Retroperitoneal lymph node recurrence of epithelial ovarian
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Epithelial ovarian cancer (EOC) is the fourth most common cause of death in females. Lack of reliable early detection method and late presentation at diagnosis contribute to the high mortality rate of ovarian cancer. Treatment at presentation includes surgery and platinum-based chemotherapy. The desired surgical outcome in advanced stage disease is complete cytoreduction, i.e. no macroscopic disease at the end of surgery. A study was conducted to evaluate the treatment outcome and survival of patients with epithelial ovarian cancer recurrence isolated to the retroperitoneal lymph nodes compared to intraperitoneal spread.

Out of 135 patients in the cohort, 66 were diagnosed with intraperitoneal recurrence, 30 with retroperitoneal lymph node recurrence and 39 with combined site recurrence. The clinical, pathological and surgical characteristics were similar among all groups, besides CA-125 which was significantly lower in the retroperitoneal recurrence group at diagnosis, end of treatment and recurrence. Overall survival (OS) and post relapse survival (PRS) were significantly higher in the retroperitoneal recurrence group vs. the intraperitoneal and combined site recurrence groups. On cox's regression analysis, retroperitoneal recurrence was found to be an independent prognostic factor for survival.

In conclusion, this study shows that the site of recurrence in EOC is a significant, independent, prognostic factor for survival. Most patients with retroperitoneal recurrence, in lymph nodes only, without an intraperitoneal spread, will have an indolent course of disease with a higher chance of surviving >5 years, compared to <2 years in patients with IP recurrence. No doubt that the micro-environment surrounding the tumor in the retroperitoneum or intra-peritoneally has influence on these results.