title: Lymphovascular invasion predicts clinical outcomes in patients with node-negative upper tract urothelial carcinoma.
abstract: OBJECTIVE
  To assess the association of lymphovascular invasion (LVI) with cancer recurrence and survival in a large international series of patients treated with radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC).
  
  
  METHODS
  Data were collected on 1,453 patients treated with RNU at 13 academic centers and combined into a relational database. Pathologic slides were rereviewed by genitourinary pathologists according to strict criteria. LVI was defined as presence of tumor cells within an endothelium-lined space.
  
  
  RESULTS
  LVI was observed in 349 patients (24%). Proportion of LVI increased with advancing tumor stage, high tumor grade, presence of tumor necrosis, sessile tumor architecture, and presence of lymph node metastasis (all P < .001). LVI was an independent predictor of disease recurrence and survival (P < .001 for both). Addition of LVI to the base model (comprising pathologic stage, grade, and lymph node status) marginally improved its predictive accuracy for both disease recurrence and survival (1.1%, P = .03; and 1.7%, P < .001, respectively). In patients with negative lymph nodes and those in whom a lymphadenectomy was not performed (n = 1,313), addition of LVI to the base model improved the predictive accuracy of the base model for both disease recurrence and survival by 3% (P < .001 for both). In contrast, LVI was not associated with disease recurrence or survival in node-positive patients (n = 140).
  
  
  CONCLUSIONS
  LVI was an independent predictor of clinical outcomes in nonmetastatic patients who underwent RNU for UTUC. Assessment of LVI may help identify patients who could benefit from multimodal therapy after RNU. After confirmation, LVI should be included in staging of UTUC.
authors.affiliation: Keio University School of Medicine, Tokyo, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kikuchi
authors.forename: Vitaly
authors.initials: V
authors.lastname: Margulis
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Marco
authors.initials: M
authors.lastname: Roscigno
authors.forename: Shuji
authors.initials: S
authors.lastname: Mikami
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Mesut
authors.initials: M
authors.lastname: Remzi
authors.forename: Christian
authors.initials: C
authors.lastname: Bolenz
authors.forename: Cord
authors.initials: C
authors.lastname: Langner
authors.forename: Alon
authors.initials: A
authors.lastname: Weizer
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Koppie
authors.forename: Mario I
authors.initials: MI
authors.lastname: Fernández
authors.forename: Jay D
authors.initials: JD
authors.lastname: Raman
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Oya
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001808:Blood Vessels / Q000473:pathology*; D004730:Endothelium, Vascular / Q000473:pathology; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008208:Lymphatic System / Q000473:pathology*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012008:Recurrence; D014571:Urologic Neoplasms / Q000401:mortality / Q000473:pathology*