DISTRIBUTION PATTERN AND RISK-FACTORS OF PELVIC AND PARAAORTIC LYMPH-NODE METASTASIS IN EPITHELIAL OVARIAN-CARCINOMA

The distribution of lymph node metastasis and the clinicopathologic ri sk factors for nodal involvement in ovarian carcinoma need to be clari fied based on systematic lymph node dissection. We studied 115 patient s with ovarian carcinoma who underwent systematic pelvic and para-aort ic lymph node dissection between 1987 and 1997, The incidence and dist ribution of lymph node metastasis are described and the clinico-pathol ogic risk factors for nodal involvement are investigated, Based on the occurrence of lymph node metastasis in the early stages, the incidenc e of solitary node involvement and the distribution of lymph node meta stasis, we conclude that the primary site of nodal involvement in ovar ian carcinoma is the para-aortic node (PAN), especially PAN superior t o the inferior mesenteric artery (IMA). By univariate analysis, clinic al stage, histologic type (mucinous vs. others), grade, multiple perit oneal metastases, peritoneal cytology, volume of ascites and serum CA1 25 level were correlated with overall incidence of lymph node metastas is. By performing a multivariate analysis with the clinical stage excl uded, it was revealed that grade and peritoneal cytology were independ ent factors for PAN metastasis (p < 0.0025 and < 0.001, respectively) and that multiple peritoneal metastases and PAN metastasis were signif icant predictors of pelvic node metastasis (p < 0.01 and < 0.005, resp ectively). In conclusion, the PANs superior and inferior to IMA should be explored in staging of ovarian carcinoma thar appears to be confin ed to the ovaries. To determine accurately the extent of disease, both the para-aortic and pelvic areas may need to be sampled or dissected in the case of ovarian carcinoma involving the peritoneal surfaces. In t. J. Cancer (Pred. Oncol.) 79:526-530, 1998. (C) 1998 Wiley-Liss, Inc .