Impact of Lymphovascular Invasion on Prognosis in the Patients with Bladder Cancer—Comparison of Transurethral Resection and Radical Cystectomy

Abstract

(1) Background: This study aimed to evaluate the associations of lymphovascular invasion (LVI) at first transurethral resection of bladder (TURBT) and radical cystectomy (RC) with survival outcomes, and to evaluate the concordance between LVI at first TURBT and RC. (2) Methods: We analyzed 216 patients who underwent first TURBT and 64 patients who underwent RC at Toho University Sakura Medical Center. (3) Results: LVI was identified in 22.7% of patients who underwent first TURBT, and in 32.8% of patients who underwent RC. Univariate analysis identified ≥cT3, metastasis and LVI at first TURBT as factors significantly associated with overall survival (OS) and cancer-specific survival (CSS). Multivariate analysis identified metastasis (hazard ratio (HR) 6.560, p = 0.009) and LVI at first TURBT (HR 9.205, p = 0.003) as significant predictors of CSS. On the other hand, in patients who underwent RC, ≥pT3, presence of G3 and LVI was significantly associated with OS and CSS in univariate analysis. Multivariate analysis identified inclusion of G3 as a significant predictor of OS and CSS. The concordance rate between LVI at first TURBT and RC was 48.0%. Patients with positive results for LVI at first TURBT and RC displayed poorer prognosis than other patients (p < 0.05). (4) Conclusions: We found that the combination of LVI at first TURBT and RC was likely to provide a more significant prognostic factor.

Prognostic impact of eligibility for adjuvant immunotherapy in locally advanced urothelial cancer

“… 11 , 12 Although many studies have suggested the negative impact of LVI+ on prognosis, it was not included in the inclusion criteria in both clinical trials. 13 , 14 , 15 , 16 , 17 , 18 , 19 We found that more than half of the patients in this cohort had LVI+ or pN+ (very high‐risk) (Figure S4A,D ). In addition, when we simply compared LVI status in the trial‐eligible group, the median DFS was significantly worse in patients with LVI+ than in those with LVI−, which was similar to that of patients with pN+ (Figure S4B,C,E,F ).…”

“…Accordingly, we speculate that the patients' LVI status may have a key role in this setting because the subanalysis of both clinical trials showed patients with T3‐4 or N+ disease had a tendency of favorable outcomes 11,12 . Although many studies have suggested the negative impact of LVI+ on prognosis, it was not included in the inclusion criteria in both clinical trials 13–19 . We found that more than half of the patients in this cohort had LVI+ or pN+ (very high‐risk) (Figure S4A,D).…”

“…Of the inclusion criteria of those phase III studies, the patient's lymphovascular invasion (LVI) status was not included in the definition of high‐risk disease. Because LVI status is one of the established pathological risk factors for poor prognosis in patients with UC, 13 , 14 , 15 , 16 , 17 , 18 , 19 we hypothesize that it might play a key role in the selection of potential candidates for adjuvant immunotherapy. Firstly, we evaluate the effect of trial eligibility for adjuvant immunotherapy on prognosis in patients with localized and locally advanced muscle‐invasive bladder carcinoma (MIBC) and upper tract urothelial carcinoma (UTUC) in a real‐world practice.…”

“…Of the inclusion criteria of those phase III studies, the patient's lymphovascular invasion (LVI) status was not included in the definition of high-risk disease. Because LVI status is one of the established pathological risk factors for poor prognosis in patients with UC, [13][14][15][16][17][18][19] we hypothesize that it might play a key role in the selection of potential candidates for adjuvant immunotherapy.…”

The Correlation of Tumor Budding Index With Grading of Infiltrating Urothelial Carcinoma

“…Lymphovascular invasion has been reported to be independently associated with recurrence and progression of cancer cells. 27 Its presence is also considered a strong prognostic marker of tumor aggressiveness and an indicator of hidden metastasis in several malignancies, including urothelial carcinoma. 28 Tilki et al reported that lymphatic invasion was associated with nodal metastasis and poorer cancer-specific survival.…”