Lymphadenectomy in endometrioid ovarian carcinoma patients with early-stage disease: A large transatlantic team initiative

Abstract

Objectives: According to the World Health Organization 2020 classification, endometrioid ovarian carcinoma (EOC) is the second most frequent ovarian carcinoma histotype. The benefit of lymph node surgery (LNS) in early-stage EOC is unknown. Prior studies examining the benefit of LNS in EOC have been hampered by small numbers and misclassified cases. Large-scale studies that consider modern classification are needed. Method(s): A cohort of 943 EOC patients was assembled from 22 centers across Canada and Europe. The histotype was confirmed by central expert pathology review and immunohistochemistry, followed by an extensive chart review. Complete lymphadenectomy was defined as the removal of at least 10 pelvic and 10 paraaortic LNs. Result(s): Chart review and histopathologic data were available from 721 patients. The median age at diagnosis was 55.57 years (28-94); 438 (60.7 %) patients were diagnosed with FIGO stage I, 170 (23.6 %) with stage II, 92 (12.8 %) with stage III and 21 (2.9 %) with stage IV disease. Grade distribution included 325 (45.1 %) grade 1, 259 (35.9 %) grade 2 and 126 (17.5 %) grade 3 tumors. Surgical lymph node sampling was performed in 303 (42.0 %) and complete lymphadenectomy in 105 (14.6 %) cases, revealing positive nodes in 30/408 (7.3 %) cases. All low-grade (grade 1) early-stage (pT1/2) cases were found to be node-negative. Conclusion(s): The international LEOPARD team initiative stands to provide a solid picture of this unique histotype including a powerful statement on the value of lymph node dissection. We were able to show that lymph node involvement is rare, especially in early-stage low-grade EOC. This type-specific approach will help to improve precision care for EOC patients.Copyright © 2025