Relevance of enlarged cardiophrenic lymph nodes in determining prognosis of patients with advanced ovarian cancer

Nuruzzaman, Hasan Shahriar Md; Tan, Grace Hwei Ching; Nadarajah, Ravichandran; Teo, Melissa Ching Ching

doi:10.1136/bcr-2017-221450

Cited by 4 publications

(7 citation statements)

References 46 publications

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“…Peritoneal tumors, especially ovarian malignancies, preferentially metastasize to CPLNs and anterior lymphatics along the internal mammary chains (30,31). Enlarged CPLNs in advanced ovarian cancer indicate mediastinal involvement, and CPLNs are one of the most common sites of extra-abdominal spread of disease (31,32).…”

Section: Lymphatic Pathologic Conditionsmentioning

confidence: 99%

Routes of Transdiaphragmatic Migration from the Abdomen to the Chest

et al. 2020

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The diaphragm serves as an anatomic border between the abdominal and thoracic cavities. Pathologic conditions traversing the diaphragm are often incompletely described and may be overlooked, resulting in diagnostic delays. Several routes allow abdominal contents or pathologic processes to spread into the thorax, including along normal transphrenic structures, through congenital defects in the diaphragm, through inherent areas of weakness between muscle groups, or by pathways created by tissue destruction, trauma, or iatrogenic injuries. A thorough knowledge of the anatomy of the diaphragm can inform an accurate differential diagnosis. Often, intraperitoneal pathologic conditions crossing the diaphragm may be overlooked if axial imaging is the only approach to this complex region because of the horizontal orientation of much of the diaphragm. Multiplanar capabilities of volumetric CT and MRI provide insight into the pathways where pathologic conditions may traverse this border. Knowledge of these characteristic routes and use of multiplanar imaging are critical for depiction of specific transdiaphragmatic pathologic conditions. © RSNA, 2020 • radiographics.rsna.org

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Section: Lymphatic Pathologic Conditionsmentioning

confidence: 99%

Routes of Transdiaphragmatic Migration from the Abdomen to the Chest

et al. 2020

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“…Thirteen articles described retrospective cohort studies [ 9 , 11 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ], one was a case report [ 34 ], and one a case series [ 35 ]. The studies spanned the period from 1997 to 2020.…”

Section: Resultsmentioning

confidence: 99%

“…Regarding the impact of CPLN resection during cytoreductive surgery, nine studies reported the mean size of preoperative suspicious nodes [ 11 , 23 , 24 , 25 , 26 , 28 , 29 , 32 , 34 ]. The baseline characteristics are presented in Table 2 .…”

Section: Resultsmentioning

confidence: 99%

“…The mean size of preoperative CPLN was 9.1 ± 3.75 mm. Four studies evaluated the CPLN location; right, left, bilateral and midline, and unknown [ 25 , 28 , 31 , 34 ]. Nearly 50% of the enlarged nodes were located in the right mediastinum.…”

Section: Resultsmentioning

confidence: 99%

“…In our analysis, about 30% of CPLN-resected patients had ≥Clavien–Dindo grade IIIa. The authors of the various publications concluded, however, that the procedure was feasible, the morbidity rate acceptable, and no procedure-related deaths had occurred [ 23 , 24 , 28 , 34 , 44 ].…”

Section: Discussionmentioning

confidence: 99%

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Survival in Advanced-Stage Epithelial Ovarian Cancer Patients with Cardiophrenic Lymphadenopathy Who Underwent Cytoreductive Surgery: A Systematic Review and Meta-Analysis

Kengsakul

Boer

Bijleveld

et al. 2021

Cancers

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Purpose: To evaluate the clinical outcomes of enlarged cardiophrenic lymph node (CPLN) in advanced-stage epithelial ovarian cancer (AEOC) patients who underwent cytoreductive surgery. Methods: The Embase, Medline, Web of Science, Cochrane Library, and Google Scholar databases were searched for articles from the database inception to June 2021. Meta-analysis was conducted to determine the prognostic impact of surgical outcome, postoperative complication, and survival using random-effects models. Results: A total of 15 studies involving 727 patients with CPLN adenopathy and 981 patients without CPLN adenopathy were included. The mean size of preoperative CPLN was 9.1± 3.75 mm. Overall, 82 percent of the resected CPLN were histologically confirmed pathologic nodes. Surgical outcomes and perioperative complications did not differ between both groups. The median OS time was 42.7 months (95% CI 10.8–74.6) versus 47.3 months (95% CI 23.2–71.2), in patients with and without CPLN adenopathy, respectively. At 5 years, patients with CPLN adenopathy had a significantly increased risk of disease recurrence (HR 2.14, 95% CI 1.82–2.52, p < 0.001) and dying from the disease (HR 1.74, 95% CI 1.06–2.86, p = 0.029), compared with those without CPLN adenopathy. CPLN adenopathy was significantly associated with ascites (OR 3.30, 95% CI 1.90–5.72, p < 0.001), pleural metastasis (OR 2.58, 95% CI 1.37–4.82, p = 0.003), abdominal adenopathy (OR 2.30, 95% CI 1.53–3.46, p < 0.001) and extra-abdominal metastasis (OR 2.30, 95% CI 1.61–6.67, p = 0.001). Conclusions: Enlarged CPLN in preoperative imaging is highly associated with metastatic involvement. Patients with CPLN adenopathy had a lower survival rate, compared with patients without CPLN adenopathy. Further randomized controlled trials should be conducted to definitively demonstrate whether CPLN resection at the time of cytoreductive surgery is beneficial.

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Cardiophrenic lymph nodes in advanced ovarian cancer

Agusti,

Bonaldo,

Kahn

et al. 2023

Int J Gynecol Cancer

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Epithelial ovarian cancer most commonly presents at advanced stages, and prognosis is influenced by residual disease following cytoreduction. The significance of cardiophrenic lymph node resection at the time of cytoreductive surgery in advanced ovarian cancer remains a topic of debate. Enlarged cardiophrenic lymph nodes are detected through high-resolution imaging; however, the optimal imaging technique in determining feasibility of node resection remains uncertain. Similarly, the impact of excision of cardiophrenic lymph nodes on progression-free and overall survival remains elusive. The indications for resection of cardiophrenic lymph nodes are not addressed in standard ovarian cancer guidelines. Patients with cardiophrenic lymph nodes exceeding 1 cm in size may be considered for resection if complete intra-abdominal cytoreduction is feasible to no gross residual. The surgical approach might be either by open access or by video-assisted thoracoscopic surgery (minimally invasive approach), and major complications following cardiophrenic lymph nodes resection are low. Pathological cardiophrenic lymph nodes are associated with a poorer overall prognosis and can serve as a prognostic parameter; however, the therapeutic benefit of cardiophrenic lymph nodes resection remains inconclusive.

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Relevance of enlarged cardiophrenic lymph nodes in determining prognosis of patients with advanced ovarian cancer

Cited by 4 publications

References 46 publications

Routes of Transdiaphragmatic Migration from the Abdomen to the Chest

Routes of Transdiaphragmatic Migration from the Abdomen to the Chest

Survival in Advanced-Stage Epithelial Ovarian Cancer Patients with Cardiophrenic Lymphadenopathy Who Underwent Cytoreductive Surgery: A Systematic Review and Meta-Analysis

Cardiophrenic lymph nodes in advanced ovarian cancer

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