Lymphovascular invasion predicts clinical outcomes in patients with node-negative upper tract urothelial carcinoma.
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.
Kikuchi
Eiji
E
Keio University School of Medicine, Tokyo, Japan.
Margulis
Vitaly
V
Karakiewicz
Pierre I
PI
Roscigno
Marco
M
Mikami
Shuji
S
Lotan
Yair
Y
Remzi
Mesut
M
Bolenz
Christian
C
Langner
Cord
C
Weizer
Alon
A
Montorsi
Francesco
F
Bensalah
Karim
K
Koppie
Theresa M
TM
Fernández
Mario I
MI
Raman
Jay D
JD
Kassouf
Wassim
W
Wood
Christopher G
CG
Suardi
Nazareno
N
Oya
Mototsugu
M
Shariat
Shahrokh F
SF
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*