stage of OC. TN and CA125 supplement each other, resulting in an increase in sensitivity without any decrease in specificity, when the variables are used in a mathematical index. TN may be valuable in a panel of tumor markers for OC screening.
FC3.27.08 MALIGNOMAS OF FALLOPIAN TUBE R. J. Popovic-Lazic, R. Maglic, E. Garalejic, N. Antic, B. Stanimirovic, B. Terzic, J. Milosevic, Dept. of Pathology, University of Belgrade, OB/GYN Clinic “Narodni Front”, Belgrade, Serbia, Yugoslavia. Objectives: The aim of this study is to analyze the frequency the primary-malignomas of the fallopian tube.
and type of