Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Int J Gynecol Cancer. 2010 Aug;20(6):979-84. doi: 10.1111/IGC.0b013e3181e833f5.
It has been hypothesized that the supradiaphragmatic lymph nodes serve as the principal nodes for lymphatic drainage of the entire peritoneal cavity. The purpose of this study was to determine the prognostic significance of enlarged supradiaphragmatic nodes noted on preoperative computed tomographic (CT) scan in patients undergoing primary cytoreduction for advanced epithelial ovarian cancer (EOC).
We performed a retrospective chart review of all patients with stage III and IV EOC according to the International Federation of Gynecology and Obstetrics who had preoperative CT scans, including the supradiaphragmatic region, and had undergone primary cytoreductive surgery at our institution between January 1997 and June 2004. Scans were retrospectively reviewed by a radiologist. We defined supradiaphragmatic adenopathy as nodes measuring greater than 5 mm on the largest of 2 perpendicular measurements on the CT scan. The Fisher exact test was used to compare proportions. Kaplan-Meier curves and log-rank tests were used for the survival analyses.
A total of 212 evaluable patients were identified. All underwent attempted primary cytoreduction followed by systemic chemotherapy. None had any supradiaphragmatic nodes removed at primary cytoreduction. With a median follow-up time of 52 months, median overall survival for the entire cohort was 48 months. Of 212 patients, 92 (43%) had supradiaphragmatic adenopathy. Median survival was 50 months for patients without adenopathy and 45 months for patients with adenopathy (P = 0.09). Of the 212 patients, 155 (73%) underwent optimal cytoreduction. In these patients, median survival was 55 months for the 91 without adenopathy and 50 months for the 64 patients with supradiaphragmatic adenopathy (P = 0.09).
We observed a trend toward worse survival in patients with enlarged supradiaphragmatic nodes. The prognostic impact of supradiaphragmatic adenopathy remains uncertain and deserves further study.
有人假设，膈上淋巴结是整个腹腔淋巴引流的主要淋巴结。本研究旨在确定术前 CT 扫描中发现的膈上肿大淋巴结在接受原发性细胞减灭术治疗晚期上皮性卵巢癌 (EOC) 患者中的预后意义。
我们对 1997 年 1 月至 2004 年 6 月期间在我院接受原发性细胞减灭术的所有国际妇产科联合会 (FIGO) III 期和 IV 期 EOC 患者进行了回顾性图表审查，这些患者术前 CT 扫描包括膈上区域。扫描由放射科医生进行回顾性评估。我们将膈上腺病定义为 CT 扫描上最大的 2 个垂直测量中直径大于 5 毫米的淋巴结。采用 Fisher 确切检验比较比例。采用 Kaplan-Meier 曲线和对数秩检验进行生存分析。
共确定 212 例可评估患者。所有患者均行原发性细胞减灭术，随后行全身化疗。在原发性细胞减灭术中，均未切除任何膈上淋巴结。中位随访时间为 52 个月，整个队列的中位总生存期为 48 个月。在 212 例患者中，92 例 (43%) 有膈上腺病。无腺病患者的中位生存期为 50 个月，有腺病患者的中位生存期为 45 个月 (P = 0.09)。在 212 例患者中，155 例 (73%) 行最佳细胞减灭术。在这些患者中，91 例无腺病患者的中位生存期为 55 个月，64 例膈上腺病患者的中位生存期为 50 个月 (P = 0.09)。
我们观察到有增大的膈上淋巴结的患者生存状况恶化的趋势。膈上腺病的预后影响尚不确定，值得进一步研究。
