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 disease, recognize their association, if any, with peritoneal metastases and establish whether they had any bearing on progression free interval and survival. Twenty-two patients (28%) were found to have enlarged paracardiac nodes, nine at initial presentation and a further 13 during the course of follow-up. The association between paracardiac node enlargement and peritoneal metastases was found to be highly significant. Thirty per cent of 27 patients with peritoneal metastases at presentation were found to have enlarged paracardiac nodes whereas of the 51 patients without peritoneal dissemination only 2% had enlarged paracardiac nodes (P < 0.001). In order to determine whether paracardiac nodal status had any independent prognostic value, multivariate analysis using Cox's regression was performed. When status at presentation was considered, the presence of enlarged paracardiac lymph nodes was found to be an independent predictor for survival. (Hazard ratio 3.70, 95% confidence interval (1.18-11.6), P < 0.04.) The hazard ratio for paracardiac nodal status with respect to progression free survival was not significant but in the expected direction. (Hazard ratio 1.85 (0.65-5.25).) When time-dependent covariate analysis was applied, paracardiac nodal status and peritoneal metastases status were found to be independent predictors for both progression free survival and overall survival. The presence of peritoneal metastases indicated a poorer prognosis than the presence of paracardiac lymph nodes, the hazards ratios for progression free survival were 12.9 and 2.58, respectively, and those for survival were 20.7 and 3.62, respectively. We have demonstrated that the presence of paracardiac lymph node enlargement is a significant adverse prognostic factor for both progression free interval and survival. The diagnosis of involved paracardiac lymph nodes is important as it can define patients having stage IV as opposed to stage III disease.