Prognostic value of lymphovascular invasion in bladder cancer in patients treated with radical cystectomy.
BACKGROUND
Bladder cancer is the fourth most frequently diagnosed cancer among males and the eleventh among females. At present, radical cystectomy is considered the standard therapy in patients with muscle invasive disease or in some cases of high-grade superficial cancer. TNM classification includes as independent predictors of disease-specific survival the grade, the pathological stage and the presence of lymph node involvement, whilst the prognostic value of lymphovascular invasion (LVI) still remains controversial. The aim of the study was to assess the prognostic role of LVI at final pathology.


METHODS
From June 1995 to January 2007, 340 consecutive patients underwent radical cystectomy. Surgical specimens were examined according to our pathological protocol. Patients with a non-transitional cell carcinoma or submitted to a salvage procedure or neoadjuvant/adjuvant chemo-radiotherapy were excluded. The follow-up consisted of abdominal ultrasound every 3 months, blood sampling every six months and both computerized tomography and urethroscopy yearly.


RESULTS
The median patient age was 69 years. Of the 265 patients, 218 were males and 47 females. LVI was present in 77 pathological specimens (29.1%). LVI was not significantly associated with age (p=0.908) or sex (p=0.382), but was significantly associated with high pathological grade (p=0.028) and stage (p<0.001), and the presence of node metastasis (p<0.001). At the multivariate analysis, pathological staging, presence of LVI and node metastasis were independent significant prognostic factors for disease-specific survival.


CONCLUSIONS
In our series, LVI is an independent prognostic factor for disease specific survival in patients who underwent radical cystectomy for transitional cell carcinoma.
Palmieri
Fabiano
F
Department of Urology, University of Bologna, S Orsola-Malpighi General Hospital, Pelagio Palagi 9 Street, 40138 Bologna, Italy. fabianopalmieri@libero.it
Brunocilla
Eugenio
E
Bertaccini
Alessandro
A
Guidi
Mascia
M
Pernetti
Remigio
R
Morselli-Labate
Antonio Maria
AM
Martorana
Giuseppe
G
D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D015653:Cystectomy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*; D014547:Urinary Diversion; D019043:Vascular Neoplasms / Q000473:pathology*