Clinical features and outcomes of neck lymphatic metastasis in ovarian epithelial carcinoma
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WORLD JOURNAL OF SURGICAL ONCOLOGY
RESEARCH
Open Access
Clinical features and outcomes of neck lymphatic metastasis in ovarian epithelial carcinoma Chien-Wen Chen1,2, Pao-Ling Torng1*, Chi-Ling Chen3 and Chi-An Chen1
Abstract Background: Neck 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. Methods: The 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. Results: Eleven 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). Conclusions: A 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. Keywords: Epithelial ovarian cancer, Neck lymph node metastasis, Survival
Background 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. Affected patients are classified as stage IIIc according to the FIGO staging system. However, a small group of these patients only have retroperitoneal lymph node metastasis without intra* Correspondence: [email protected] 1 Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung Shan South Road, Taipei 10002, Taiwan Full list of author information is available at the end of the article
peritoneal carcinomatosis and are upstaged from stages I through IIIB disease to stage IIIc. These patients are reported to have a better survival compared with typical EOC patients who show macroscopic peritoneal carcin
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