Prevalence and prognosis of extra-capsular extension in isolated lymph nodal recurrence from ovarian cancer: the ECEROC study

OBJECTIVE: To evaluate the prevalence and prognostic impact of extra-capsular extension in isolated lymph nodal recurrence from ovarian cancer and its correlation with histopathologic features and oncologic outcomes. METHODS: Retrospective, single-center study analyzing patients undergoing secondary cytoreductive surgery for isolated lymph node ovarian cancer recurrence from January 2016 to December 2022. Lymph node metastases were classified as intra-capsular growth, extra-capsular extension measuring ≤2 mm, or extra-capsular extension >2 mm. Based on histopathologic findings, intra-capsular growth and extra-capsular extension ≤2 mm were combined into a single group (group A) and compared with extra-capsular extension >2 mm (group B). RESULTS: During the study period, 111 patients with isolated ovarian cancer recurrence were included. Forty-seven patients (42.3%) had intra-capsular growth and 64 (57.7%) presented extra-capsular extension. Among these, 28 had extra-capsular extension ≤2 mm and 36 macroscopic extension (>2 mm). Compared with group A, group B was associated with higher rates of tumor emboli, necrosis, and sclerosis. Serous histology and elevated CA125 (>35 IU/mL) were independent predictors of extra-capsular extension >2 mm; in the multi-variate analysis, only CA125 >35 IU/mL maintained statistical significance. After a median follow-up of 47.0 months, recurrence occurred in 75% of group B compared with 61.3% in group A. Median post-relapse disease-free survival was 27 months in the group A versus 20 months in the group B (p = .028). In the multi-variate analysis, extra-capsular extension >2 mm and elevated CA125 >35 IU/mL remained independently associated with poorer prognosis; site of recurrence, previous maintenance therapies, or BRCA status did not impact recurrence outcomes. CONCLUSIONS: Extra-capsular extension >2 mm is a frequent entity in lymph nodal ovarian cancer recurrences and correlates with more aggressive histopathologic features and potentially less favorable outcomes. These findings support its role as a prognostic marker to guide treatment strategies in isolated lymph node recurrence from ovarian cancer.