title: Lymphovascular invasion is independently associated with overall survival, cause-specific survival, and local and distant recurrence in patients with negative lymph nodes at radical cystectomy.
abstract: OBJECTIVE
  We hypothesized that bladder cancer patients with associated lymphovascular invasion (LVI) are at increased risk of occult metastases.
  
  
  METHODS
  A multi-institutional group (University of Texas Southwestern [Dallas, TX], Baylor College of Medicine [Houston, TX], Johns Hopkins University [Baltimore, MD]) carried out a retrospective study of 958 patients who underwent cystectomy for bladder cancer between 1984 and 2003. Of patients with transitional-cell carcinoma (n = 776), LVI status was available for 750. LVI was defined as the presence of tumor cells within an endothelium-lined space.
  
  
  RESULTS
  LVI was present in 36.4% (273 of 750) overall, involving 26% (151 of 581) and 72% (122 of 169) of node-negative and node-positive patients, respectively. Prevalence of LVI increased with higher pathologic stage (9.0%, 23%, 60%, and 78%, for T1, T2, T3, and T4, respectively; P < .001). Using multivariate Cox regression analyses including age, stage, grade, and number of pelvic lymph nodes removed, LVI was an independent predictor of local (HR = 2.03, P = .049), distant (HR = 2.60, P = .0011), and overall (HR = 2.02, P = .0003) recurrence in node-negative patients. LVI was an independent predictor of overall (HR = 1.84, P = .0002) and cause-specific (HR = 2.07, P = .0012) survival in node-negative patients. LVI maintained its independent predictor status in competing risks regression models (P = .013), where other-cause mortality was considered as a competing risk. LVI was not a predictor of recurrence or survival in node-positive patients.
  
  
  CONCLUSIONS
  LVI is an independent predictor of recurrence and decreased cause-specific and overall survival in patients who undergo cystectomy for invasive bladder cancer and are node-negative. These patients represent a high risk group that may benefit from integrated therapy with cystectomy and perioperative systemic chemotherapy.
authors.affiliation: Department of Urology, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390-9110, USA. yair.lotan@UTSouthwestern.edu
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Ganesh S
authors.initials: GS
authors.lastname: Palapattu
authors.forename: Amnon
authors.initials: A
authors.lastname: Vazina
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Bastian
authors.forename: Craig G
authors.initials: CG
authors.lastname: Rogers
authors.forename: Gilad
authors.initials: G
authors.lastname: Amiel
authors.forename: Paul
authors.initials: P
authors.lastname: Perotte
authors.forename: Mark P
authors.initials: MP
authors.lastname: Schoenberg
authors.forename: Seth P
authors.initials: SP
authors.lastname: Lerner
authors.forename: Arthur I
authors.initials: AI
authors.lastname: Sagalowsky
mesh_terms: D017677:Age Distribution; D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D002423:Cause of Death; D015331:Cohort Studies; D015653:Cystectomy / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery