Luger 2020.

Study characteristics
Methods	Retrospectively review of patients diagnosed between 2000 and 2016 Austria
Participants	178 stage III and IV ovarian cancer patients Median age at diagnoses was 64.6 years (interquartile range (IQR) 50.8 to 72.7) Only patients without surgically removed enlarged cardiophrenic lymph nodes (CPLN) were eligible for this study FIGO III: 91 (51%); FIGO IV: 87 (49%) Histology Serous: 157 (88%); mucinous: 3 (2%); endometrioid: 13 (7%); clear cell: 5 (3%) Tumour grade: 1: 17 (10%); 2: 82 (46%); 3: 79 (44%) Median follow‐up duration: 49.6 months (IQR 32.9 to 66.3)
Residual disease details	All patients received primary upfront primary debulking surgery (PDS) by dedicated teams including at least one certified gynaecologic oncologist, and all received adjuvant platinum‐based chemotherapy. The authors defined “No residual disease” as complete macroscopic tumour resection at the end of debulking surgery Residual disease groups: NMRD: 133 (75%) RD > 0 cm: 45 (25%)
Outcomes	Overall and progression‐free survival
Risk of bias (QUIPS)	1. Study participation (a‐f): low risk Adequate number of participants and description of target population. Baseline characteristics, eligibility criteria, sampling frame and period/place study took place presented clearly. 2. Study attrition (a‐e): unclear risk Unclear if patients with incomplete follow‐up were excluded before arriving at the stated sample size. Insufficient information to permit judgement. 3. Prognostic factor measurement (a‐f): low risk Valid and reliable measurement of RD Outcome level assessment: Outcome: overall survival 4. Outcome measurement (a‐c): low risk Definition of OS not provided but it usually has a standard definition 5. Adjustment for other prognostic factors (a‐g): low risk HR for OS was adjusted for age (> 64.6 years), CA‐125, paraaortic nodes (positive), stage, residual disease, and CPLN dimension in multivariable Cox model 6. Statistical analysis and reporting (a‐d): high risk No conceptual framework; unclear of variable selection criteria in multivariate model Outcome: progression‐free survival 4. Outcome measurement (a‐c): low risk Definition of PFS not provided but it usually has a standard definition 5. Adjustment for other prognostic factors (a‐g): low risk HR for PFS was adjusted for age (> 64.6 years), CA‐125, paraaortic nodes (positive), stage, residual disease, and CPLN dimension in multivariable Cox model 6. Statistical analysis and reporting (a‐d): high risk No conceptual framework; unclear of variable selection criteria in multivariate model
Notes	Residual disease in multivariate model for: PFS: HR 2.44 (95% CI 1.23 to 4.84), P = 0.011; OS: HR 2.17 (95% CI 1.11 to 4.69), P = 0.028. The upper 95% CI for OS was entered into forest plots as 4.26 so slight margin of error in the reported statistic). Multivariate model was adjusted for age, CA‐125, histologically positive paraaortic lymph nodes, FIGO stage (IIIA to IIIC vs FIGO IVA and IVB), cardiophrenic lymph node (CPLN) and residual disease. Recurrence was observed in 66.9% (n = 119) of patients and the median progression‐free survival was 12.0 months (IQR 5.5 to 30.5). 80 patients (44.9%) died during a median time of follow‐up of 49.6 months (IQR 32.89 to 66.26). Adjuvant chemotherapy: Carboplatin + paclitaxel: 150 (84%); carboplatin: 24 (14%); carboplatin + endoxan: 4 (2%) Platinum response: Refractory + resistant: 35 (20%); sensitive: 143 (80%) A systematic pelvic and paraaortic lymphadenectomy (removal of ≥ 20 retroperitoneal lymph nodes was performed in 84.2% of patients Systematic retroperitoneal lymphadenectomy (removal of ≥ 20 nodes): 150 (84.2%) Sampling retroperitoneal lymphadenectomy (removal of < 20 nodes): 8 (4%) Median number of removed nodes: 26 (IQR 7 to 37) 88 (68%) had exhibited histologically proven retroperitoneal lymph node metastases Intraperitoneal carcinomatosis radiologically evident in 151 (85%) Radiological diagnosis of upper abdominal spread in 72 (41%)