What are the implications of radiologically abnormal cardiophrenic lymph nodes in advanced ovarian cancer? An analysis of tumour burden, surgical complexity, same-site recurrence and overall survival

Addley, Susan; Asher, Viren; Kirke, Rathy; Bali, Anish; Abdul, S; Phillips, Andrew

doi:10.1016/j.ejso.2022.06.006

Cited by 4 publications

(5 citation statements)

References 37 publications

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“…Through the addition of quantitative indicators, the prediction effect of the model had been greatly improved. Other studies on the CALN in ovarian cancer had also confirmed the significance of the size of the CALN in the diagnosis of PM [ 20 , 21 ]. This revealed the significance of quantitative indicators in the evaluation of CALN.…”

Section: Discussionmentioning

confidence: 79%

“…The cardiophrenic angle lymph node (CALN) was effective in predicting rectal and ovarian cancer peritoneal metastasis [ 17 , 18 ]. Especially for ovarian cancer, the cardiophrenic angle lymph nodes showed predictive value in diagnosis and prognosis [ 19 – 21 ]. Moreover, CT scanning of cardiophrenic lymph nodes could be performed at the same time as routine abdominal CT scanning, without the need to book additional examinations again.…”

Section: Introductionmentioning

confidence: 99%

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Construction of a nomogram model for predicting peritoneal metastasis in gastric cancer: focused on cardiophrenic angle lymph node features

Shi

Yang

et al. 2023

Abdom Radiol

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Background A different treatment was used when peritoneal metastases (PM) occurred in patients with gastric cancer (GC). Certain cancers' peritoneal metastasis could be predicted by the cardiophrenic angle lymph node (CALN). This study aimed to establish a predictive model for PM of gastric cancer based on the CALN. Methods Our center retrospectively analyzed all GC patients between January 2017 and October 2019. Pre-surgery computed tomography (CT) scans were performed on all patients. The clinicopathological and CALN features were recorded. PM risk factors were identified via univariate and multivariate logistic regression analyses. The receiver operator characteristic (ROC) curves were generated using these CALN values. Using the calibration plot, the model fit was assessed. A decision curve analysis (DCA) was conducted to assess the clinical utility. Results 126 of 483 (26.1%) patients were confirmed as having peritoneal metastasis. These relevant factors were associated with PM: age, sex, T stage, N stage, enlarged retroperitoneal lymph nodes (ERLN), CALN, the long diameter of the largest CALN (LD of LCALN), the short diameter of the largest CALN (SD of LCALN), and the number of CALNs (N of CALNs). The multivariate analysis illustrated that the LD of LCALN (OR = 2.752, p < 0.001) was PM’s independent risk factor in GC patients. The area under the curve (AUC) of the model was 0.907 (95% CI 0.872–0.941), demonstrating good performance in the predictive value of PM. There is excellent calibration evident from the calibration plot, which is close to the diagonal. The DCA was presented for the nomogram. Conclusion CALN could predict gastric cancer peritoneal metastasis. The model in this study provided a powerful predictive tool for determining PM in GC patients and helping clinicians allocate treatment.

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Section: Discussionmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Construction of a nomogram model for predicting peritoneal metastasis in gastric cancer: focused on cardiophrenic angle lymph node features

Shi

Yang

et al. 2023

Abdom Radiol

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“…This underscores the complex nature of ovarian cancer, where symptoms and complications often arise from intraabdominal disease burden. Previous studies have suggested suspicious CPLNs to be a marker for upper abdominal disease, such as thoracic involvement at relapse [ 20 ]. However, neoplastic metastases associated with mechanical obstruction, and subsequent tumor-induced morbidity occurred mostly in the small and large intestines when multifocal, and in the rectosigmoid region when unifocal.…”

Section: Discussionmentioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

Prognostic impact of suspicious extraabdominal lymph nodes on patient survival in advanced ovarian cancer

