title: A retrospective analysis of the prognosis of prostate cancer patients with lymph node involvement on MR lymphography: who might be cured.
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.
  
  
  CONCLUSIONS
  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.
authors.forename: Hanneke J M
authors.initials: HJ
authors.lastname: Meijer
authors.forename: Oscar A
authors.initials: OA
authors.lastname: Debats
authors.forename: Emile N J Th
authors.initials: EN
authors.lastname: van Lin
authors.forename: Johannes Alfred
authors.initials: JA
authors.lastname: Witjes
authors.forename: Johannes H A M
authors.initials: JH
authors.lastname: Kaanders
authors.forename: Jelle O
authors.initials: JO
authors.lastname: Barentsz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis / Q000473:pathology*; D008220:Lymphography; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000473:pathology*; D012189:Retrospective Studies
references.citation: Urology. 2006 Jul;68(1):121-5
references.pmid: 16806432
references.citation: Eur J Radiol. 2007 Sep;63(3):369-72
references.pmid: 17689215
references.citation: N Engl J Med. 2003 Jun 19;348(25):2491-9
references.pmid: 12815134
references.citation: Lancet Oncol. 2010 Nov;11(11):1066-73
references.pmid: 20933466
references.citation: Radiology. 2009 May;251(2):408-14
references.pmid: 19401573
references.citation: J Clin Oncol. 2006 May 1;24(13):1990-6
references.pmid: 16648499
references.citation: Lancet Oncol. 2008 Sep;9(9):850-6
references.pmid: 18708295
references.citation: Urology. 1999 Feb;53(2):367-71
references.pmid: 9933056
references.citation: Int J Radiat Oncol Biol Phys. 2012 Jan 1;82(1):175-83
references.pmid: 21075555
references.citation: Cancer. 2001 Jan 1;91(1):66-73
references.pmid: 11148561
references.citation: Prostate. 2009 Mar 1;69(4):352-62
references.pmid: 19016478
references.citation: Radiother Oncol. 2013 Jan;106(1):59-63
references.pmid: 23199653
references.citation: Int J Radiat Oncol Biol Phys. 2011 Apr 1;79(5):1364-72
references.pmid: 20797823
references.citation: Int J Radiat Oncol Biol Phys. 2011 May 1;80(1):6-16
references.pmid: 21481721
references.citation: Eur Urol. 2009 Feb;55(2):261-70
references.pmid: 18838212
references.citation: J Urol. 2004 Nov;172(5 Pt 1):1840-4
references.pmid: 15540734
references.citation: Int J Radiat Oncol Biol Phys. 1994 Jan 1;28(1):7-16
references.pmid: 8270461
references.citation: Int J Radiat Oncol Biol Phys. 2007 Nov 1;69(3):646-55
references.pmid: 17531401
references.citation: Cancer. 2006 Jun 15;106(12):2531-9
references.pmid: 16700035
references.citation: Clin Radiol. 2008 Apr;63(4):387-95
references.pmid: 18325358