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Lymphovascular invasion in prostate cancer
Author(s) -
Brooks Joseph P.,
Albert Paul S.,
O'Connell John,
McLeod David G.,
Poggi Matthew M.
Publication year - 2006
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.21774
Subject(s) - lymphovascular invasion , medicine , urology , confidence interval , prostate cancer , proportional hazards model , prostatectomy , biochemical recurrence , oncology , cancer , metastasis
BACKGROUND Lymphovascular invasion (LVI) is found in approximately 5% to 53% of specimens after radical prostatectomy (RP). Although LVI is associated with higher rates of recurrence after RP, its prognostic significance after postprostatectomy radiotherapy (P‐XRT) is unclear. METHODS The medical records of men who received P‐XRT from 1991 to 2001 at 2 institutions were reviewed for the presence of LVI in RP specimens. Multiple patient variables were evaluated for their association with LVI using Fisher exact tests and Wilcoxon rank‐sum tests. The time to biochemical recurrence (BCR) and the time to distant metastases (DM) after RP were analyzed using Kaplan–Meier estimations, log‐rank tests, and Cox regression analyses. RESULTS Eighteen of 160 patients (11%) who received P‐XRT had LVI in their RP specimen. High Gleason score and seminal vesicle invasion were associated significantly with LVI. After a median follow‐up of 8.3 years after RP, 16 patients with LVI had BCR after P‐XRT, 9 of whom developed DM. The median time to BCR in patients with LVI was 2.6 years (95% confidence interval [95% CI], 1.8‐5.4) compared with 7.8 years (95% CI, 6.8‐10.3) in patients without LVI ( P < .001). Multivariate analysis revealed an adjusted relative risk for LVI of 5.5 ( P < .001). Other significant factors were Gleason score, undetectable post‐RP serum prostate‐specific antigen (PSA) levels, preradiotherapy serum PSA levels, and the interval from RP to P‐XRT. LVI was the only significant factor associated with an increased risk of DM in univariate analysis (hazard ratio, 7.4; P < .001). CONCLUSIONS LVI was useful as a pathologic marker for reduced efficacy of P‐XRT after RP in terms of increased risk of BCR and DM. Future studies will be needed to validate these findings. Cancer 2006. Published 2006 American Cancer Society.