• Beyhan Ataseven, Christoph Grimm, Philipp Harter, Sonia Prader, Alexander Traut, Florian Heitz, and du BoisAndreasADepartment of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Henricistrasse 92, 45136 Essen, Germany..
• Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Henricistrasse 92, 45136 Essen, Germany. Electronic address: b.ataseven@kliniken-essen-mitte.de.
• Gynecol. Oncol. 2014 Dec 1; 135 (3): 435-40.

ObjectiveLymph node status is an established prognostic factor in epithelial ovarian cancer (EOC). Lymph node ratio (number of positive LN/number of resected LN) reflects both qualitative and quantitative lymph node spread as well as surgical effort and extent of disease. We evaluated whether LNR is a more precise prognostic factor than conventional lymph node status in patients with EOC.MethodsThe present retrospective study includes 809 patients with EOC, who underwent primary cytoreductive surgery between 2000-2013. Clinico-pathological parameters and survival data were extracted from a prospectively maintained tumor registry database. The optimal cut-off point for LNR was calculated by using Martingale residuals. Survival analyses were calculated using Kaplan-Meier method and Cox regression models.ResultsLymphadenectomy was performed in 693 (85.7%) out of 809 patients. Median number of removed LN was 64 (IQR 25-75%: 39-84). LNR of 0.25 was identified as the optimal prognostic cut-off value. The estimated 5-year-OS rates were 69.3% for patients with node-negative EOC compared to 33.1% for patients with any lymph node metastasis (p<0.001). The estimated 5-year-OS rates were 42.5% for patients with LNR≤0.25, and 18.0% for patients with LNR>0.25 (p<0.001). Additionally in multivariate analysis LNR>0.25 was approved to be an independent prognostic factor for overall survival (adjusted HR 1.44, 95% CI 1.04-2.00; p=0.028).ConclusionLNR more precisely predicts overall survival than conventional lymph node status in EOC patients undergoing primary debulking surgery.Copyright © 2014 Elsevier Inc. All rights reserved.

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