Epithelial ovarian cancer relapsing as isolated lymph node disease: natural history and clinical outcome.
BACKGROUND
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.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Legge
Francesco
F
Gynecologic Oncology Unit, Department of Oncology, Catholic University of Campobasso, Italy. francescolegge@libero.it
Petrillo
Marco
M
Adamo
Vincenzo
V
Pisconti
Salvatore
S
Scambia
Giovanni
G
Ferrandina
Gabriella
G
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D015999:Multivariate Analysis; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D000970:Antineoplastic Agents