title: The presence of lymphovascular invasion in radical cystectomy specimens from patients with urothelial carcinoma portends a poor clinical prognosis.
abstract: OBJECTIVE
  To assess the prognostic significance of lymphovascular invasion (LVI) on clinical outcomes in patients with transitional cell carcinoma of the bladder treated with radical cystectomy (RC).
  
  
  METHODS
  We retrospectively evaluated a prospectively maintained and authorised cystectomy database; the presence or absence of LVI was determined by pathological examination of the RC specimen. Cox regression analysis and Kaplan-Meier tables were developed to evaluate the contribution of LVI to clinical outcomes.
  
  
  RESULTS
  In all, we analysed 356 patients treated with RC and urinary diversion between 1988 and 2006, with a mean follow-up of 45.6 months. Of these patients, 242 (68%) had no evidence of LVI in the RC specimen, whereas 114 (32%) had LVI. Patients with LVI tended to present with higher pathological stage; 84 (74%) had pT3 or pT4 disease. On univariable analysis the presence of LVI conferred a significant risk for decreased overall, cancer-specific and recurrence-free survival (P < 0.001); the mean values for LVI-negative patients were 96.8, 157.4, and 135.0 months, respectively, vs LVI-positive patients, whose survival times were 52.3, 82.7 and 75.2 months, respectively. The multivariable analysis showed significant independent risk for cancer-specific and overall survival for patients who were LVI-positive and had no lymph-node metastases. The hazard ratios (95% confidence interval) were 1.63 (1.06-2.51, P < 0.026) and 1.81 (1.06-3.08, P < 0.03) for overall and disease-specific survival, respectively.
  
  
  CONCLUSIONS
  The presence of LVI in the pathological RC specimen confers significant independent risk for reduced bladder cancer-specific and overall survival. This variable could be used to prospectively stratify patients who would benefit from adjuvant chemotherapy.
authors.affiliation: Department of Urology, University of Pennsylvania School of Medicine, Philadelphica, PA, USA. daniel.canter@uphs.upenn.edu
authors.forename: Daniel
authors.initials: D
authors.lastname: Canter
authors.forename: Thomas
authors.initials: T
authors.lastname: Guzzo
authors.forename: Matthew
authors.initials: M
authors.lastname: Resnick
authors.forename: Laurie
authors.initials: L
authors.lastname: Magerfleisch
authors.forename: Seema
authors.initials: S
authors.lastname: Sonnad
authors.forename: Meredith
authors.initials: M
authors.lastname: Bergey
authors.forename: John
authors.initials: J
authors.lastname: Tomazewski
authors.forename: David
authors.initials: D
authors.lastname: Vaughn
authors.forename: Keith
authors.initials: K
authors.lastname: Van Arsdalen
authors.forename: Bruce
authors.initials: B
authors.lastname: Malkowicz
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy / Q000379:methods*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy
chemical_list: D000970:Antineoplastic Agents