The clinical outcome of epithelial ovarian cancer patients with apparently isolated lymph node recurrence: A multicenter retrospective Italian study

Objectives. To assess the clinical outcome of epithelial ovarian cancer patients who developed an apparently isolated lymph node recurrence after primary therapy. Methods. The authors retrospectively assessed 69 patients with epithelial ovarian cancer who were clinically or pathologically free of disease after primary therapy and who subsequently developed ail apparently isolated lymph node recurrence. The median follow-up of survivors was 74.5 months. Results. Median age was 58 years, FIGO stage was III-IV in 52 (75%) patients, residual disease after primary surgery was >1 cm in 36 (52%), first-line chemotherapy consisted of paclitaxel-/platinum-based chemotherapy in 44 (64%), time to recurrence was >12 months in 43 (62%), recurrence was pelvic and/or para-aortic it) 4 1 (59%), and treatment at recurrence consisted of chemotherapy alone in 44 (64%), surgery plus chemotherapy in 22 (32%), Surgery alone in one patient, surgery Plus irradiation in one, and irradiation alone in one patient. Survival after recurrence was significantly related to the type of treatment (chemotherapy alone versus surgery Plus chemotherapy, median: 20.8 months versus not reached, p = 0.0002), and patient age (>58 versus <58 years, median: 26.8 versus 44.0 months, p 0.02). Overall survival was significantly related to the type of treatment (chemotherapy alone versus surgery Plus chemotherapy, median: 45.4 months Versus not reached, p=0.0001), patient age (>58 versus <58 years, median: 45.4 versus 62.9 months, p = 0.03) and time to recurrence (<12 months versus >12 months, median: 45.4 versus 66.9 months, p=0.01). Cox model showed that treatment at recurrence was the strongest independent prognostic variable for both Survival after recurrence (hazard ratio [HR] = 0.277, p = 0.0003) and overall survival (HR = 0.249, p = 0.0002). Conclusion. Patients who underwent surgery Plus chemotherapy had a 72% reduction in the risk of death after recurrence and a 75% reduction in the risk of death after initial diagnosis when compared with those treated with chemotherapy alone. Secondary cytoreductive surgery appears to be able to prolong survival in epithelial Ovarian cancer patients with apparently isolated lymph node recurrence. (C) 2009 Elsevier Inc. All rights reserved.