The prognostic value of lymphovascular invasion in radical prostatectomy: a systematic review and meta-analysis

Abstract

To systematically evaluate the prognostic value of lymphovascular invasion (LVI) in radical prostatectomy (RP) by a meta-analysis based on the published literature. To identify relevant studies, PubMed, Cochrane Library, and Web of Science database were searched from 1966 to May 2014. Finally, 25 studies (9503 patients) were included. LVI was found in 12.2% (1156/9503) of the RP specimens. LVI was found to be correlated with higher pathological tumor stages (greater than pT3 stage) (risk ratio [RR] 1.90, 95% confidence interval [CI] 1.73–2.08, P < 0.00001), higher Gleason scores (greater than GS = 7) (RR 1.30, 95% CI 1.23–1.38, P < 0.00001), positive pathological node (pN) status (RR 5.67, 95% CI 3.14–10.24, P < 0.00001), extracapsular extension (RR 1.72, 95% CI 1.46–2.02, P < 0.00001), and seminal vesicle involvement (RR 3.36, 95% CI 2.41–4.70, P < 0.00001). The pooled hazard ratio (HR) was statistically significant for Biochemical Recurrence-Free (BCR-free) probability (HR 2.05, 95% CI 1.64–2.56; Z = 6.30, P < 0.00001). Sensitivity analysis showed that the pooled HR and 95% CI were not significantly altered by the omission of any single study. Begg's Funnel plots showed no significant publication bias (P = 0.112). In conclusion, LVI exhibited a detrimental effect on the BCR-Free probability and clinicopathological features in RP specimens, and may prove to be an independent prognostic factor of BCR.

Prognostic significance of lymphovascular invasion in patients with prostate cancer treated with postoperative radiotherapy

“…Among pathologic features, one study showed that LVI was observed in 12.2% of patients who received RP [19]. The presence of LVI is an unfavorable factor associated with poor treatment results [20-24].…”

“…In patients who underwent RP, BCFFS was worse in patients with LVI compared to those without LVI (30% vs. 92%; p = 0.001) [23]. In a systematic review, patients with LVI had a higher probability for BCF after RP (hazard ratio [HR] = 2.05; 95% confidence interval [CI], 1.64–2.56; p < 0.001) [19]. Currently, only a few studies have evaluated the prognostic significance of LVI in patients treated with PORT.…”

The impact of lymphovascular invasion in patients with prostate cancer following radical prostatectomy and its association with their clinicopathological features

“…In 2016, Huang et al [41] attempted to explore the impact of LVI on the BCR-free probability in a meta-analysis. They concluded that LVI may a predictor of the BCR–free probability in PCa patients.…”

Risk stratification for disease progression in pT3 prostate cancer after robot-assisted radical prostatectomy

“… 21 22 The ISUP recommended a routine examination of LVI as a part of standard pathologic report at RP. 16 Although the utility of LVI as a prognostic factor remains controversial, 23 24 25 the magnitude of independent association of LVI (HR: 2.167; 95% CI: 1.099–4.273; P = 0.026) in our cohort suggested that it may be a relevant predictor of BCR. In subgroup analysis for patients with undetectable PSA postoperatively, preoperative PSA ≥10 ng ml −1 ( vs <10 ng ml −1 ; HR: 3.192; 95% CI: 1.333–7.645; P = 0.009) and pGS ≥8 ( vs pGS 6; HR: 9.310; 95% CI: 2.028–42.734; P = 0.004) were also independent predictors of BCR in multivariate analysis.…”