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

Abstract

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

Scoring system development for prediction of extravesical bladder cancer

“…We found that LVI at TURBT to be strongly associated with advanced MIBC, that in accordance with previous studies, that have determined LVI to be a strong independent predictor of upstaging, poor clinical outcome 18 , nodal invasion and survival in patients undergoing RC 19 . Although LVI was less commonly found in TUR samples than in RC specimens, the pathological feature is strongly suggestive of advanced MIBC 20 and pathologists should be encouraged to report LVI in TURBT pathological reports as it has a direct impact on patients staging and prognosis.…”

Reporting trends and prognostic significance of lymphovascular invasion in muscle‐invasive urothelial carcinoma: A population‐based study

“…These results are similar to previous studies of pT1 urothelial cancers removed by RC, in which LVI was found in 5-10% of patients, and was an important prognostic factor for recurrence free survival and CSS. 19,22,23 Additional studies are required to ascertain whether LVI can be reliably and accurately detected in biopsies, and used to identify patients who might benefit from early cystectomy.…”

Immune Therapies in Non-Muscle Invasive Bladder Cancer

“…Lymphovascular invasion (LVI) is another important high-risk pathologic feature with its presence associated with high rates of progression and worse disease-specific survival [45,46]. The depth of invasion within the lamina propria also has been identified as a risk factor.…”