Abstract
BackgroundSeveral evidences suggested that ovarian cancer (OC) patients showing isolated lymph node recurrence (ILNR) have an indolent evolution. The aim of the study was to retrospectively review ILNR observed in our Institution over the past 11 years in order to investigate: the pattern of disease progression after the first diagnosis of ILNR, and their clinical outcome.MethodsBetween September 1995 and September 2006, 523 epithelial OC were diagnosed in our centers, and 301 of these relapsed. Cases with a diagnosis of ILNR, and at least 12 months of follow up after the diagnosis of ILNR were included. Post-relapse survival (PRS) was recorded from the date of the diagnosis of ILNR to the date of death or date last seen. Survival probabilities were estimated according to the method of Kaplan and Meier and compared by the log rank test. Cox's regression model with stepwise variable selection was used to analyse the role of clinico-pathological parameters as prognostic factors for PRS.ResultsThirty-two cases were identified as ILNR (10.6% of the recurrences, and 6.1% of the OC population). Most of the patients continued to exhibit the same pattern of progression during follow up, with 75% of the patients free from peritoneal disease after 2 years from the diagnosis of ILNR. Median Post-Relapse Survival (PRS) was 37 months, and median Overall Survival (OS) was 109 months, with all patients surviving more than 2 years after the initial diagnosis. In multivariate analysis only Platinum-Free Interval (PFI) retained a prognostic role for PRS (p value = 0.033).ConclusionILNR represents a less aggressive pattern of OC relapse which keeps progressing in the lymph nodes in a relatively high percentage of cases. On the other hand, the occurrence of peritoneal spreading after ILNR is associated with a rapidly fatal outcome.
Highlights
Several evidences suggested that ovarian cancer (OC) patients showing isolated lymph node recurrence (ILNR) have an indolent evolution
The pattern of recurrence has been shown to play a role in conditioning the clinical outcomes: OC patients suffering from recurrence with a prevalent pattern of diffuse abdominal carcinomatosis exhibit an unfavourable prognosis compared to cases presenting with discrete lesions, regardless of Platinum-Free Interval (PFI) duration [2,5,6]
Several evidences suggest that lymph node disease in OC may progress in an indolent fashion; in particular i) the clinical outcome of primary OC patients staged as FIGO stage IIIC only on the basis of lymph node involvement is more favourable compared to the prognosis of patients with peritoneal FIGO stage III disease [11,12,13,14]; ii) retroperitoneal residual tumor at second-look did not seem to influence survival [15]; iii) the clinical impact of systematic lymphadenectomy at primary surgery is still a debated issue in OC [16,17,18], suggesting a minor role of extensive lymph node dissection compared to primary maximal surgical effort for intraperitonal disease
Summary
Several evidences suggested that ovarian cancer (OC) patients showing isolated lymph node recurrence (ILNR) have an indolent evolution. Several evidences suggest that lymph node disease in OC may progress in an indolent fashion; in particular i) the clinical outcome of primary OC patients staged as FIGO stage IIIC only on the basis of lymph node involvement is more favourable compared to the prognosis of patients with peritoneal FIGO stage III disease [11,12,13,14]; ii) retroperitoneal residual tumor at second-look did not seem to influence survival [15]; iii) the clinical impact of systematic lymphadenectomy at primary surgery is still a debated issue in OC [16,17,18], suggesting a minor role of extensive lymph node dissection compared to primary maximal surgical effort for intraperitonal disease All this data suggests that tumor cells metastasizing or recurring through the lymphatic versus the transcoelomic route have distinct, less aggressive biological features. While ILNR could represent a peculiar setting in order to investigate whether lymphophilic OC cells tend to have a distinct, potentially indolent biologic behaviour, the natural history of disease after the diagnosis/treatment of ILNR has been not yet addressed
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