Recurrence patterns in patients with abnormal cardiophrenic lymph nodes at ovarian cancer diagnosis

Abstract

ObjectivesMetastases in cardiophrenic lymph nodes noted at diagnosis of epithelial ovarian cancer confer a poor prognosis. It is unclear if cardiophrenic nodal metastases portend an atypical pattern of recurrence. We report on patients with radiographically involved cardiophrenic lymph nodes who underwent optimal primary debulking surgery to describe patterns of recurrence and response to chemotherapy.MethodsPatients undergoing primary debulking surgery for stage IIIC/IV epithelial ovarian carcinoma with residual disease ≤1.0 cm at our institution from 2003 to 2011 with a pre-operative computed tomography (CT) scan were identified. Scans were reviewed by blinded radiologists, who identified abnormal cardiophrenic lymph nodes via a qualitative assessment scale based on size, heterogeneity, and architecture.ResultsOf the 250 patients identified, a recurrence site was documented in 22/27 (81.5%) with abnormal pre-operative cardiophrenic lymph nodes (defined by an elevated Qualitative Assessment Scale (QAS) score of ≥4), and in 128/223 (57.4%) without abnormal pre-operative cardiophrenic lymph nodes. Median short axis and long axis lymph node diameters for these patients was 9 (range 6–15) mm and 15 (range 11–22) mm, respectively. Cardiophrenic lymph nodes were resected in one patient. Patients with abnormal cardiophrenic nodes are more likely to have synchronous recurrence in thorax/pelvis and abdomen (50.0% (11/22) vs 25.0% (32/128), p=0.02) and less likely to have isolated recurrence in pelvis or abdomen (40.9% (9/22) vs 68.0% (87/128)). All patients who had a CT scan after six cycles of chemotherapy had improvement (defined as reduction of QAS score) in cardiophrenic lymphadenopathy.ConclusionsDespite cardiophrenic adenopathy demonstrating a complete radiographic response to chemotherapy, their presence pre-operatively is associated with an increased risk of recurrence in the thorax. Knowledge of this propensity to recur in the thorax is important to ensure all extra-abdominal recurrence sites are diagnosed and managed appropriately.

Role of the Cardiophrenic Lymph Node Status After Neoadjuvant Chemotherapy in Primary Advanced Ovarian Cancer

“…Consistent with the literature, our data revealed a tendency to an impaired prognosis for patients with radiological CPLN enlargement (9,(18)(19)(20)26). Yet, this correlation was not significant in our patient cohort, probably due to the small number of patients and short follow-up time.…”

Cardiophrenic lymph nodes in advanced ovarian cancer

“…According to published data, patients with enlarged cardiophrenic lymph nodes at the time of initial diagnosis might have a higher recurrence rate (81.5% vs 57.4%) than those without pathological nodes. 47 Recurrence pattern maybe different in those with pathological cardiophrenic lymph nodes, showing a higher rate of synchronous recurrence in the thorax, abdomen, and pelvis (50.0% (n=11/22) vs 25.0% (n=32/128)) and a less likely isolated recurrence in the pelvis or abdomen (40.9% (n=9/22) vs 68.0% (n=87/128)). 47 Thus, involvement of cardiophrenic lymph nodes may represent a surrogate marker of a higher likelihood of extensivecarcinomatosis, especially disease in the upper abdomen, conferring a decreased rate of complete intra-abdominal disease resection.…”

“…47 Recurrence pattern maybe different in those with pathological cardiophrenic lymph nodes, showing a higher rate of synchronous recurrence in the thorax, abdomen, and pelvis (50.0% (n=11/22) vs 25.0% (n=32/128)) and a less likely isolated recurrence in the pelvis or abdomen (40.9% (n=9/22) vs 68.0% (n=87/128)). 47 Thus, involvement of cardiophrenic lymph nodes may represent a surrogate marker of a higher likelihood of extensivecarcinomatosis, especially disease in the upper abdomen, conferring a decreased rate of complete intra-abdominal disease resection. 45 Figure 5 shows the comprehensive approach to managing cardiophrenic lymph node involvement in advanced epithelial ovarian cancer.…”