SynthesisInternational journal of gynecological cancer : official journal of the International Gynecological Cancer Society2026
Frequency of lymph node involvement in clinically early-stage low-grade serous ovarian cancer: a systematic review and meta-analysis.
Synthesis in International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThe objective of this systematic review and meta-analysis was to estimate the incidence of lymph node metastasis among patients with clinically early-stage (International Federation of Gynecology and Obstetrics 2014 stage I-IIA) low-grade serous ovarian carcinoma undergoing primary surgical treatment.
methodsRegistered in International Prospective Register of Systematic Reviews (CRD420251165472), this systematic review was conducted in accordance with the Meta-analysis of Observational Studies in Epidemiology guidelines. We searched Ovid MEDLINE, Embase, and Web of Science from inception through September 2025. Eligible studies included patients with pathologically confirmed low-grade serous ovarian carcinoma who were clinically presumed to have International Federation of Gynecology and Obstetrics 2014 stage I to IIA disease at surgery and underwent primary surgical management with pelvic and/or para-aortic lymph node dissection. We conducted a meta-analysis of single proportions to estimate the pooled rate of lymph node metastasis. Study-specific proportions (events/total) were pooled using an inverse-variance random-effects model with Freeman-Tukey double-arcsine transformation and back-transformed to proportions with 95% confidence intervals. Subgroup analyses excluded registry-based studies, studies at high risk of bias, and stage II disease.
resultsAmong 129 screened records, 8 studies met the inclusion criteria after full-text review. Overall, 77 patients had lymph node metastasis, corresponding to a pooled incidence of lymph node metastasis of 9.6% (95% confidence interval 4.4% to 16.0%; I
conclusionsApproximately 1 in 10 patients with clinically early-stage low-grade serous ovarian carcinoma harbors occult nodal metastasis. These findings support discussing lymph node assessment as a source of staging information during preoperative counseling and individualized surgical planning. The prognostic and therapeutic value of identifying isolated nodal disease and the morbidity trade-offs in this setting remain unclear.
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