The clinicopathological features and prognostic value of lymphovascular invasion in patients with upper tract urinary carcinoma after radical nephroureterectomy:  an updated systematic review and meta-analysis.

Abstract

Background and Purpose: Although the prognostic value of lymphovascular invasion (LVI) for upper tract urinary carcinoma (UTUC) have been described. There is lack of consensus regarding the prognostic factor of LVI in UTUC. The aim of present study was to evaluate the current evidence regarding the contemporary role of LVI through systematic review and meta-analysis according to the updated literatures. Materials and Methods: In the light of Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, a systematic search of Web of Science, PubMed and EMBASE was performed for all reports published until July 2019 that included detailed results on the predictors of LVI. Results: Our meta-analysis included thirty one eligible studies containing 14,653 UTUC patients (81-1,363 per study). According to our final results, there was a significant correlation of LVI with worse cancer-specific survival (CSS) (HR=1.62, 95 % CI: 1.49-1.76, p < 0.001), overall survival (OS) (HR=1.55, 95 % CI: 1.41-1.71, p < 0.001), recurrence-free survival (RFS) (HR=1.46, 95 % CI: 1.32-1.61, p < 0.001), cancer-specific mortality (CSM) (HR=1.25, 95 % CI: 1.00-1.56, p = 0.047) and recurrence(HR=1.23, 95 % CI: 1.03-1.48, p = 0.026). In addition, LVI was also correlated with advanced TNM stage (III/IV vs. I/II: OR = 7.63, 95% CI: 5.60–10.39, p < 0.001), higher tumor grade (3 vs. 1/2: OR = 5.61, 95% CI: 3.71–8.48, p < 0.001), lymph node metastasis (yes vs. no: OR = 4.95, 95% CI: 3.66–6.71, p < 0.001), carcinoma in situ (yes vs. no: OR = 1.92, 95% CI: 1.36–2.70, p < 0.001) and positive surgical margin (yes vs. no: OR = 4.38, 95% CI: 2.71–7.07, p < 0.001), but not related to gender (male vs. female: OR = 0.98, 95% CI: 0.80–1.19, p = 0.825) and multifocality (multifocal vs. unifocal: OR = 1.10, 95% CI: 0.82–1.47, p = 0.539). The funnel plot test indicated that no significant publication bias in the meta-analysis. Conclusions: This study demonstrated that LVI was associated with more aggressive clinicopathological features and could serve as a poor prognostic factor for patient with UTUC after radical nephroureterectomy.