Mert I, et al. - In this study, researchers sought to assess the prognostic significance of abnormal cardiophrenic lymph nodes (CPLNs) in ovarian cancer (OC) detected by preoperative CT scans using three different definitions. They realized that in advanced stage OC, abnormal CPLNs were an important predictor of survival. They recommended considering management of abnormal CPLNs in treatment planning when the goal is no gross residual disease (NGR).

Methods

• Researchers included patients undergoing primary debulking surgery for stage IIIC/IV with residual disease (RD) ≤ 1.0 cm and a preoperative abdominopelvic CT scan available.
• Two blinded radiologists reviewed the scans.
• Using three different definitions, they characterized abnormal CPLNs:
• i) Qualitative assessment score (QAS);
• ii) Nodes > 7 mm on the short axis; or,
• iii) Nodes ≥ 10 mm on the short axis.
• Overall survival (OS) using the log-rank test was compared.

Results

• Researchers included 253 patients (mean age 64.0 years); 136 had no gross residual disease (NGR) and 117 had RD.
• As per QAS definition,CPLNs were abnormal in 28 (11.1%) patients and removed in one case.
• Presence of abnormal CPLNs was associated with worse OS (median OS, 38.4 vs 69.6 months, p=0.08) among patients with NGR.
• Among patients with RD, they noticed no association between abnormal CPLNs and OS (median OS, 37.5 vs 28.5 months, p=0.49).
• They observed significantly better OS in NGR group without abnormal CPLNs (median OS for NGR vs RD, 69.6 vs 28.5 months, p < 0.001); however, no difference was observed in terms of OS between patients with NGR vs RD when abnormal CPLNs were present (median OS, 38.4 vs 37.5 months, p=0.99).
• For all three definitions tested, they observed lack of benefit from NGR when abnormal CPLNs were present.