Clinical features and outcomes of neck lymphatic metastasis in ovarian epithelial carcinoma

Chien-Wen Chen,Chi-Ling Chen,Chi-An Chen,Pao-Ling Torng

doi:10.1186/1477-7819-11-255

Abstract

BackgroundNeck lymph node metastasis (NLNM) in epithelial ovarian cancer (EOC) is rare and treated as advanced stage cancer. However, ovarian cancer with lymphatic metastasis may manifest a different clinical course from peritoneal carcinomatosis.MethodsThe authors retrospectively assessed 20 patients with EOC and pathologically diagnosed as NLNM between January 2001 and December 2010. The patients were divided into two groups according to the time of NLNM identification. Statistical methods included Kaplan-Meier, log-rank, and Cox regression analysis.ResultsEleven patients were diagnosed with NLNM at the same time of surgical exploration of EOC (Group A) and nine patients at cancer recurrence 43.3 months after initial surgery (Group B). In Group A, patients with tumors confined to the pelvic cavity had no recurrence or had isolated lymph node recurrence (ILNR), and survived longer than patients with abdominal tumor spreading (P = 0.0007). In Group B, 2 patients showed ILNR. The median survival time after NLNM was 42 months in Group A and 6 months in Group B (P = 0.01). Cox model demonstrated that non-serous histology, brain metastasis, and NLNM identified at cancer recurrence were major predictors for poor overall survival (Hazard ratio [HR] = 18.67, 6.93, and 4.52; P = 0.01, 0.02, and 0.04, respectively).ConclusionsA subgroup of EOC patients with NLNM who presented limited pelvic cancer had much better overall survival than patients who had cancer spreading beyond the pelvic cavity or were diagnosed with NLNM at cancer recurrence.

Highlights

Neck lymph node metastasis (NLNM) in epithelial ovarian cancer (EOC) is rare and treated as advanced stage cancer
11 patients identified as having NLNM were classified as Group A; 9 patients identified as having NLNM at ovarian cancer recurrence after previous cancer remission were classified as Group B
NLNM is a manifestation of the advanced disease status of EOC or a unique entity of EOC that spreads via lymphatic routes

Summary

Introduction

Neck lymph node metastasis (NLNM) in epithelial ovarian cancer (EOC) is rare and treated as advanced stage cancer. Epithelial ovarian cancer (EOC) is one of the most lethal gynecological cancers and patients are usually diagnosed at advanced stages with wide spreading of the cancer. Four routes of cancer spreading in EOC have been identified: by direct extension, by a transperitoneal route, by a lymphatic route, and more rarely, through the blood stream [1]. The lymphatic route of cancer dissemination to retroperitoneal pelvic and para-aortic lymph nodes is rather common in advanced-stage EOC. A small group of these patients only have retroperitoneal lymph node metastasis without intra-. We divided our patients into two groups according to the time of NLNM identification: either at initial exploratory surgery or during cancer recurrence. We evaluated the factors that influenced subsequent disease progression, the pattern of cancer recurrence, and the clinical outcomes, aiming to identify the subgroup of patients with NLNM that might have a better survival outcome

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Conclusion