title: [Treatment and prognostic analysis of ovarian cancer patients with isolated region of lymph node recurrence].
abstract: OBJECTIVE
  To evaluate the management and survival of lymph node region recurrence of epithelial ovarian cancer (EOC), and discuss its suitable therapeutic strategy.
  
  
  METHODS
  Thirty-eight patients with the recurrence of lymph node region were extracted from 1945 patients who were diagnosed EOC and treated in Sun Yat-sen University Cancer Center from January 1995 to December 2008. The clinical characteristics, therapy methods and survival of them were retrospectively analyzed. Patient age at initial diagnosis was > 50 years old in 24 patients and ≤ 50 years old in 14 patients. There were 15 cases with stage II and 23 cases with stage III in terms of initial International Federation of Gynecology and Obstetrics (FIGO, 1987) staging. Classified with histological grade, 7 cases were in G(1), 14 cases were in G(2), 17 cases were in G(3); according to the histological types, 19 cases were with serous adenocarcinomas, and 19 cases were with non-serous adenocarcinomas (including 9 endometrioid adenocarcinoma, 1 mucinous adenocarcinoma and 9 unclassified adenocarcinoma). The median follow-up time was 59 months (ranged 16 to 124 months).
  
  
  RESULTS
  (1) Feature of recurrences: the median interval of last treatment to recurrence was 18 months (range 9 to 96 months). Most of them were absence of symptoms. The serum level of CA(125) was elevated in 15 patients (39%, 15/38). (2) Treatment of recurrences:of the 38 patients, 19 underwent lymphadnectomy for recurrence regions and received adjuvant chemotherapy (surgery + chemotherapy group), 14 received local radiotherapy and adjuvant chemotherapy (radiotherapy + chemotherapy group), 5 received chemoherapy only (chemotherapy group). There were 35 cases achieved complete response (CR), including 19 patients underwent secondary debulking surgery in surgery + chemotherapy group, 14 cases in radiotherapy + chemotherapy group (12 of them treated by radiotherapy, the other 2 cases reached CR after adjuvant chemotherapy) and 2 cases in chemotherapy group. While only 3 patients reached partial response in chemotherapy group. (3) Survival and second recurrences: during follow-up, 14 cases died of tumor, 4 cases survival with tumor while 20 cases survival without evidence of tumor. The 5-year post-recurrence survival rate of 38 cases was 66.5%, with 71.8%, 68.8% and 40.0% in surgery + chemotherapy, radiotherapy + chemotherapy, and chemotherapy group, respectively, and there was no significant difference in survival rate between them (P > 0.05). A total of 15 patients experienced second recurrences, including 7 cases with peritoneal and 8 cases with lymph node region recurrences. (4) Prognosis factors: the univariate analysis shown that survival after recurrence was significantly related to patient age, tumor-free interval and number of recurrence disease (P < 0.05), while not to FIGO stage, histological type, histological grade, and lymphadnectomy during primary surgery (P > 0.05). The multivariate analysis showed that patient age and tumor-free interval were independent prognostic variables for survival after recurrence (P < 0.05).
  
  
  CONCLUSIONS
  The lymph node region recurrence of EOC may be have good prognosis and distinctive clinical process. Local treatment strategies including secondary surgery and radiotherapy should be considered, which may significantly improve survival in ovarian cancer patients with lymph node region recurrence.
authors: Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.
authors: Hua
authors: H
authors: Tu
authors: He
authors: H
authors: Huang
authors: Qi-dan
authors: QD
authors: Huang
authors: Zheng
authors: Z
authors: Li
authors: Yan-ling
authors: YL
authors: Feng
authors: Ji-hong
authors: JH
authors: Liu
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D018284:Cystadenocarcinoma, Serous / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012008:Recurrence; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents