title: Perineural invasion in transitional cell carcinoma and the effect on prognosis following radical cystectomy.
abstract: OBJECTIVE
  The relationship between perineural invasion and prognosis has been demonstrated to be poor in a number of malignancies. This has not been evaluated in the bladder. We performed a study to determine the occurrence of nodal metastases, extranodal metastases, and disease-free survival in patients with perineural invasion (PNI) and/or angiolymphatic invasion (ALI) in transitional cell carcinoma of the bladder (TCCB) from radical cystectomy specimens.
  
  
  METHODS
  A retrospective review of 27 patients treated with radical cystectomy for TCCB was conducted. Comparisons were performed between three groups: PNI with or without ALI (PNI +/- ALI, 12 patients), ALI alone (8 patients), and a control group (no PNI or ALI) (7 patients).
  
  
  RESULTS
  The mean patient age was 70 years (range 49 to 83). The overall median follow-up period was 11 months (range 1 to 32). PNI +/- ALI was predominantly found in Stage T3b disease (14 of 20 [70%] cases). The overall 1-year disease-free survival was 48%, 67%, and 83% for the PNI +/- ALI, ALI alone, and control groups, respectively. Nodal metastases (for all stages combined) were found in 6 of 12 (50%), 3 of 8 (38%), and 1 of 7 (14%) patients in the PNI +/- ALI, ALI alone, and control groups, respectively. Similarly, extranodal metastatic disease was found in 5 of 12 (42%), 4 of 8 (50%), and 1 of 7 (14%) patients in the PNI +/- ALI, ALI alone, and control groups, respectively. The percentage of deaths for the PNI +/- ALI, ALI only, and control groups were 33%, 50%, and 14%, respectively.
  
  
  CONCLUSIONS
  In TCCB, perineural invasion with or without angiolymphatic invasion and angiolymphatic invasion alone are associated with a higher incidence of nodal and extranodal metastases and death.
authors.affiliation: Division of Urology, University of Pittsburgh, USA.
authors.forename: A K
authors.initials: AK
authors.lastname: Nangia
authors.forename: B R
authors.initials: BR
authors.lastname: Konety
authors.forename: S
authors.initials: S
authors.lastname: Wachtel
authors.forename: R
authors.initials: R
authors.lastname: Dhir
authors.forename: M J
authors.initials: MJ
authors.lastname: Becich
authors.forename: R R
authors.initials: RR
authors.lastname: Bahnson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000453:epidemiology / Q000556:secondary* / Q000601:surgery*; D015653:Cystectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009423:Nervous System Neoplasms / Q000453:epidemiology / Q000556:secondary*; D011379:Prognosis; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*; D019043:Vascular Neoplasms / Q000453:epidemiology / Q000556:secondary*