Does lymphadenectomy predict survival in early-stage epithelial ovarian cancer? An updated systematic review and meta-analysis

Abstract

Background & Objective: The added value of lymphadenectomy is a widely debated topic, especially in cases of early-stage epithelial ovarian cancer (EOC). We present robust evidence through an updated systematic review and meta-analysis regarding the effects of lymphadenectomy on overall survival (OS) and progression-free survival (PFS) in early-stage EOC (eEOC).

Methodology: PubMed, PubMed CENTRAL, Embase, and Web of Science databases were searched from their inception until 10 March 2025 for all types of studies reporting adjusted outcomes of eEOC based on lymphadenectomy. Random-effect meta-analysis, subgroup analysis, and meta-regression were conducted.

Results: Twenty-four studies were included. The number of studies was far more than previously published reviews (4-8 studies). Meta-analysis of 20 and 13 studies showed that patients undergoing lymphadenectomy had significantly better OS (HR: 0.808 95% CI: 0.692, 0.943 I2=34%) and PFS (HR: 0.743 95% CI: 0.583, 0.947 I²=44%) respectively. The estimates were stable on exclusion of majority studies on sensitivity analysis. Meta-regression showed that lymph node metastasis in the lymphadenectomy group and use of chemotherapy in the lymphadenectomy and control groups did not have a significant impact on the results. Subgroup analysis based on study type, location, histology, stage, protocols of study and control groups, and adjustment for chemotherapy and cancer stage in the multivariate analysis of the studies showed mixed results.

Conclusions: Lymphadenectomy in eEOC may lead to better OS and PFS. The retrospective nature of the data and the heterogeneity among studies are significant limitations that warrant caution in interpretation of the results.