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Lymphovascular invasion is independently associated with bladder cancer recurrence and survival in patients with final stage T 1 disease and negative lymph nodes after radical cystectomy
Author(s) -
Tilki Derya,
Shariat Shahrokh F.,
Lotan Yair,
Rink Michael,
Karakiewicz Pierre I.,
Schoenberg Mark P.,
Lerner Seth P.,
Sonpavde Guru,
Sagalowsky Arthur I.,
Gupta Amit
Publication year - 2013
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2012.11455.x
Subject(s) - lymphovascular invasion , cystectomy , medicine , bladder cancer , stage (stratigraphy) , pathological , cancer , urology , carcinoma , t stage , oncology , metastasis , biology , paleontology
What's known on the subject? and What does the study add? Lymphovascular invasion ( LVI ) is an important step in systemic cancer cell dissemination. LVI has been shown to be an independent predictor of disease recurrence and cancer‐specific survival in urothelial carcinoma of the bladder ( UCB ) for patients with carcinoma invading bladder muscle. Patients with final pathological stage T 1 N 0 UCB who underwent radical cystectomy ( RC ) have not been separately analysed for influence of LVI on outcomes. Our study shows that LVI predicts disease recurrence and cancer‐specific survival in patients with final stage T 1 UCB after RC .Objective To determine the outcomes of patients with final pathological stage T 1 N 0 disease after radical cystectomy ( RC ) for urothelial carcinoma of the bladder ( UCB ) and to determine whether lymphovascular invasion ( LVI ) is an independent predictor of prognosis in these patients.Patients and Methods Records of 958 consecutive patients who underwent RC at three academic centres were reviewed. A total of 101 patients with negative lymph nodes and with final stage (the higher of the pre‐ RC clinical/transurethral resection [ TUR ] and post‐ RC pathological stages) T 1 UCB were identified. The median (range) follow‐up was 38 (0.4–177) months and the median (range) number of nodes examined was 19 (9–80).Results Overall, 12/101 (11.9%) patients experienced cancer recurrence and 7/101 (6.9%) died from their cancer. The 3‐year recurrence‐free survival probability (SD) was 0.89 (0.04) and 3‐year cancer‐specific survival probability (SD) was 0.96 (0.02). Six of 101 (6%) patients had LVI , of whom four experienced disease recurrence and three died from bladder cancer. All recurrences and deaths occurred in patients who had either LVI and/or concomitant carcinoma in situ . On multivariable analysis, LVI (hazard ratio [ HR ] 4.9, P = 0.01) and higher pathological stage ( HR 8.5, P = 0.04) predicted cancer recurrence and LVI ( HR 6.7, P = 0.01) predicted cancer‐specific survival.ConclusionsLVI helps identify patients with final pathological T 1 N 0 UCB who are at significantly increased risk of bladder cancer recurrence and death. These patients should be considered for close monitoring after cystectomy.