Objective: Enlarged cardiophrenic lymph nodes (CPLN) are common in patients with advanced ovarian cancer and may indicate stage IV disease. Hyperthermic intraperitoneal chemotherapy (HIPEC) improves survival in patients with stage III disease who are eligible for interval cytoreductive surgery (CRS). This OVHIPEC-1 side study investigates the prognostic value of enlarged CPLN and their predictive value for HIPEC benefit.
Methods: We performed a post-hoc analysis of the OVHIPEC-1 trial, which randomized stage III ovarian cancer patients to interval CRS with or without HIPEC. CPLN presence with short-axis diameter (SAD) ≥10 mm was an exclusion criterion for this study. Two expert radiologists independently reviewed baseline and response CT scans from trial participants and identified CPLNs ≥5 mm. Discrepancies were resolved by consensus.
Results: CT scans before start of neoadjuvant chemotherapy were available for 237/245 patients; 105 (44%) had at least one CPLN ≥5 mm. CPLN-positive patients had higher peritoneal cancer index scores but otherwise comparable baseline characteristics. CPLN size decreased in 81% after neoadjuvant chemotherapy. Overall survival was similar between patients with and without CPLN (HR 0.98 [95% CI 0.74-1.30]). No interaction between CPLN status and overall survival benefit of HIPEC was observed (HR 0.56 [95% CI 0.37-0.85] with CPLN ≥5 mm versus HR 0.78 [95% CI 0.54-1.14] without; interaction p-value = 0.28).
Conclusion: In stage III ovarian cancer treated with interval CRS, no evidence was found to suggest a difference in prognostic impact or a reduction in HIPEC efficacy among patients with CPLN SAD 5-10 mm at diagnosis.
Keywords: Cardiophrenic lymph nodes; HIPEC; Ovarian cancer.
Copyright © 2026 Elsevier Inc. All rights reserved.