# Impact of Lymph Node Involvement on Prognosis and Survival in Patients With Ovarian Carcinoma: A Clinicopathological Correlation Study

## TL;DR

This study shows that lymph node involvement in ovarian cancer patients is linked to worse survival and should be considered in treatment planning.

## Contribution

The study identifies lymph node positivity as an independent prognostic factor in epithelial ovarian carcinoma.

## Key findings

- Lymph node metastasis was found in 38.4% of patients with epithelial ovarian carcinoma.
- Patients with lymph node involvement had a 42.7% three-year survival rate versus 78.1% for node-negative cases.
- Lymph node positivity and advanced FIGO stage were independent predictors of poor survival.

## Abstract

Background: Ovarian carcinoma remains a leading cause of gynecologic cancer mortality worldwide, primarily due to its late presentation and high recurrence rates.

Objective: This study aims to determine the impact of lymph node involvement on prognosis and survival in patients with epithelial ovarian carcinoma and to correlate nodal status with clinicopathological parameters.

Methods: This retrospective cross-sectional study was conducted at Shalamar Medical and Dental College, Lahore, from September 2024 to May 2025. A total of 125 patients with histologically confirmed epithelial ovarian carcinoma who underwent primary cytoreductive surgery with lymphadenectomy were included. Data regarding patient demographics, tumor grade, FIGO stage, histologic subtype, and lymph node status were collected.

Results: Lymph node metastasis was identified in 48 patients (38.4%). Node positivity showed a significant association with high-grade tumors (p = 0.02) and advanced FIGO stage (p < 0.001). The mean number of lymph nodes dissected was 14.2 ± 6.8, while the mean lymph node ratio was 0.21 ± 0.14. Patients with lymph node involvement demonstrated a markedly lower three-year overall survival rate of 42.7%, compared with 78.1% in node-negative cases (p = 0.003, log-rank test). On multivariate Cox regression, lymph node positivity (heart rate (HR) = 2.41, 95% confidence interval (CI): 1.38-4.21, p = 0.002) and advanced FIGO stage (HR = 3.05, 95% CI: 1.76-5.18, p < 0.001) emerged as independent predictors of poor survival.

Conclusion: It is concluded that lymph node involvement is a significant independent prognostic factor in epithelial ovarian carcinoma, strongly associated with advanced stage, high tumor grade, and reduced survival. Accurate lymph node assessment should be routinely incorporated into surgical and pathological evaluation for precise staging and individualized management.