Lymphovascular invasion in radical cystectomy specimen: is it an independent prognostic factor in patients without lymph node metastases?

Manoharan, Murugesan; Katkoori, Devendar; Kishore, TA; Jordà, Mercè; Luongo, Tony; Soloway, Mark S.

doi:10.1007/s00345-009-0448-3

Cited by 21 publications

(11 citation statements)

References 18 publications

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“…Lymphovascular invasion (LVI) has been identified in 30-50% of RC specimens. It not only correlates with aggressive pathological features of BC, but also serves as a predictor of outcome independent of LN status [48,59,69,70,71,72,73,74,75]. This important distinction might improve the selection of patients for neoadjuvant and adjuvant chemotherapy adjunct to RC.…”

Section: Lymphovascular Invasionmentioning

confidence: 98%

Predictors of Outcome of Non–Muscle-Invasive and Muscle-Invasive Bladder Cancer

Youssef

Lotan

2011

The Scientific World JOURNAL

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Bladder cancer is a major cause of morbidity and mortality. At initial diagnosis, 75% of patients present with non—muscle-invasive disease and 25% of patients have muscle-invasive or metastatic disease.Patients with noninvasive disease suffer from a high rate of recurrence and 10–30% will have disease progression. Patients with muscle-invasive disease are primarily treated with radical cystectomy, but frequently succumb to their disease despite improvements in surgical technique. In non–muscle-invasive disease, multiplicity, tumor size, and prior recurrence rates are the most important predictors for recurrence, while tumor grade, stage, and carcinoma in situ are the most important predictors for progression. The most common tool that clinicians use to predict outcomes after radical cystectomy is still the tumor-node-metastasis (TNM) staging system, with lymph node involvement representing the most important prognostic factor. However, the predictive accuracy of staging and grading systems are limited, and nomograms incorporating clinical and pathologic factors can improve prediction of bladder cancer outcomes. One limitation of current staging is the fact that tumors of a similar stage and grade can have significantly different biology. The integration of molecular markers, especially in a panel approach, has the potential to further improve the accuracy of predictive models and may also identify targets for therapeutic intervention or patients who will respond to systemic therapies.

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Section: Lymphovascular Invasionmentioning

confidence: 98%

Predictors of Outcome of Non–Muscle-Invasive and Muscle-Invasive Bladder Cancer

Youssef

Lotan

2011

The Scientific World JOURNAL

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“…However, several previous reports held a contrary opinion, maintaining that LVI did not necessarily portend a poor prognosis in pT1 bladder cancer, 10 and the presence of LVI in patients with node-negative was not an unfavorable factor of prognosis on multivariate analysis. 18 They revealed that the pathologic stage was the only independent prognostic factor for survival. This study provided further evidence suggesting that LVI was a pathological variable that might play an important role as a prognostic indicator in patients with newly diagnosed pT1 bladder cancer.…”

Section: Discussionmentioning

confidence: 99%

Impact of lymphovascular invasion on recurrence and progression rates in patients with pT1 urothelial carcinoma of bladder after transurethral resection

Sha¹,

Xie²,

Chen³

et al. 2015

OTT

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ObjectiveTo evaluate the clinical significance of lymphovascular invasion (LVI) on recurrence and progression rates in patients with pT1 urothelial carcinoma of bladder after transurethral resection.MethodsThis retrospective study was performed with 155 patients with newly diagnosed pT1 urothelial carcinoma of bladder who were treated with transurethral resection of bladder tumor at our institution from January 2006 to January 2010. The presence or absence of LVI was examined by pathologists. Chi-square test was performed to identify the correlations between LVI and other clinical and pathological features. Kaplan–Meier method was used to estimate the recurrence-free survival (RFS) and progression-free survival curves and difference was determined by the log-rank test. Univariate and multivariate analyses were performed to determine the predictive factors through a Cox proportional hazards analysis model.ResultsLVI was detected in a total of 34 patients (21.9%). While LVI was associated with high-grade tumors (P<0.001) and intravesical therapy (P=0.009). Correlations with age (P=0.227), sex (P=0.376), tumor size (P=0.969), tumor multiplicity (P=0.196), carcinoma in situ (P=0.321), and smoking (P=0.438) were not statistically significant. There was a statistically significant tendency toward higher recurrence rate and shorter RFS time in LVI-positive patients. However, no statistically significant differences were observed in progression rate between the two groups. Moreover, multivariate Cox proportional hazards analysis revealed that LVI, tumor size, and smoking were independent prognostic predictors of recurrence. The hazard ratios (95% confidence interval) were 2.042 (1.113–3.746, P=0.021), 1.817 (1.014–3.256, P=0.045), and 2.079 (1.172–3.687, P=0.012), respectively.ConclusionThe presence of LVI in transurethral resection of bladder tumor specimens is significantly associated with higher recurrence rate and shorter RFS time in patients with newly diagnosed T1 urothelial carcinoma of the bladder. It is an independent prognostic predictor for disease recurrence. Thus, patients with LVI should be followed up closely.

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“…The presence of intercellular bridges or keratinization was indicative of squamous differentiation. The presence of LVI in TURBT specimens was assessed using conventional hematoxylin and eosin (H&E) staining and immunohistochemical staining (IHC) markers against the lymphatic (D2-40) and vascular endothelium (CD 31)1415. IHC assessment of LVI was performed on TURBT specimens of primary diagnosis.…”

Section: Methodsmentioning

confidence: 99%

Poor prognostic value of lymphovascular invasion for pT1 urothelial carcinoma with squamous differentiation in bladder cancer

Song

Wang

et al. 2016

Sci Rep

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Lymphovascular invasion (LVI) is the primary and essential step in the systemic dissemination of cancer cells. The aim of our study was to assess the independent prognostic role of LVI for pT1 urothelial carcinoma with squamous differentiation in bladder cancer. We retrospectively analyzed the clinical and pathological information of 206 patients diagnosed pT1 urothelial carcinoma with squamous differentiation. Of the 206 patients, LVI was detected in 57 (27.6%) patients. The 5 year cancer specific survival (CSS) rates were 87.2% in LVI (−) and 52.4% in LVI (+) (p < 0.001). According to univariate analysis, tumor multiplicity, tumor size, recurrence and LVI were the prognostic factors associated with CSS. Additionally, tumor size and LVI significantly influenced the CSS in multivariate analysis. TURBT had shorter median CSS than RC in recurred patients with LVI (+). Our study suggested that LVI is an important predictor for survival of pT1 urothelial carcinoma with squamous differentiation. LVI positive status and tumor size ≥3 cm led to a higher risk of death. RC should be routinely performed in recurred LVI (+) bladder cancer patients of pT1 urothelial carcinoma with squamous differentiation.

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Lymphovascular invasion in radical cystectomy specimen: is it an independent prognostic factor in patients without lymph node metastases?

Abstract: Although, the presence of LVI in node-negative patients is an adverse prognostic factor on univariate analysis of disease-specific survival, it is not an independent prognostic factor on multivariate analysis. Pathological stage is the only independent prognostic factor for survival.

Cited by 21 publications

References 18 publications

Predictors of Outcome of Non–Muscle-Invasive and Muscle-Invasive Bladder Cancer

Predictors of Outcome of Non–Muscle-Invasive and Muscle-Invasive Bladder Cancer

Impact of lymphovascular invasion on recurrence and progression rates in patients with pT1 urothelial carcinoma of bladder after transurethral resection

Poor prognostic value of lymphovascular invasion for pT1 urothelial carcinoma with squamous differentiation in bladder cancer

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