International validation of the prognostic value of lymphovascular invasion in patients treated with radical cystectomy |
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| Authors: | Shahrokh F Shariat Robert S Svatek Derya Tilki Eila Skinner Pierre I Karakiewicz Umberto Capitanio Patrick J Bastian Bjoern G Volkmer Wassim Kassouf Giacomo Novara Hans‐Martin Fritsche Jonathan I Izawa Vincenzo Ficarra Seth P Lerner Arthur I Sagalowsky Mark P Schoenberg Ashish M Kamat Colin P Dinney Yair Lotan Michael J Marberger Yves Fradet |
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| Institution: | 1. University of Texas Southwestern Medical Center, Dallas,;2. University of Texas MD Anderson Cancer Center, Houston, Texas, USA,;3. Ludwig‐Maximilians‐Universit?t München, Klinikum Grosshadern, Munich, Germany,;4. University of Southern California, Los Angeles, California, USA,;5. University of Montréal, Montréal, Quebec, Canada,;6. Vita Salute, Milano, Italy,;7. Universit?t Bonn, Bonn,;8. University of Ulm, Ulm, Germany,;9. McGill University Health Centre, Montréal, Quebec, Canada,;10. University of Padua, Padua, Italy,;11. University of Regensburg, Regensburg, Germany,;12. University of Western Ontario, London, Ontario, Canada,;13. Baylor College of Medicine, Houston, Texas,;14. John Hopkins University, Baltimore, Maryland, USA,;15. Medical University of Vienna, Vienna, Austria, and;16. Laval University, Québec City, Québec, Canada |
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| Abstract: | Study Type – Prognosis (retrospective cohort)Level of Evidence 2b OBJECTIVE To externally validate the prognostic value of lymphovascular invasion (LVI) in a large international cohort of patients treated with radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). PATIENTS AND METHODS We collected data from 4257 patients treated with RC and pelvic lymphadenectomy for UCB, without neoadjuvant chemotherapy, at 12 centres. LVI was defined as presence of nests of tumour cells within an endothelium‐lined space. RESULTS LVI was detected in 1407 patients (33.1%); the proportion of LVI increased with advancing stage, higher grade, soft‐tissue surgical margin involvement, and lymph node metastasis (P < 0.001 for all). In standard multivariate models, LVI was associated with both disease recurrence (hazard ratio 1.43, P < 0.001) and cancer‐specific mortality (1.45, P < 0.001). In the entire cohort, adding LVI to a base model that included standard features improved only minimally its predictive accuracy for both recurrence and cancer‐specific mortality (by 1.1% and 1.2%, respectively). In 3122 patients with negative lymph nodes, LVI remained independently associated with and improved the predictive accuracy of the standard predictors for recurrence (hazard ratio 1.68, P < 0.001; +2.3%) and cancer‐specific mortality (1.70, P < 0.001; +2.4%). By contrast, in 1071 node‐positive patients, LVI only marginally improved the prediction of cancer‐specific recurrence (hazard ratio 1.20, P < 0.001; +0.2%) and survival (1.23, P < 0.001; +0.5%). CONCLUSIONS LVI is strongly associated with clinical outcome in node‐negative patients treated with RC. The assessment of LVI might help to identify patients who could benefit from adjuvant therapy after RC. After confirmation in different populations, LVI should be included in the staging of UCB. |
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| Keywords: | lymphovascular invasion prognosis bladder cancer urothelial carcinoma survival recurrence |
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