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454 Study in progress: international retrospective study on lymphadenectomy in endometrioid ovarian carcinoma patients with early stage disease (LEOPARD)
  1. P Krämer1,
  2. M Grube1,
  3. T Renno1,
  4. H Brar2,
  5. JN McAlpine2,
  6. CD de Kroon3,
  7. F Heitz4,
  8. S Heublein5,
  9. R Manchanda6,
  10. M Plante7,
  11. D Bachvarov8,
  12. AG Zeimet9,
  13. B Schmalfeldt10,
  14. P Wimberger11,
  15. B Lampe12,
  16. F Trillsch13,
  17. C Grimm14,
  18. A Staebler15,
  19. F Kommoss16,
  20. A Talhouk2,
  21. M Köbel17,
  22. MS Anglesio2 and
  23. S Kommoss1
  1. 1Department of Women’s Health, Tuebingen University Hospital, Germany
  2. 2Department of Obstetrics and Gynecology, University of British Columbia, Canada
  3. 3Department of Gynecology, Leiden University Medical Centre (LUMC), Netherlands
  4. 4Kliniken Essen Mitte, Department of Gynecology and Gynecologic Oncology, Germany
  5. 5Department of Obstetrics and Gynecology, Heidelberg University Hospital, Germany
  6. 6Department of Gynecological Oncology, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, UK
  7. 7Department of Obstetrics, Gynecology, and Reproduction Faculty of Medicine, Université Laval, Canada
  8. 8Department of Molecular Medicine, Faculty of Medicine, Université Laval, Canada
  9. 9Department of Gynecology and Obstetrics, Innsbruck Medical University, Austria
  10. 10Department of Gynecology, University Medical Center Hamburg-Eppendorf, Germany
  11. 11Department of Gynecology and Obstetrics, TU Dresden, and national Center for Tumor Diseases, Germany
  12. 12Department of Gynecology, Kaiserswerther Diakonie, Florence Nightingale Hospital, Germany
  13. 13Department of Gynecology and Obstetrics, University of Munich, Germany
  14. 14Department of General Gynaecology and Gynaecological Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
  15. 15Institute of Pathology and Neuropathology, Tuebingen University Hospital, Germany
  16. 16Institute of Pathology, Medical Campus Bodensee, Germany
  17. 17Department of Pathology and Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Canada


Introduction The benefit of systematic lymphadenectomy (LNE) in low-stage, low-grade ovarian carcinoma is unknown. However, most guidelines still recommend LNE in these patients. Prior studies examining the benefit of this invasive procedure have been hampered small numbers, and large-scale studies that consider modern classification are needed.

Methods A cohort of 666 pathology-reviewed and immunohistochemistry-validated endometrioid ovarian carcinomas has recently been evaluated using endometrial carcinoma-inspired molecular subtyping. This molecularly characterized series is now being used to assess the value of LNE. Contributing centers are performing detailed chart reviews, so that surgical procedures and lymph node status can be correlated with molecular subtype and outcomes.

Results 349 stage I, 181 stage II, 85 stage III, and 22 stage IV cases with a median OS follow-up of 6.11 years (RevKM) were collected from 17 centres across Canada and Europe. Analysis of the first 70/666 cases revealed positive nodes in only a single presumed low stage patient after systematic pelvic and paraaortic LNE (n=1/44). LNE was not performed in 3/44 and restricted to pelvic nodes in 6/44 low-stage cases, all of which were pN0. Tumor spread beyond the Uterus and/or Adnexa was associated with positive nodes in 33%.

Conclusion Preliminary results indicate that abandonment of LNE in low-stage, low-grade endometrioid ovarian carcinoma may reduce morbidity without worsening prognosis for these patients. Completion and expansion of our international team initiative stands to provide a powerful statement on the value of LNE, and influence of molecular subtype on disease spread, possibly improving precision care for ovarian carcinoma patients.

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