DCE MRI is an established component of multi-parametric MRI of the prostate. The sequence highlights the vascularization of cancerous lesions, allowing readers to corroborate suspicious findings on T2W and DW MRI and to note subtle lesions not visible on the other sequences. In this article, we review the technical aspects, methods of evaluation, limitations, and future perspectives of DCE MRI.
Objective
To describe the incidence of ascites in metastatic papillary renal cell cancer (pRCC), identify the factors associated with its development and evaluate its prognostic effect on the survival of these patients.
Methods
A retrospective evaluation of the medical records of patients with metastatic pRCC seen at National Cancer Institute (2000–2014) was undertaken. Logistic regression to identify predictors of the development of malignant ascites and Kaplan-Meier analysis to estimate survival was done.
Results
106 consecutive patients with metastatic pRCC were identified; sufficient data was available in 100 patients to enable assessment of ascites. 20% had evidence of malignant ascites. Median age at diagnosis of ascites was 48.0 years (26.1–76.6 years) and median time to development of ascites from initial diagnosis of metastatic disease was 16.0 (0–73.3) months. There was no significant difference in the incidence of ascites between patients with hereditary or sporadic pRCC (p=0.803) or among patients with different subtypes of pRCC (p=0.456). Elevated platelet-lymphocyte ratio (PLR) predicted development of malignant ascites in our cohort (p=0.009). Median overall survival was shorter for patients who developed ascites [25.0(10.2–39.8 months] compared to patients who did not develop this complication [42.5(30.5–54.4) months, p=0.041].
Conclusion
To our knowledge, this is the first systematic evaluation of the incidence, predictors and prognostic impact of ascites in metastatic pRCC. Malignant ascites is a common manifestation of metastatic pRCC and is associated with a shorter overall survival. An elevated PLR predicts a higher risk of developing malignant ascites.
Cancer-positive APLs represented the highest risk GS in most cases. AA men with prior negative SBx are twice as likely to harbor a concerning APL. In our cohort, AA and W/O men had comparable rates of APLs on mpMRI. Thus, differences in APLs do not explain the higher risk of AA men for deahth due to PCa. However, targeting of APLs via FBx can clinically improve PCa risk stratification and guide appropriate treatment options.
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