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Prognostic significance of supraclavicular lymphadenopathy in patients with high-grade serous ovarian cancer
  1. Paulina Cybulska1,
  2. Sara A Hayes2,
  3. Alexandra Spirtos3,
  4. Michael J Rafizadeh3,
  5. Olga T Filippova1,
  6. Mario Leitao1,
  7. Oliver Zivanovic1,
  8. Yukio Sonoda1,
  9. Jennifer Mueller1,
  10. Yuliya Lakhman2,
  11. Kara Long1 and
  12. Dennis S Chi1
  1. 1 Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York City, New York, USA
  2. 2 Medical Imaging, Memorial Sloan Kettering Cancer Center, New York, New York, United States
  3. 3 Memorial Sloan-Kettering Cancer Center, New York City, New York, USA
  1. Correspondence to Dr Dennis S Chi, Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA; chid{at}mskcc.org

Abstract

Objectives To assess outcomes and patterns of recurrence in patients with high-grade serous ovarian/tubal/primary peritoneal cancers with radiographic supraclavicular lymphadenopathy at diagnosis.

Methods We evaluated all patients with newly diagnosed high-grade serous ovarian cancers treated at our center between January 1, 2008 and May 1, 2013 who had supraclavicular lymphadenopathy (defined as ≥1 cm in short axis) on radiographic imaging (either computed tomography or positron emission tomography) at the time of diagnosis.

Results Of 586 patients with high-grade serous ovarian cancer receiving primary treatment during the study period, we identified 13 (2.2%) with supraclavicular lymphadenopathy diagnosed on pre-treatment imaging. The median age at diagnosis was 52.0 years (range 38.2–72.3). Five (31%) had clinically palpable nodes on physical examination. Four (31%) had a known BRCA mutation. All 13 patients underwent neoadjuvant chemotherapy, followed by interval debulking surgery. Each patient received a median of four cycles of neoadjuvant intravenous chemotherapy (range 3–7). At interval debulking surgery, complete gross resection was achieved in nine (70%) patients, and optimal resection (0.1–1 cm residual disease) in four (30%). Eleven patients (85%) recurred; however, only one (8%) recurred in the supraclavicular lymph nodes. Median follow-up time was 44.3 months (range 22.4–95.0). Median progression-free survival for the cohort was 11.7 months (95% CI 9.2 to 14.1). Median overall survival was 44.3 months (95% CI 41.5 to 47.1). In patients obtaining complete gross resection at interval debulking surgery, median progression-free survival and overall survival were 13.9 months (95% CI 8.9 to 18.9) and 78.1 months (95% CI 11.1 to 145.1), respectively.

Conclusions In our study, approximately 2% of patients with high-grade serous ovarian cancer presented with radiographic evidence of supraclavicular lymphadenopathy. Supraclavicular lymphadenopathy at diagnosis did not portend an unfavorable outcome when complete gross resection was achieved at interval debulking surgery.

  • ovarian cancer
  • surgical oncology
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Footnotes

  • Contributors Conception and design: PC, DSC. Collection of data: SAH, AS, MJR. Data analysis and interpretation: PC, SAH, OTF, MML, OZ, YS, JJM, YL, KLR, DSC. Manuscript writing: PC, SAH, DSC. Revising manuscript critically: PC, SAH, AS, MJR, OTF, MML, OZ, YS, JJM, YL, KLR, DSC. Final approval of manuscript: All authors.

  • Funding This study was funded by National Cancer Institute, http://dx.doi.org/10.13039/100000054 and grant number: P30 CA008748.

  • Competing interests DSCi reports personal fees from Bovie Medical Co, personal fees from Verthermia Inc, personal fees from C Surgeries, outside the submitted work. KLR reports other* from Intuitive Surgical Inc, outside the submitted work (*airfare to a survivorship conference, where she spoke).

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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