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Prognostic significance of supradiaphragmatic lymph nodes at initial presentation in patients with stage III high-grade serous ovarian cancer

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Abstract

Purpose

To identify the optimal size threshold and to assess the prognostic significance of supradiaphragmatic lymph nodes at initial presentation of patients with high-grade serous ovarian cancer (HGSC).

Methods

This IRB-approved, HIPAA-compliant retrospective study included baseline pretreatment staging abdominal CTs of 88 women (mean age 62 years, SD 10.4, range 29–85) with FIGO stage III HGSC. Patients with stage IV disease were excluded due to worse prognosis and management guided by distant metastases. Two fellowship-trained radiologists independently reviewed abdominal CTs to record the presence of supradiaphragmatic nodes, abdominal lymphadenopathy, peritoneal carcinomatosis, and ovarian mass. Progression-free survival (PFS) and overall survival (OS) were recorded after median 79 months follow-up (IQR 58–115, range 13–144). The optimal short-axis size threshold for supradiaphragmatic lymphadenopathy was determined by correlating 3, 4, 5, 6, 7, and 10 mm thresholds with PFS and OS using Log-rank test. Prognostic significance of supradiaphragmatic lymphadenopathy was assessed using Cox proportional hazards models.

Results

There was good interobserver agreement for presence (κ = 0.65, 95%CI 0.51–0.79) and size (ICC = 0.77, 95%CI 0.66–0.86) of supradiaphragmatic nodes. 5 mm short-axis size threshold was associated with significantly shorter PFS (median 14 months, IQR 11–17 vs. 23 months, IQR 12–59; p = 0.02) and OS (median 44 months, IQR 27–69 vs. 65 months, IQR 45–96; p = 0.03). Total 38/88 (43%) patients had supradiaphragmatic lymphadenopathy. On Cox proportion hazards analysis, supradiaphragmatic lymphadenopathy was significantly associated with shorter PFS (p = 0.02; HR 1.81, 95%CI 1.11–2.96) and OS (p = 0.008; HR 2.11, 95%CI 1.21–3.65).

Conclusion

In patients with stage III HGSC, supradiaphragmatic lymphadenopathy is associated with shorter PFS and OS. Further studies would help determine its implications on staging, decision regarding neoadjuvant therapy, and surgical technique.

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Abbreviations

HGSC:

High-grade serous ovarian cancer

FIGO:

International Federation of Gynecology and Obstetrics

NCCN:

National Comprehensive Cancer Network

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Authors and Affiliations

  1. Department of Radiology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA

    L. J. McIntosh, A. C. O’Neill, S. Bhanusupriya, S. A. Matalon, A. D. Van den Abbeele, N. H. Ramaiya & A. B. Shinagare

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  1. L. J. McIntosh
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  2. A. C. O’Neill
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  3. S. Bhanusupriya
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  4. S. A. Matalon
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  5. A. D. Van den Abbeele
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  6. N. H. Ramaiya
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  7. A. B. Shinagare
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Correspondence to A. B. Shinagare.

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No funding was received for this study.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors. For this type of study formal consent is not required.

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Statement of informed consent was not applicable since the manuscript does not contain any patient data.

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McIntosh, L.J., O’Neill, A.C., Bhanusupriya, S. et al. Prognostic significance of supradiaphragmatic lymph nodes at initial presentation in patients with stage III high-grade serous ovarian cancer. Abdom Radiol 42, 2513–2520 (2017). https://doi.org/10.1007/s00261-017-1158-8

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  • DOI: https://doi.org/10.1007/s00261-017-1158-8

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