title: Lymphovascular invasion in radical cystectomy specimen: is it an independent prognostic factor in patients without lymph node metastases?
abstract: OBJECTIVE
  To determine the prognostic significance of lymphovascular invasion (LVI) in patients with urothelial carcinoma of the bladder undergoing radical cystectomy (RC) and bilateral pelvic lymph node dissection.
  
  
  METHODS
  From 1992 to 2008, 526 patients underwent RC and pelvic lymphadenectomy at our institution by a single surgical team. All relevant data were entered into a database and analyzed. LVI was defined as "the presence of tumor cells within an endothelial lined space." The exclusion criteria were non-TCC histology, salvage cystectomy, neoadjuvant chemotherapy, and unknown LVI status.
  
  
  RESULTS
  A total of 357 patients met the inclusion criteria. Overall prevalence of LVI was 29%. LVI was significantly associated with higher T stage, lymph node (LN) metastases, and higher grade. Patients with LVI had significantly higher recurrence rate (P < 0.001) and decreased long-term survival (P < 0.001). In patients without LN metastases, LVI in the primary led to a significantly decreased recurrence-free (P = 0.003) and disease-specific survival (P = 0.001). In the presence of LN metastases, LVI did not significantly alter the recurrence-free or disease-specific survival. On multivariate analysis, T stage (P < 0.0001) and LN metastases (P = 0.01) were significant independent prognostic factors influencing disease-specific survival. LVI did not have independent prognostic value. T stage was the only significant prognostic factor in the lymph node negative group.
  
  
  CONCLUSIONS
  Although, the presence of LVI in node-negative patients is an adverse prognostic factor on univariate analysis of disease-specific survival, it is not an independent prognostic factor on multivariate analysis. Pathological stage is the only independent prognostic factor for survival.
authors: Department of Urology, Miller School of Medicine, University of Miami, P.O. Box 016960 (M814), Miami, FL 33101, USA. mmanoharan@med.miami.edu
authors: Murugesan
authors: M
authors: Manoharan
authors: Devendar
authors: D
authors: Katkoori
authors: T A
authors: TA
authors: Kishore
authors: Merce
authors: M
authors: Jorda
authors: Tony
authors: T
authors: Luongo
authors: Mark S
authors: MS
authors: Soloway
mesh_terms: D000368:Aged; D015653:Cystectomy; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D009367:Neoplasm Staging; D015995:Prevalence; D011379:Prognosis; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery; D019459:Urothelium / Q000473:pathology* / Q000601:surgery