Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Jul 30:8:190.
doi: 10.1186/1748-717X-8-190.

A retrospective analysis of the prognosis of prostate cancer patients with lymph node involvement on MR lymphography: who might be cured

Hanneke J M Meijer, Oscar A Debats, Emile N J Th van Lin, Johannes Alfred Witjes, Johannes H A M Kaanders, Jelle O Barentsz

A retrospective analysis of the prognosis of prostate cancer patients with lymph node involvement on MR lymphography: who might be cured

Hanneke J M Meijer et al. Radiat Oncol. .

Abstract

Background: The prognosis of prostate cancer patients with lymph node metastases so small they can only be visualized by new imaging techniques as MR lymphography (MRL) is unknown. The purpose of this study was to investigate the prognosis of prostate cancer patients with non-enlarged metastatic lymph nodes on MRL and to identify a subgroup of MRL-positive patients who might be candidates for curative treatment.

Methods: The charts of 138 prostate cancer patients without enlarged lymph nodes on CT, in whom a pre-treatment MRL was performed were reviewed. Endpoints were distant metastases-free survival and overall survival. Relation between the following factors and outcome were investigated: T-stage, PSA value at diagnosis, Gleason score, diameter (short axis and long axis) of the largest MRL-positive lymph node, number of MRL-positive lymph nodes, the presence of extra-pelvic nodal disease, and the extent of resection of the positive lymph nodes. Kaplan-Meier analysis was performed to estimate the survival functions.

Results: Of the 138 patients, 24 (17%) had a positive MRL. Patients with a short axis of the largest positive lymph node of ≤8 mm had a significantly better 5-year distant metastases-free (79% vs 16%) and overall survival (81% vs 36%) than patients with larger positive lymph nodes. This also accounted for patients with a largest long axis of ≤10 mm (71% vs 20% and 73% vs 40%, respectively). Outcome was also better in patients in whom all positive lymph nodes had been resected.

Conclusion: A selection of MRL-positive patients with a good prognosis could be identified, consisting of patients with small positive lymph nodes. In these patients, cure might be pursued.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Example of a negative (A) and a positive (B) MRL. Upper panel: T1 image, which provides good visualization of non-enlarged lymph nodes (arrows). Lower panel: T2* image. The positive lymph node (B) has a high signal intensity, because accumulation of the iron particles has been blocked. This in contrast to the low signal intensity of the negative lymph node (A). Modified from: Hanneke J.M. Meijer et al.; Magnetic resonance lymphography findings in patients with a biochemical recurrence after prostatectomy and the relation with the Stephenson nomogram. Int. J. Radiat. Oncol. Biol. Phys. 2012; 84(5): 1186–1191.
Figure 2
Figure 2
Survival curves for MRL negative vs MRL positive patients. A. Distant metastases-free survival. B. Overall survival. p-value indicates level of statistical significance as determined with unstratified log-rank statistical analysis Max = maximum.
Figure 3
Figure 3
Survival curves for subgroups of the MRL positive patients with different MRL related factors. Upper panel: Patients with a short axis of the largest lymph node of ≤8 mm vs patients with a short axis of the largest lymph node of >8 mm. A. Distant metastases-free survival. B. Overall survival. Lower panel: Patients with a long axis of the largest lymph node of ≤10 mm vs patients with a long axis of the largest lymph node of >10 mm. C. Distant metastases-free survival. D. Overall survival. p-value indicates level of statistical significance as determined with unstratified log-rank statistical analysis Max = maximum.
See this image and copyright information in PMC

References

    1. Tiguert R, Gheiler EL, Tefilli MV, Oskanian P, Banerjee M, Grignon DJ, Sakr W, Pontes JE, Wood DP Jr. Lymph node size does not correlate with the presence of prostate cancer metastasis. Urology. 1999;53:367–371. doi: 10.1016/S0090-4295(98)00518-4. - DOI - PubMed
    1. Fleischmann A, Schobinger S, Schumacher M, Thalmann GN, Studer UE. Survival in surgically treated, nodal positive prostate cancer patients is predicted by histopathological characteristics of the primary tumor and its lymph node metastases. Prostate. 2009;69:352–362. doi: 10.1002/pros.20889. - DOI - PubMed
    1. Briganti A, Karnes JR, Da Pozzo LF, Cozzarini C, Gallina A, Suardi N, Bianchi M, Freschi M, Doglioni C, Fazio F, Rigatti P, Montorsi F, Blute ML. Two positive nodes represent a significant cut-off value for cancer specific survival in patients with node positive prostate cancer. a new proposal based on a two-institution experience on 703 consecutive N + patients treated with radical prostatectomy, extended pelvic lymph node dissection and adjuvant therapy. Eur Urol. 2009;55:261–270. doi: 10.1016/j.eururo.2008.09.043. - DOI - PubMed
    1. Cheng L, Zincke H, Blute ML, Bergstralh EJ, Scherer B, Bostwick DG. Risk of prostate carcinoma death in patients with lymph node metastasis. Cancer. 2001;91:66–73. doi: 10.1002/1097-0142(20010101)91:1<66::AID-CNCR9>3.0.CO;2-P. - DOI - PubMed
    1. Morikawa LK, Roach M III. Pelvic nodal radiotherapy in patients with unfavorable intermediate and high-risk prostate cancer: evidence, rationale, and future directions. Int J Radiat Oncol Biol Phys. 2011;80:6–16. doi: 10.1016/j.ijrobp.2010.11.074. - DOI - PubMed

LinkOut - more resources