{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T14:19:03Z","timestamp":1765808343847,"version":"3.40.5"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T00:00:00Z","timestamp":1716854400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To evaluate the clinical impact of suspicious extra-abdominal lymph nodes (EALNs) identified preoperatively on CT and\/or PET\/CT images in advanced ovarian cancer.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A retrospective study was conducted with 122 patients diagnosed with stage III or IV ovarian cancer with preoperative CT and\/or PET\/CT images from 2006 to 2022. Imaging studies were evaluated for the presence, size and location of suspicious EALNs. Suspicious lymph node enlargement was defined by a cut-off \u22655mm short-axis dimension on CT and\/or lesions with maximum standardized uptake values of \u22652.5 on PET\/CT. This study only included patients who did not have their EALNs surgically removed.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total 109 patients met the inclusion criteria; 36 (33%) had suspicious EALNs and were categorized as \u201cnode-positive\u201d. The median overall survival (OS) was 45.73 months for the \u201cnode-positive\u201d and 46.50 months for the \u201cnode-negative\u201d patients (HR 1.17, 95% CI 0.68\u20132.00, p = 0.579). In multivariate analysis, after adjusting for other variables selected by process of backward elimination using a significance level of p&lt;0.20, suspicious EALNs still showed no clinical significance on OS (aHR 1.20, 95% CI 0.67\u20132.13, p = 0.537) as well as progression-free survival (aHR 1.43, 95% CI 0.85\u20132.41, p = 0.174). Old age (aHR 2.23, 95% CI 1.28\u20133.89, p = 0.005) and platinum resistance (aHR 1.92, 95% CI 1.10\u20133.36, p = 0.023) affects adversely on OS.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Suspicious EALNs did not worsen the prognosis of patients with advanced ovarian cancer. However, its impact on survival is not yet clarified. Further investigation is required to assess the clinical significance of suspicious EALNs on preoperative imaging studies.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0299205","type":"journal-article","created":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T18:19:35Z","timestamp":1716920375000},"page":"e0299205","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prognostic impact of suspicious extraabdominal lymph nodes on patient survival in advanced ovarian cancer"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7219-6386","authenticated-orcid":true,"given":"Kena","family":"Park","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5775-0995","authenticated-orcid":true,"given":"Ji Young","family":"Kwon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4640-963X","authenticated-orcid":true,"given":"Jeong Min","family":"Song","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8601-1701","authenticated-orcid":true,"given":"Seung Yeon","family":"Pyeon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seon Hwa","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Young Shin","family":"Chung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0562-5443","authenticated-orcid":true,"given":"Jong-Min","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,5,28]]},"reference":[{"issue":"5","key":"pone.0299205.ref001","doi-asserted-by":"crossref","first-page":"444","DOI":"10.5468\/ogs.21116","article-title":"The incidence and survival of cervical, ovarian, and endometrial cancer in Korea, 1999\u20132017: Korea Central Cancer Registry","volume":"64","author":"HI Ha","year":"2021","journal-title":"Obstet Gynecol Sci"},{"article-title":"Annual report of cancer statistics in Korea in 2019, Ministry of Health and Welfare","year":"2021","author":"Korea Central Cancer Registry, National Cancer Center","key":"pone.0299205.ref002"},{"issue":"1","key":"pone.0299205.ref003","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1097\/01.AOG.0000192407.04428.bb","article-title":"Aggressive surgical effort and improved survival in advanced-stage ovarian cancer","volume":"107","author":"GD Aletti","year":"2006","journal-title":"Obstet Gynecol"},{"issue":"2","key":"pone.0299205.ref004","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.ygyno.2015.12.007","article-title":"Prognostic impact of debulking surgery and residual tumor in patients with epithelial ovarian cancer FIGO stage IV","volume":"140","author":"B Ataseven","year":"2016","journal-title":"Gynecol Oncol"},{"issue":"1b","key":"pone.0299205.ref005","first-page":"681","article-title":"A phase III randomized study comparing paclitaxel and cisplatin versus cyclophosphamide and cisplatin in patients with advanced ovarian cancer","volume":"27","author":"D Mouratidou","year":"2007","journal-title":"Anticancer Res"},{"issue":"1","key":"pone.0299205.ref006","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ijgo.2013.10.001","article-title":"Staging classification for cancer of the ovary, fallopian tube, and peritoneum.","volume":"124","author":"J. 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