ちょっと調べてみたので、お裾分け。
英語は苦手なので、間違っていたらご指摘いただけたらありがたいです。
びっくりしたのは、外国のリンパ節郭清率の低さ。
デンマーク、アメリカとも、なんと50%以下(￣□￣;)!!
●2014年3月に発表された論文（デンマーク2005－2011年の前向き統計)
Svolgaard O et al.Lymphadenectomy in surgical stage I epithelial ovarian cancer.Acta Obstet Gynecol Scand. 2014 Mar;93(3):256-60.
上皮性卵巣がんステージ１患者は627人でそのうち、リンパ節郭清を受けたのは216人。
うち、13人からリンパ節への転移が見つかった。
５年生存率はリンパ節郭清を受けたグループが85％で、
受けないグループが80％でほんのわずかな違いしかなかった（統計的有意差なし）。
Abstract
OBJECTIVE:
To identify the extent of lymphadenectomy performed in women presenting with epithelial ovarian cancer macroscopically confined to the ovary. Furthermore, the effect of lymphadenectomy on overall survival is evaluated.
DESIGN:
A prospective nationwide case-only study.
SETTING:
Denmark 2005-2011.
SAMPLE:
All women registered in the nationwide Danish Gynecologic Cancer Database from 1 January 2005 to 1 May 2011, presenting with a tumor macroscopically confined to the ovary without visible evidence of abdominal spread at the time of the initial exploration (surgical stage I).
METHOD:
Descriptive and survival analyses of data from Danish Gynecologic Cancer Database.
MAIN OUTCOME MEASURES:
The annual proportion of women with surgical stage I disease who received lymphadenectomy and the survival in the two groups.
RESULTS:
Of 2361 women with epithelial ovarian cancer, 627 were identified with surgical stage I. Lymphadenectomy was performed in 216 women (34%) of whom 13 (6%) had lymph node metastases. At 5-year follow up 85% remained alive in the lymphadenectomy group compared with 80% in the control group (p = 0.064). The lymphadenectomy fraction increased from 24% in 2005 to 55% in 2011. When univariate and multivariate analyses were conducted only an insignificant difference in the survival probability was found between lymphadenectomy and no lymphadenectomy in women presenting with tumor macroscopically confined to the ovary.
CONCLUSION:
Although increasing, the number of women with surgical stage I disease in Denmark who receive lymphadenectomy remains low, but this did not seem to make a difference to survival.
●2007年1月に発表された論文（アメリカ1988－2001年の後向き統計)
Chan JK et al.Association of lymphadenectomy and survival in stage I ovarian cancer patients.Obstet Gynecol. 2007 Jan;109(1):12-9.
卵巣がんステージ１患者は6686人で、そのうち2862人がリンパ節郭清を受けた。
リンパ節郭清は５年生存率を、87.0%から92.6%に改善した（統計的有意差あり）。
明細胞腺癌以外の上皮性腺癌に限れば、85.9%から93.3%への改善が見られた（統計的有意差あり）。
しかしながら、明細胞腺癌、胚細胞腫瘍、性索間質性腫瘍、サルコーマでは差がなかった。
Abstract
OBJECTIVE:
To estimate the survival impact of lymphadenectomy in women diagnosed with clinical stage I ovarian cancer.
METHODS:
Demographic and clinicopathologic information were obtained from the Surveillance, Epidemiology and End Results Program between 1988 and 2001. Data were analyzed using Kaplan-Meier methods and Cox proportional hazards regression.
RESULTS:
A total of 6,686 women had clinical stage I ovarian cancer (median age 54 years, range 1-99). Of this total, 75.9% of patients were Caucasian, 8.3% were Hispanic, 5.8% were African American, and 7.3% were Asian. Epithelial tumors were present in 85.8% of the women, and 2,862 (42.8%) patients underwent lymphadenectomy. Patients aged 50 years or more were less likely to undergo lymphadenectomy compared with their younger cohorts (39.8% compared with 60.2%, P<.001). Only 32.7% of African-American women had lymphadenectomy compared with 42.7% of Caucasian women, 47.2% of Hispanics, and 48.8% of Asians (P<.001). Lymphadenectomy was associated with improved 5-year disease-specific survival of all patients from 87.0% to 92.6% (P<.001). More specifically, lymphadenectomy improved the survival in those with non-clear cell epithelial ovarian cancer (85.9% to 93.3%, P<.001) but not in those with clear cell carcinoma, germ cell tumors, sex cord stromal tumors, and sarcomas. Moreover, the extent of lymphadenectomy (0 nodes, less than 10 nodes, and 10 or more nodes) increased the survival rates from 87.0% to 91.9% to 93.8%, respectively (P<.001). On multivariable analysis, the extent of lymphadenectomy was a significant prognostic factor for improved survival, independently of other factors such as age, stage, histology, and grade of disease.
CONCLUSION:
Our data suggest that women with stage I non-clear cell ovarian cancers who underwent lymphadenectomy had a significant improvement in survival.
●2006年9月に発表された論文（イタリア1991－2003年の無作為ランダム化試験)
Maggioni A et al.Randomised study of systematic lymphadenectomy in patients with epithelial ovarian cancer macroscopically confined to the pelvis.Br J Cancer. 2006 Sep 18;95(6):699-704.
上皮性卵巣がんステージ１と２の患者268人を無作為にリンパ節郭清をする群と、
リンパ節サンプリングのみ行なう群の２グループに分け、87.8ヶ月追跡調査した。
5年無増悪生存率は、サンプリング群71.3%に対して、リンパ節郭清群78.3%（統計的有意差なし）、
5年生存率は、サンプリング群81.3%に対して、リンパ節郭清群84.2%だった（統計的有意差なし）。
Abstract
No randomised trials have addressed the value of systematic aortic and pelvic lymphadenectomy (SL) in ovarian cancer macroscopically confined to the pelvis. This study was conducted to investigate the role of SL compared with lymph nodes sampling (CONTROL) in the management of early stage ovarian cancer. A total of 268 eligible patients with macroscopically intrapelvic ovarian carcinoma were randomised to SL (N=138) or CONTROL (N=130). The primary objective was to compare the proportion of patients with retroperitoneal nodal involvement between the two groups. Median operating time was longer and more patients required blood transfusions in the SL arm than the CONTROL arm (240 vs 150 min, P<0.001, and 36 vs 22%, P=0.012, respectively). More patients in the SL group had positive nodes at histologic examination than patients on CONTROL (9 vs 22%, P=0.007). Postoperative chemotherapy was delivered in 66% and 51% of patients with negative nodes on CONTROL and SL, respectively (P=0.03). At a median follow-up of 87.8 months, the adjusted risks for progression (hazard ratio [HR]=0.72, 95%CI=0.46-1.21, P=0.16) and death (HR=0.85, 95%CI=0.49-1.47, P=0.56) were lower, but not statistically significant, in the SL than the CONTROL arm. Five-year progression-free survival was 71.3 and 78.3% (difference=7.0%, 95% CI=-3.4-14.3%) and 5-year overall survival was 81.3 and 84.2% (difference=2.9%, 95% CI=-7.0-9.2%) respectively for CONTROL and SL. SL detects a higher proportion of patients with metastatic lymph nodes. This trial may have lacked power to exclude clinically important effects of SL on progression free and overall survival.