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.
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.
Lotan
Yair
Y
Department of Urology, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390-9110, USA. yair.lotan@UTSouthwestern.edu
Gupta
Amit
A
Shariat
Shahrokh F
SF
Palapattu
Ganesh S
GS
Vazina
Amnon
A
Karakiewicz
Pierre I
PI
Bastian
Patrick J
PJ
Rogers
Craig G
CG
Amiel
Gilad
G
Perotte
Paul
P
Schoenberg
Mark P
MP
Lerner
Seth P
SP
Sagalowsky
Arthur I
AI
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