The Significance of Paracardiac Lymph-Node Enlargement In Patients With Newly Diagnosed Stage IIIC Ovarian Cancer

abstract

OBJECTIVE:

Extra-abdominal metastases in epithelial ovarian cancer (EOC) are relatively rare. Interpreting computed tomography (CT) scans, during initial work-up, little attention is focused on enlargement of paracardiac lymph nodes (PCLN) and their significance is not clear. We aimed to examine whether the presence of PCLN during initial diagnosis of EOC influences prognosis.

METHODS:

A retrospective study comparing patients with stage 3 EOC who were diagnosed with PCLN on CT scan during initial evaluation to stage 3C patients without PCLN. Scans were reviewed by a single radiologist for peritoneal involvement, distal metastases and presence of PCLN. Disease status at diagnosis, results of surgery, chemotherapy and response, disease free interval (DFI) and overall survival (OS) were recorded.

RESULTS:

Thirty one patients with stage 3C EOC with PCLN on initial CT scan were included and compared with 41 controls. There was no significant difference between groups in abdominal optimal cytoreduction rate. Lower rates of complete response (CR) to initial treatment were detected in the study group (45.2% vs. 78.0%, p=.004). In survival analysis, the DFI for patients with PCLN was shorter (median 9.0 vs. 24.0months, p=.0097) and overall survival was shorter (median 31.7 vs. 61.3months, p=.001). Multivariate analysis showed that PCLN was significantly associated with a lower rate of CR, a shorter DFI and a shorter OS.

CONCLUSION:

The presence of enlarged PCLN at presentation appears to be associated with poor prognosis in Stage 3C EOC. Further attention should be given to detection and follow-up of such findings when considering treatment.