title: The role of lymphovascular space invasion in renal cell carcinoma as a prognostic marker of survival after curative resection.
abstract: OBJECTIVE
  Lymphovascular invasion (LVI) correlates with adverse outcomes in numerous malignancies. However, its role in predicting outcomes in RCC is unclear. Herein, we evaluated what effect LVI had on metastasis free survival (MFS), disease-specific survival (DSS), and overall survival (OS) in patients with RCC treated with surgical excision.
  
  
  METHODS
  Eight hundred forty-one consecutive patients who underwent partial or radical nephrectomy from 1989 to 2004 were identified. Pathologic and gross features examined were LVI, subtype, Fuhrman grade, stage, and size. Age and gender were also analyzed. Slides were re-reviewed by a single pathologist (MS). Variables with P < 0.1 on univariate analysis were incorporated in a Cox proportional hazards multivariate model. MFS, DSS, and OS were described for patients with and without LVI using the Kaplan-Meier method, and compared with the log-rank test.
  
  
  RESULTS
  LVI was seen on H and E stained slides in 91 patients (11%); 120 (14%) developed metastatic disease, 91 (11%) died of RCC, and 306 (36%) died during a median follow-up of 61 months. While on univariate analysis, LVI was strongly associated with decreased MFS, DSS, and OS (P < 0.0001), on multivariate analysis, LVI was no longer statistically significant for MFS, DSS, and OS with a HR of 0.976 (95% CI: 0.583-1.63; P = 0.93), 0.96 (95% CI: 0.542-1.69; P = 0.88), and 1.24 (95% CI: 0.869-1.77; P = 0.24).
  
  
  CONCLUSIONS
  We found LVI to be associated with worse MFS, DSS, and OS on univariate analysis, but not on multivariate analysis for patients with nonmetastatic RCC. In contrast to previously reported studies, LVI may not be an independent prognostic variable in patients with localized RCC.
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Katz
authors.forename: Maria F
authors.initials: MF
authors.lastname: Serrano
authors.forename: Peter A
authors.initials: PA
authors.lastname: Humphrey
authors.forename: Robert L
authors.initials: RL
authors.lastname: Grubb
authors.forename: Ted A
authors.initials: TA
authors.lastname: Skolarus
authors.forename: Feng
authors.initials: F
authors.lastname: Gao
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kibel
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis / Q000473:pathology*; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models