THE SIGNIFICANCE OF PARACARDIAC LYMPH-NODE ENLARGEMENT IN OVARIAN-CANCER

The computed tomography (CT) scans of 78 patients with stage II, stage III and relapsed stage I ovarian carcinoma were reviewed in order to identify the incidence of enlarged paracardiac lymph nodes in this dis ease, recognize their association, if any, with peritoneal metastases and establish whether they had any bearing on progression free interva l and survival. Twenty-two patients (28%) were found to have enlarged paracardiac nodes, nine at initial presentation and a further 13 durin g the course of follow-up. The association between paracardiac node en largement and peritoneal metastases was found to be highly significant . Thirty per cent of 27 patients with peritoneal metastases at present ation were found to have enlarged paracardiac nodes whereas of the 51 patients without peritoneal dissemination only 2% had enlarged paracar diac nodes (P < 0.001). In order to determine whether paracardiac noda l status had any independent prognostic value, multivariate analysis u sing Cox's regression was performed, When status at presentation was c onsidered, the presence of enlarged paracardiac lymph modes was found to be an independent predictor for survival, (Hazard ratio 3.70, 95% c onfidence interval (1.18-11.6), P < 0.04). The hazard ratio for paraca rdiac nodal status with respect to progression free survival was not s ignificant but in the expected direction, (Hazard ratio 1.85 (0.65-5.2 5).) When time-dependent covariate analysis was applied, paracardiac n odal status and peritoneal metastases status were found to be independ ent predictors for both progression free survival and overall survival . The presence of peritoneal metastases indicated a poorer prognosis t han the presence of paracardiac lymph nodes, the hazards ratios for pr ogression free survival were 12.9 and 2.58, respectively, and those fo r survival were 20.7 and 3.62, respectively. We have demonstrated that the presence of paracardiac lymph node enlargement is a significant a dverse prognostic factor for both progression free interval and surviv al. The diagnosis of involved paracardiac lymph nodes is important as it can define patients having stage IV as opposed to stage III disease .