title: Clinical significance of lymphovascular invasion in upper urinary tract urothelial cancer.
abstract: OBJECTIVE
  To clarify the significance of lymphovascular invasion (LVI) in patients with pT3N0M0 upper urinary tract (UUT) urothelial carcinoma (UC) relative to prognosis in terms of disease-specific survival, as LVI, which implies both blood vessel and lymph vessel involvement, is reportedly a poor prognostic factor in patients with UUT-UC.
  
  
  METHODS
  The clinical records of 90 patients who had surgery for UUT-UC were reviewed retrospectively. The median patient age was 71 years and the median follow-up was 42 months. The prognostic significances of LVI (with vs without), T stage (< 1 vs 2-4), grade (1-2 vs 3), N stage (0 vs 1-2), age (< or = 70 vs > 70 years), gender and tumour location (renal pelvis vs ureter) for survival time were evaluated.
  
  
  RESULTS
  LVI of UUT-UC was found in 34 patients (37.8%). There were significantly higher frequencies of LVI with advancing stage and lymph node metastasis. Kaplan-Meier analysis showed that LVI was strongly associated with disease-specific survival in all patients (P < 0.001) and in patients with pT3N0M0 disease (P < 0.001). Univariate analyses showed that LVI, T stage, N stage and tumour grade were significantly related to disease-specific survival in all patients (P < 0.001, < 0.001, 0.003 and 0.007, respectively). Multivariate analysis using Cox proportional hazards model showed that LVI was the only prognostic factor with independent significance for disease-specific survival (P < 0.001).
  
  
  CONCLUSIONS
  LVI appears to be an important and independent prognostic factor for UUT-UC in patients treated by nephroureterectomy. Our data suggest that the LVI status might be a predictive marker for disease-specific survival in patients with T3N0M0 UTT-UC.
authors.affiliation: Department of Urology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
authors.forename: Jumpei
authors.initials: J
authors.lastname: Akao
authors.forename: Hideyasu
authors.initials: H
authors.lastname: Matsuyama
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Hara
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kawai
authors.forename: Shigeru
authors.initials: S
authors.lastname: Sakano
authors.forename: Chietaka
authors.initials: C
authors.lastname: Ohmi
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Gondo
authors.forename: Katsusuke
authors.initials: K
authors.lastname: Naito
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D016019:Survival Analysis; D014516:Ureteral Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D019459:Urothelium / Q000473:pathology; D019043:Vascular Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery