Lymphovascular Invasion Independently Predicts Increased Disease Specific Survival in Patients With Transitional Cell Carcinoma of the Upper Urinary Tract

Kikuchi, Eiji; Horiguchi, Yutaka; Nakashima, Jun; Hatakeyama, Naoki; Matsumoto, Masakazu; Nishiyama, Toru; Murai, Masaru

doi:10.1097/01.ju.0000181801.22474.8b

Cited by 79 publications

(56 citation statements)

References 20 publications

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“…There are several studies that have found LVI to be an independent prognostic variable when examining RC specimens [2,5,6]. There is also evidence that LVI leads to a poorer prognosis in patients with upper tract disease [14,15]. In the present study LVI in TURBT and RC specimens was associated with a poor prognosis.…”

Section: Discussionsupporting

confidence: 53%

The significance of lymphovascular invasion in transurethral resection of bladder tumour and cystectomy specimens on the survival of patients with urothelial bladder cancer

et al. 2009

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TURBT and/or RC specimens to a group of controls who did not have LVI on TURBT (34) or RC (32). RESULTSPatients with LVI present in their TURBT specimen had a shorter disease-specific survival than those without LVI, with a 5-year survival of 33.6% vs 62.9% (log-rank test P = 0.027; hazard ratio 2.21). LVI at TURBT varied with clinical stage ( P = 0.049). Patients with LVI and who were clinical stage I or II had lower survival than those without LVI ( P = 0.049; hazard ratio 2.68). LVI did not affect survival among those with clinical stage III or IV ( P = 0.29). There was a trend for patients with LVI at TURBT to be clinically understaged compared to those without LVI (75% vs 46%) but the difference was not significant ( P = 0.086). Patients with LVI detected in their RC specimen were significantly more likely to have cancer recurrence than were those with no evidence of LVI (48% vs 19%, P = 0.006). For the RC group there was also a significant difference in survival distribution between patients with evidence of LVI vs those without (5-year survival 45.5% vs 78.4%, P = 0.017). Those with LVI were significantly more likely to die from the disease than those without LVI ( P = 0.017; hazard ratio 2.92). CONCLUSIONSOur findings suggest that LVI is a histological feature that might be associated with a poorer prognosis in patients with urothelial carcinoma of the bladder. The presence of LVI in TURBT specimens predicts shorter survival for patients with stage I or II disease. The presence of LVI in RC specimens predicts recurrence of disease and shorter survival. Further studies are needed to determine whether this group of patients would benefit from early RC and/or perioperative chemotherapy to improve clinical outcomes. KEYWORDSbladder cancer, lymphatic metastasis, neoplasm staging, cystectomy Study Type -Prognosis (case series) Level of Evidence 4 OBJECTIVETo test the hypothesis that patients with bladder cancer who had evidence of lymphovascular invasion (LVI) in their transurethral resection of bladder tumour (TURBT) and radical cystectomy (RC) specimens would have a worse prognosis and higher likelihood of clinical understaging, and to assess the effect of LVI discovered at RC on subsequent diseaserelated mortality, as the prognostic significance of LVI in TURBT or RC specimens of patients treated for urothelial carcinoma of the bladder is not completely established. PATIENTS AND METHODSWe retrospectively reviewed the records of 163 patients with urothelial carcinoma of the bladder seen at our institution, and who had TURBT (69) or RC (94) between 1995 and 2005. We compared patients with LVI on

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Section: Discussionsupporting

confidence: 53%

The significance of lymphovascular invasion in transurethral resection of bladder tumour and cystectomy specimens on the survival of patients with urothelial bladder cancer

et al. 2009

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“…As previously reported in several cystectomy and RNU series, LVI was associated with advanced stage, grade, and LN status. 4,8,9,12,[23][24][25][26] Importantly, we found that LVI was also an independent predictor of relapse and death from UTUC. Several investigators have reported that the tumor growth pattern, as defined by Jimenez at al is an independent predictor of oncologic outcome in patients treated with radical cystectomy for urothelial carcinoma of the urinary bladder.…”

Section: 46mentioning

confidence: 53%

“…Whereas tumor stage and histologic grade are well established prognostic factors of outcome after RNU, the oncologic significance of other potentially relevant variables, such as tumor site, architecture, histologic tumor necrosis, lymphovascular invasion (LVI), and the presence of concomitant carcinoma-in situ (CIS), among others, has not been clearly established. 4,[8][9][10][11][12][13][14][15] Recognizing these limitations, we developed a comprehensive database incorporating the clinical and pathologic characteristics and outcomes of over 1300 patients treated with RNU for UTUC at 12 academic centers. Using this large international patient cohort, strict accrual criteria, and pathologic re-review of all slides, we sought to more clearly define the natural history, patterns of failure, and the impact of potential prognostic factors on relapse and survival after surgical management of UTUC.…”

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confidence: 99%

Outcomes of radical nephroureterectomy: A series from the Upper Tract Urothelial Carcinoma Collaboration

Margulis

Shariat²,

Matin

et al. 2009

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“…31 Other prognostic variables following nephroureterectomy include lymphovascular invasion, concomitant carcinoma in situ (CIS), positive surgical margins, ureteral tumour location (as opposed to renal pelvis), previous or concomitant bladder tumours, tumour multifocality, and lack of postoperative intravesical mitomycin C instillation. 4,6,7,[10][11][12][14][15][16][17][18][19][21][22][23][24]26,[28][29][30][31][32][33][34][35][36][65][66][67][68][69] The rates of recurrence stratified by these variables are seldom reported.…”

Section: Prognostic Variablesmentioning

confidence: 99%

Canadian guidelines for postoperative surveillance of upper urinary tract urothelial carcinoma

Kapoor¹,

Allard²,

Black³

et al. 2013

CUAJ

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Lymphovascular Invasion Independently Predicts Increased Disease Specific Survival in Patients With Transitional Cell Carcinoma of the Upper Urinary Tract

Abstract: In addition to pathological stage and tumor grade, LVI is an independent prognostic factor for disease specific survival in upper tract TCC. Patients in the high and/or intermediate risk groups may benefit from integrated therapies with surgery and postoperative systemic chemotherapy.

Cited by 79 publications

References 20 publications

The significance of lymphovascular invasion in transurethral resection of bladder tumour and cystectomy specimens on the survival of patients with urothelial bladder cancer

The significance of lymphovascular invasion in transurethral resection of bladder tumour and cystectomy specimens on the survival of patients with urothelial bladder cancer

Outcomes of radical nephroureterectomy: A series from the Upper Tract Urothelial Carcinoma Collaboration

Canadian guidelines for postoperative surveillance of upper urinary tract urothelial carcinoma

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