Park,

Kwon,

Song

et al. 2024

PLoS ONE

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Objective To evaluate the clinical impact of suspicious extra-abdominal lymph nodes (EALNs) identified preoperatively on CT and/or PET/CT images in advanced ovarian cancer. Methods A retrospective study was conducted with 122 patients diagnosed with stage III or IV ovarian cancer with preoperative CT and/or PET/CT images from 2006 to 2022. Imaging studies were evaluated for the presence, size and location of suspicious EALNs. Suspicious lymph node enlargement was defined by a cut-off ≥5mm short-axis dimension on CT and/or lesions with maximum standardized uptake values of ≥2.5 on PET/CT. This study only included patients who did not have their EALNs surgically removed. Results A total 109 patients met the inclusion criteria; 36 (33%) had suspicious EALNs and were categorized as “node-positive”. The median overall survival (OS) was 45.73 months for the “node-positive” and 46.50 months for the “node-negative” patients (HR 1.17, 95% CI 0.68–2.00, p = 0.579). In multivariate analysis, after adjusting for other variables selected by process of backward elimination using a significance level of p<0.20, suspicious EALNs still showed no clinical significance on OS (aHR 1.20, 95% CI 0.67–2.13, p = 0.537) as well as progression-free survival (aHR 1.43, 95% CI 0.85–2.41, p = 0.174). Old age (aHR 2.23, 95% CI 1.28–3.89, p = 0.005) and platinum resistance (aHR 1.92, 95% CI 1.10–3.36, p = 0.023) affects adversely on OS. Conclusion Suspicious EALNs did not worsen the prognosis of patients with advanced ovarian cancer. However, its impact on survival is not yet clarified. Further investigation is required to assess the clinical significance of suspicious EALNs on preoperative imaging studies.

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“…As the same, though evidence confirmed the safety of cardiophrenic angle lymph node (CPLN) dissection, the correlation between this procedure and prognosis remains unclear. Several studies had found that CPLN dissection did not prove a statistically significant therapeutic benefit ( 48 , 49 ). Up to date, the impact of HCLN and CPLN resection on survival remains uncertain, and no recommendation can be made based on evidence.…”

Section: Discussionmentioning

confidence: 99%

A retrospective analysis for investigating the relationship between FIGO stage IVA/IVB and cytoreductive surgery with prognosis in epithelial ovarian cancer

Hong¹,

Luo²,

Peng³

et al. 2023

Front. Oncol.

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ObjectiveTo investigate the effect of primary debulking surgery (PDS), NACT followed by interval debulking surgery (NACT-IDS), and chemotherapy alone on the prognosis of FIGO stage IV epithelial ovarian cancer (EOC) with different metastatic patterns.MethodsWe retrospectively analyzed 133 cases of FIGO stage IV EOC with pleural effusion (stage IVA), parenchymal metastases (stage IVB), or extra-abdominal lymph node metastases (stage IVB) at our Hospital between January 2014 and July 2021.ResultsAmong 133 cases with stage IV disease, 16.5% (n=22) presented with pleural effusion, 46.6% (n=62) with parenchymal metastases, and 36.9% (n=49) with extra-abdominal lymph node metastases. Regardless of the metastatic patterns, the 90.2% (n=120) of cases who underwent PDS/NACT-IDS exhibited a significantly superior overall survival (OS) compared to the 9.8% cases (n=13) who received chemotherapy alone (32 vs 17 months, p=0.000). The cohort was further stratified into 58 cases (48.3%) with R0, 41 cases (34.2%) with R1, and 21 cases (17.5%) with R2. The median OS of cases with R0 was significantly better than that of cases with R1/R2 (74 vs 27 months, p=0.000). There was no significant difference in median OS between PDS and NACT-IDS (43 vs 31 months, p=0.676), as well as between FIGO IVA and IVB (35 vs 31 months, p=0.582). Additionally, the metastatic patterns and the number of neoadjuvant chemotherapy cycles (≤4 or >4) did not demonstrate any prognostic significance for median OS (p=0.820 and 33 vs 26 months, p=0.280, respectively).ConclusionRegardless of FIGO IVA and IVB stages or metastatic patterns, patients diagnosed with stage IV EOC may benefit from cytoreductive surgery with abdominal R0, compared with chemotherapy alone.

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What are the implications of radiologically abnormal cardiophrenic lymph nodes in advanced ovarian cancer? An analysis of tumour burden, surgical complexity, same-site recurrence and overall survival

Cited by 4 publications

References 37 publications

Construction of a nomogram model for predicting peritoneal metastasis in gastric cancer: focused on cardiophrenic angle lymph node features

Construction of a nomogram model for predicting peritoneal metastasis in gastric cancer: focused on cardiophrenic angle lymph node features

Prognostic impact of suspicious extraabdominal lymph nodes on patient survival in advanced ovarian cancer

A retrospective analysis for investigating the relationship between FIGO stage IVA/IVB and cytoreductive surgery with prognosis in epithelial ovarian cancer

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