Prognostic and predictive value of supradiaphragmatic lymph node involvement detected by 18F-FDG PET/CT in advanced ovarian cancer: a systematic review and meta-analysis.

Abstract

<h4>Objective</h4>To evaluate the prognostic and predictive significance of supradiaphragmatic lymph node (SDLN) positivity detected by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in patients undergoing primary cytoreductive surgery for advanced epithelial ovarian cancer.<h4>Methods</h4>A systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines and registered with PROSPERO. Studies reporting on overall survival (OS), progression-free survival (PFS), and complete cytoreduction (R0) in patients with and without 18F-FDG PET/CT-detected SDLN metastases were identified through comprehensive database searches conducted on December 18, 2024. Data from five retrospective, single-center studies comprising a total of 605 patients were included in the quantitative synthesis. Meta-analyses were performed using a random-effects model.<h4>Results</h4>SDLN positivity on 18F-FDG PET/CT was significantly associated with worse survival outcomes and lower resection rates. The pooled hazard ratio (HR) for OS was 1.60 (95% CI 1.19-2.25, p = 0.002) and for PFS 1.53 (95% CI 1.19-1.96; p = 0.0009), indicating poorer prognosis in SDLN-positive patients. The odds of achieving complete cytoreduction were significantly reduced in this group (OR = 0.32, 95% CI 0.15-0.68, p = 0.003). While heterogeneity was low for progression-free and overall survival (I² = 0%), moderate heterogeneity was observed in the analysis of complete cytoreduction (I² = 54%). None of the included studies provided histologic confirmation of 18F-FDG PET/CT-positive SDLNs.<h4>Conclusions</h4>18F-FDG PET/CT-detected SDLN positivity is associated with worse survival and lower resectability in advanced ovarian cancer. Due to lacking histologic confirmation and retrospective data, prospective validation is needed.