title: Lymphovascular invasion is independently associated with bladder cancer recurrence and survival in patients with final stage T1 disease and negative lymph nodes after radical cystectomy.
abstract: OBJECTIVE
  To determine the outcomes of patients with final pathological stage T1N0 disease after radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB) and to determine whether lymphovascular invasion (LVI) is an independent predictor of prognosis in these patients.
  
  
  METHODS
  Records of 958 consecutive patients who underwent RC at three academic centres were reviewed. A total of 101 patients with negative lymph nodes and with final stage (the higher of the pre-RC clinical/transurethral resection [TUR] and post-RC pathological stages) T1 UCB were identified. The median (range) follow-up was 38 (0.4-177) months and the median (range) number of nodes examined was 19 (9-80).
  
  
  RESULTS
  Overall, 12/101 (11.9%) patients experienced cancer recurrence and 7/101 (6.9%) died from their cancer. The 3-year recurrence-free survival probability (SD) was 0.89 (0.04) and 3-year cancer-specific survival probability (SD) was 0.96 (0.02). Six of 101 (6%) patients had LVI, of whom four experienced disease recurrence and three died from bladder cancer. All recurrences and deaths occurred in patients who had either LVI and/or concomitant carcinoma in situ. On multivariable analysis, LVI (hazard ratio [HR] 4.9, P = 0.01) and higher pathological stage (HR 8.5, P = 0.04) predicted cancer recurrence and LVI (HR 6.7, P = 0.01) predicted cancer-specific survival.
  
  
  CONCLUSIONS
  LVI helps identify patients with final pathological T1N0 UCB who are at significantly increased risk of bladder cancer recurrence and death. These patients should be considered for close monitoring after cystectomy.
authors.affiliation: Department of Urology, Ludwig-Maximilians-University Munich, Klinikum Grosshadern, Munich, Germany.
authors.forename: Derya
authors.initials: D
authors.lastname: Tilki
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Michael
authors.initials: M
authors.lastname: Rink
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Mark P
authors.initials: MP
authors.lastname: Schoenberg
authors.forename: Seth P
authors.initials: SP
authors.lastname: Lerner
authors.forename: Guru
authors.initials: G
authors.lastname: Sonpavde
authors.forename: Arthur I
authors.initials: AI
authors.lastname: Sagalowsky
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D015653:Cystectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D009367:Neoplasm Staging; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery