Legge Francesco, Petrillo Marco, Adamo Vincenzo, Pisconti Salvatore, Scambia Giovanni, Ferrandina Gabriella
Gynecologic Oncology Unit, Department of Oncology, Catholic University of Campobasso, Italy.
BMC Cancer. 2008 Dec 12;8:367. doi: 10.1186/1471-2407-8-367.
Several 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.
Between 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.
Thirty-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).
ILNR 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.
多项证据表明，出现孤立性淋巴结复发（ILNR）的卵巢癌（OC）患者病情发展较为缓慢。本研究旨在回顾性分析过去11年在我院观察到的ILNR情况，以调查：首次诊断ILNR后的疾病进展模式及其临床结局。
1995年9月至2006年9月期间，我院中心诊断出523例上皮性OC，其中301例复发。纳入诊断为ILNR且在诊断ILNR后至少随访12个月的病例。记录复发后生存期（PRS），从ILNR诊断日期至死亡日期或最后一次随访日期。根据Kaplan-Meier方法估计生存概率，并通过对数秩检验进行比较。采用逐步变量选择的Cox回归模型分析临床病理参数作为PRS预后因素的作用。
32例被确定为ILNR（占复发病例的10.6%，占OC患者总数的6.1%）。大多数患者在随访期间继续表现出相同的进展模式，75%的患者在诊断ILNR后2年无腹膜疾病。复发后中位生存期（PRS）为37个月，总中位生存期（OS）为109个月，所有患者在初始诊断后存活超过2年。多因素分析中，仅无铂间期（PFI）对PRS具有预后作用（p值 = 0.033）。
ILNR代表一种侵袭性较低的OC复发模式，在相当比例的病例中，复发局限于淋巴结。另一方面，ILNR后出现腹膜播散与快速致命的结局相关。
