The impact of lymphadenectomy on survival outcomes of ovarian clear cell carcinoma: A systematic review and meta-analysis.

person Yan Liu Qilu Hospital of Shandong University, Jinan, China info_outline Yan Liu, Kun Song, Changzhen Huang, Ran Chu

Authors person Yan Liu Qilu Hospital of Shandong University, Jinan, China info_outline Yan Liu, Kun Song, Changzhen Huang, Ran Chu Organizations Qilu Hospital of Shandong University, Jinan, China Abstract Disclosures Research Funding Other Government Agency National Key Technology Research and Development Programme of China (2022YFC2704200 and 2022YFC2704202) Background: The treatment strategies for ovarian clear cell carcinoma (OCCC) are the same as those for epithelial ovarian cancer. Due to the rarity of OCCC, no prospective studies of its surgery have been reported. Therefore, the therapeutic significance of lymphadenectomy for OCCC needs to be further clarified. Methods: The Web of Science, Scopus, PubMed, and other sources (e.g. Google Scholar) were searched from each database’s earliest inception to June 2021. English-language publications of observational studies that investigated the role of lymphadenectomy in patients with OCCC were included.The pooled hazard ratio (HR) and 95% confidence interval (CI) were calculated. Results: The analysis demonstrated that lymphadenectomy is associated with significantly improved disease-specific survival (DSS) (HR = 0.76; 95%CI = 0.60-0.95; P = 0.02; I 2 = 0.0%) and disease-free survival (DFS) (HR = 0.58; 95%CI = 0.33-1.00; P = 0.05; I 2 = 61%), but not for overall survival (OS) (HR = 0.80; 95%CI = 0.60-1.06; P = 0.12; I 2 = 19%) and progression-free survival (PFS) (HR = 0.95; 95%CI = 0.64-1.42; P = 0.79; I 2 = 0.0%). But it is worth noting that several single studies indicated a tendency of improved OS, PFS, DFS, DSS with lymphadenectomy. The discrepancy of different results from similar studies should be viewed with caution. Conclusions: Lymphadenectomy could not significantly improve OS and PFS for OCCC, but is associated with improved DFS and DSS. Gynecologic oncologists should tailor treatment to patients to achieve optimal outcomes. Lymph node metastasis should be detected as accurately as possible before and during surgery to identify patients who can benefit from lymphadenectomy. The establishment of an international OCCC database and the development of multicenter clinical studies with international cooperation will help improve the treatment strategy.