title: Lymphatic invasion is a prognostic factor for bladder cancer treated with radical cystectomy.
abstract: BACKGROUND
  We aimed to elucidate the significance of pathological prognostic factors in patients with bladder cancer treated with radical cystectomy and pelvic lymphadenectomy focusing on the association between lymphatic invasion and disease recurrence.
  
  
  METHODS
  Ninety-one patients with ladder cancer who had undergone radical cystectomy were examined retrospectively. Clinicopathological findings and clinical outcomes were analyzed. Patients who received palliative cystectomy or neoadjuvant chemotherapy and patients who did not receive lymphadenectomy owing to a poor general condition or far advanced local disease status were excluded.
  
  
  RESULTS
  Lymphatic invasion and lymph node involvement were present in 45.1% and 23.1% of patients, respectively. Multivariate analyses, using the Cox proportional hazards model, indicated that lymphatic invasion (hazard ratio [HR], 5.30; P = 0.007) and lymph node involvement (HR = 3.05; P = 0.016) were independent prognostic factors for disease-specific survival. Of the 91 patients, 29 (31.9%) had recurrent disease during the follow-up period. The rate of recurrence in patients with lymphatic invasion and without lymph node involvement was 50% (11/22), which was not significantly different from that in patients with both lymphatic invasion and lymph node involvement (73.7%; 14/19; P = 0.121), indicating a high risk of disease recurrence in patients with bladder cancer with lymphatic invasion even in the absence of the lymph node involvement.
  
  
  CONCLUSIONS
  In patients with bladder cancer treated with radical cystectomy, lymphatic invasion is an independent prognostic factor for disease-specific and disease-free survival. Patients with lymphatic invasion have a high risk of disease recurrence after radical cystectomy even in the absence of lymph node involvement.
authors: Department of Urology, Akita University School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan.
authors: Yohei
authors: Y
authors: Horikawa
authors: Teruaki
authors: T
authors: Kumazawa
authors: Shintaro
authors: S
authors: Narita
authors: Takamitsu
authors: T
authors: Inoue
authors: Takeshi
authors: T
authors: Yuasa
authors: Shinobu
authors: S
authors: Matsuura
authors: Hiroshi
authors: H
authors: Nanjo
authors: Shigeru
authors: S
authors: Satoh
authors: Norihiko
authors: N
authors: Tsuchiya
authors: Tomonori
authors: T
authors: Habuchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002278:Carcinoma in Situ / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015653:Cystectomy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012107:Research Design; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D019043:Vascular Neoplasms / Q000175:diagnosis / Q000556:secondary