Introduction We aimed to evaluate the prognostic impact in patients with the isolated distant lymph node metastases for stage IVB epithelial ovarian cancer.

Methods We conducted a multi-institutional retrospective analysis of patients with stage IV ovarian cancer. We compare OS in women with lymph node as only distant metastatic site to those with pleural metastases only and to patients with other/multiple stage IV ovarian cancer.

Results All 618 eligible patients were screened. These patients were diagnosed with stage IVA (n =135, 21.8%), stage IVB only due to distant lymph node metastases (stage IVB-LN) (n = 163, 26.4%), stage IVB with other/multiple sites of distant metastases (stage IVB-other/multiple) (n =320, 51.8%). The age, histological type, cell differentiation, performance status, postoperative residual tumor, first line chemotherapy among the different stages were balanced (each, P > 0.05). The median OS for patients with stage IVB-LN was 48.62 months (95% CI: 31.25 - 54.29) compared to 29.82 months (95% CI: 23.24- 34.48) for those with stage IVA (p < 0.001) and 21.27 months (95% CI: 15.43 - 28.46) for those with stage IVB-other/multiple (p < 0.001). Multivariable analysis revealed that stage IVB-other/multiple was an independent indicator of increased risk of mortality compared with stage IVB-LN (HR: 2.15, 95% CI: 1.67 - 2.23, p < 0.001); Patients with stage stage IVA had a worse survival compared to those with stage IVB-LN (HR: 1.68, 95% CI: 1.25 -1.84, p=0.019 ).

Conclusion/Implications Stage IVB-LN is associated with better survival compared to stage IVB-other/multiple and stage IVA.