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Incidence and prognostic significance of inguinal lymph node metastasis in women with newly diagnosed epithelial ovarian cancer

  • Julia Chalif
    Correspondence
    Corresponding author at: Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH, United States of America.
    Affiliations
    Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH, United States of America
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  • Meng Yao
    Affiliations
    Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States of America
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  • Morgan Gruner
    Affiliations
    Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH, United States of America
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  • Michelle Kuznicki
    Affiliations
    Division of Gynecologic Oncology; Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH, United States of America
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  • Roberto Vargas
    Affiliations
    Division of Gynecologic Oncology; Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH, United States of America
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  • Peter G. Rose
    Affiliations
    Division of Gynecologic Oncology; Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH, United States of America
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  • Chad Michener
    Affiliations
    Division of Gynecologic Oncology; Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH, United States of America
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  • Robert DeBernardo
    Affiliations
    Division of Gynecologic Oncology; Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH, United States of America
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  • Laura Chambers
    Affiliations
    Division of Gynecologic Oncology; Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH, United States of America

    Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, Columbus, OH, United States of America
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      Highlights

      • The data is limited to guide prognosis and management for inguinal lymph node metastasis (ILNM) in newly diagnosed EOC
      • 27.8% of the ILNM cohort had a mutation in BRCA1, BRCA2, or BRIP1
      • ILNM did not portend a worse clinical outcome compared to all Stage III/IV and Stage IVB patients
      • Resection to no gross residual disease was associated with improved PFS in the ILNM cohort

      Abstract

      Objective(s)

      To assess incidence and oncologic outcomes in women with advanced epithelial ovarian cancer (EOC) with inguinal lymph node metastasis (ILNM) at diagnosis.

      Methods

      An IRB-approved, retrospective single-institution cohort study was performed in women with stage III/IV EOC from 2009 to 2017. Patients with inguinal lymphadenopathy (defined as >1 cm in short axis) clinically or radiographically were identified. The impact of ILNM on progression-free survival (PFS) and overall survival (OS) were assessed.

      Results

      Of the 562 women with advanced EOC, 18 (3.2%) had ILNM at diagnosis, accounting for 25.7% of all patients with stage IVB disease (n = 70). Five patients (27.7%) had a known genetic predisposition for EOC, including BRCA1 (11.1%, n = 2), BRCA2 (11.1%, n = 2) and BRIP1 (5.6%, n = 1). The majority of patients underwent optimal primary cytoreductive surgery (CRS), including debulking of inguinal nodal metastasis (83.3%, n = 15), with 50% (n = 9) having no gross residual disease after surgery. There was no difference in PFS (19.9 vs. 19.9 vs. 17.2 months, p = 0.84) or OS (137.2 vs. 52.9 vs. 67.6 months, p = 0.29) in women with stage III/IV with ILNM, stage III/IV without ILNM, and stage IVB disease without ILNM, respectively. Progression-free survival was improved in women with ILNM who underwent an optimal resection to no macroscopic disease vs. non-optimal resection (27.4 vs. 14.3 months, p = 0.019). Median overall survival at the time of analysis did not reach statistical significance (137.2 vs. 57.3 months, p = 0.24).

      Conclusion(s)

      In this retrospective cohort study, 3.2% of women with advanced EOC presented with ILNM at diagnosis. Although ILNM did not portend worse clinical outcomes compared to all Stage III/IV and Stage IVB patients, respectively, resection to no gross residual disease was associated with improved PFS.

      Keywords

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