Association of Microvascular and Capillary-Lymphatic Invasion with Outcome in Patients with Renal Cell Carcinoma

Abstract

Purpose We evaluated the association of microvascular invasion (MVI) and capillary-lymphatic invasion (CLI) with patient outcome following nephrectomy for renal cell carcinoma (RCC). Material and Methods We identified 1,433 patients surgically treated for sporadic, unilateral RCC between 2001 and 2008. All specimens were reviewed by a single uropathologist for MVI and CLI. Associations with time to metastases and death from RCC were evaluated using Cox proportional hazards models, controlling for established clinicopathologic prognostic variables. Results MVI and CLI were identified in 11% (119/1,103) and 2% (17/1,103) with clear cell, 2% (5/219) and <1% (1/219) with papillary, and 1% (1/86) and 0 with chromophobe RCC, respectively. Median follow-up for patients still alive was 6.4 years (range 0-11). In clear cell RCC, MVI was univariately associated with an increased risk of metastases (HR 3.5,p<0.001) and cancer-specific death (HR 3.0,p<0.001). However, on multivariate analyses, these associations were no longer statistically significant (HR 1.2,p=0.4 and HR 1.3,p=0.1, respectively). CLI remained significantly associated with an increased risk of metastases and death both univariately (HR 15.9,p<0.001 and HR 11.6,p<0.001, respectively) and on multivariate analyses (HR 3.2,p<0.001 and HR 3.1,p<0.001, respectively). Conclusions MVI is associated with an increased risk of metastases and cancer death for patients with clear cell RCC, although this does not remain significant after controlling for established prognostic variables. Meanwhile, CLI appears to be independently associated with metastases and cancer death even after controlling for known prognostic risk factors; however, given its rarity, this feature may prove to be of limited clinical significance.

Kidney injury molecule-1 inhibits metastasis of renal cell carcinoma

“…Our current findings regarding KIM-1 in RCC contrast that of several groups who have claimed that KIM-1 promotes tumour growth and exacerbates cancer progression. Microvascular invasion (MVI) is defined by the invasion of cancer cells into the endothelial walls of small blood vessels and is associated with higher risks of metastases and death in patients with ccRCC 14 , 37 . Mijuskovic et al (2018) showed that high degrees of MVI were associated with significantly increased expression of tumour tissue KIM-1, and that urinary KIM-1 was associated with worse disease prognoses and higher TNM staging 38 .…”

Evaluation of microvascular invasion as a prognostic factor in the progression of non-metastatic renal cancer

“…However, previously in 2013, a Mayo Clinic study assessed 119/1433 patients with MVI and observed an association with unfavorable prognostic characteristics, risk of metastasis and death from cancer in the univariate analysis, but in the multivariate analysis does not remain significant after being controlled with other prognostic variables established [27].…”

Diagnostic and Prognostic Significance of Radiologic Node-positive Renal Cell Carcinoma in the Absence of Distant Metastases: A Retrospective Analysis of Patients Undergoing Nephrectomy and Lymph Node Dissection

“…Sarcomatoid component was defined as a spindle cell malignancy with the histological appearance of a sarcoma. Capillary-lymphatic invasion (CLI) was used to define tumors in microscopic capillary or lymphatic channels in lacking a muscular coat ( 15 ). All removed LNs were examined for the presence of nodal metastases.…”