Lymphovascular invasion is an independent predictor of oncological outcomes in patients with lymph node-negative urothelial bladder cancer treated by radical cystectomy: a multicentre validation trial.
OBJECTIVE
To validate the association of lymphovascular invasion (LVI) with disease recurrence and cancer-specific survival (CSS) in a multicentre cohort of patients treated with radical cystectomy (RC) for urothelial bladder cancer (UBC).


METHODS
We collected pathological and clinical data on 1099 lymph node-negative patients treated with RC at six German institutions. LVI was defined as the presence of tumour cells within an unequivocal endothelium-lined space in haematoxylin and eosin-stained sections.


RESULTS
LVI was present in 295 (26.8%) patients; the presence of LVI correlated significantly with increasing tumour stage, i.e. pT1, 65 (29.4%); pT2, 88 (31.5%); pT3 110 (31.8%); and pT4 32 (38.1%) (P= 0.002) and grade (P < 0.001). In univariable analysis the presence of LVI was significantly associated with reduced recurrence-free survival (P= 0.008) and reduced CSS (P= 0.039). On multivariable Cox regression analysis tumour stage (P < 0.001), age (>75 vs >or=75 years; P= 0.018) and LVI (P < 0.001) were identified as independent predictors of CSS.


CONCLUSIONS
Our large multicentre study confirms the independent prognostic value of LVI in patients with node-negative UBC. LVI can be regarded as a surrogate variable for lymphatic micrometastasis in node-negative UBC. Assessment of LVI might improve the selection of patients who are likely to benefit from adjuvant therapy after RC. The identification of factors involved in the process of LVI could reveal new therapeutic targets for UBC.
Bolenz
Christian
C
Department of Urology, Mannheim Medical Centre, University of Heidelberg, Germany. christian.bolenz@umm.de
Herrmann
Edwin
E
Bastian
Patrick J
PJ
Michel
Maurice S
MS
Wülfing
Christian
C
Tiemann
Arne
A
Buchner
Alexander
A
Stief
Christian G
CG
Fritsche
Hans-Martin
HM
Burger
Maximilian
M
Wieland
Wolf F
WF
Höfner
Thomas
T
Haferkamp
Axel
A
Hohenfellner
Markus
M
Müller
Stefan C
SC
Ströbel
Philipp
P
Trojan
Lutz
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D011379:Prognosis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D019459:Urothelium