Kliniken Essen-Mitte, Department of Gynecology and Gynecologic Oncology, Essen, Germany.
Kliniken Essen-Mitte, Department of Radiology, Essen, Germany.
Gynecol Oncol. 2019 Jan;152(1):76-81. doi: 10.1016/j.ygyno.2018.11.001. Epub 2018 Nov 18.
Cardiophrenic lymph nodes (CPLN) define FIGO stage IVB disease. We evaluate the pattern of CPLN metastases, their prognostic impact and the potential role of CPLN resection in patients with epithelial ovarian cancer (EOC).
Analysis of 595 consecutive patients with EOC treated in the period 01/2011-05/2016. CT scans were re-reviewed by two radiologists. Positive CPLN were defined as ≥5 mm in the short-axis diameter. The role of CPLN resection was evaluated in a case-control matched-pair analysis.
Of 595 patients 458 had FIGO stage IIIB-IV disease. We excluded patients undergoing interval surgery (n = 54), without debulking surgery (n = 32) and without sufficient pre-operative imaging (n = 22), resulting in a study cohort of 350 patients. Of these, 133 (37.9%) had negative CPLN and 217 (62.0%) had radiologically positive CPLN. In patients with postoperative residual tumor, enlarged CPLN had no impact on survival. In patients with complete resection (n = 223), 98 (44.0%) had negative CPLN and a 5-year OS of 69% and a 5-year PFS of 41%; in contrast, in the 125 patients (56.0%) with positive CPLN, 5-year OS was 30% and 5-year PFS was 13%. In 52 patients we resected CPLN. The matched-pair case-control analysis did not demonstrate any significant impact on survival of CPLN resection.
CPLN metastases are associated with impaired PFS and OS in patients with macroscopically completely resected tumor. Intraabdominal residual tumor has a greater prognostic impact than positive CPLN. The impact of the resection of CPLN remains unclear.
心膈角淋巴结（CPLN）定义为FIGO 分期 IVB 期疾病。我们评估了 CPLN 转移的模式、它们的预后影响以及 CPLN 切除术在卵巢上皮癌（EOC）患者中的潜在作用。
分析了 2011 年 1 月至 2016 年 5 月期间治疗的 595 例连续 EOC 患者。两名放射科医生对 CT 扫描进行了重新评估。CPLN 阳性定义为短轴直径≥5mm。在病例对照配对分析中评估了 CPLN 切除术的作用。
595 例患者中 458 例为 FIGO 分期 IIIB-IV 期。我们排除了接受间隔手术的患者（n=54）、未行减瘤手术的患者（n=32）和无足够术前影像学检查的患者（n=22），结果研究队列中有 350 例患者。其中，133 例（37.9%）CPLN 阴性，217 例（62.0%）CPLN 影像学阳性。在术后残留肿瘤患者中，CPLN 增大对生存无影响。在完全切除肿瘤的患者中（n=223），98 例（44.0%）CPLN 阴性，5 年 OS 为 69%，5 年 PFS 为 41%；相比之下，在 125 例（56.0%）CPLN 阳性的患者中，5 年 OS 为 30%，5 年 PFS 为 13%。在 52 例患者中，我们切除了 CPLN。病例对照配对分析未显示 CPLN 切除术对生存有任何显著影响。
在宏观上完全切除肿瘤的患者中，CPLN 转移与 PFS 和 OS 受损相关。腹腔内残留肿瘤比 CPLN 阳性具有更大的预后影响。CPLN 切除术的影响仍不清楚。
