Clinical significance of enlarged cardiophrenic lymph nodes in advanced ovarian cancer: Implications for survival

Objective Advanced ovarian cancer (OC) commonly spreads to cardiophrenic lymph nodes (CPLNs), and is often visible on preoperative imaging. We investigated the prognostic significance of abnormal CPLNs in OC detected by preoperative CT scans using three different definitions. Methods Patients undergoing primary debulking surgery for stage IIIC/IV with residual disease (RD) ≤ 1.0 cm and a preoperative abdominopelvic CT scan available were included. Scans were reviewed by two blinded radiologists. We characterized abnormal CPLNs using three different definitions: i) qualitative assessment score (QAS); ii) nodes > 7 mm on the short axis; or, iii) nodes ≥ 10 mm on the short axis. We compared overall survival (OS) using the log-rank test. Results Of the 253 patients (mean age 64.0 years), 136 had no gross residual disease (NGR) and 117 had RD. By the QAS definition, CPLNs were abnormal in 28 (11.1%) patients and removed in one case. Among patients with NGR, presence of abnormal CPLNs was associated with worse OS (median OS, 38.4 vs. 69.6 months, p = 0.08). We observed no association between abnormal CPLNs and OS among patients with RD (median OS, 37.5 vs. 28.5 months, p = 0.49). OS was significantly better in NGR group without abnormal CPLNs (median OS for NGR vs. RD, 69.6 vs. 28.5 months, p < 0.001); however, there was no difference in OS between patients with NGR versus RD when abnormal CPLNs were present (median OS, 38.4 vs. 37.5 months, p = 0.99). Lack of benefit from NGR when abnormal CPLNs were present was observed for all three definitions tested. Conclusion Abnormal CPLNs are an important predictor of survival in advanced stage OC. Management of abnormal CPLNs should be considered in treatment planning when the goal is NGR.