title: Prognostic value of the lymphovascular invasion in high-grade stage pT1 bladder cancer.
abstract: OBJECTIVE
  High-grade (HG) stage pT1 bladder cancers have the highest recurrence and progression rates of all non-muscle-invasive bladder cancers. Some prognostic factors for recurrence and progression have been identified: multifocal HG pT1, concomitant carcinome in situ, tumor diameter >3 cm, infiltration of the deep lamina propria, and persistence of pT1 tumor on a second transurethral resection of the bladder. The objective of this study was to determine whether the presence of lymphovascular invasion (LVI) is also a prognostic factor that must be taken into account.
  
  
  METHODS
  This retrospective study was performed with 108 patients with HG stage pT1 bladder cancer: 89 patients were treated conservatively (transurethral resection of the bladder plus bacille Calmette-Guérin therapy), and 19 patients underwent early cystectomy. The mean (SD) follow-up was 47.8 ± 41.2 months. Classic prognostic factors and LVI were analyzed in terms of overall survival, specific survival, recurrence-free survival, and progression-free survival.
  
  
  RESULTS
  Thirty-six percent of patients had LVI on the chips of the first transurethral resection of the bladder. Five-year overall survival and specific survival were 40% and 75%, respectively. Multivariate analysis of risk factors showed a significant reduction of overall survival in the presence of LVI (P = .007). The presence of LVI was also a factor of poor prognosis in the case of delayed cystectomy (P = .010) but not in the case of early cystectomy.
  
  
  CONCLUSIONS
  Identification of LVI on the first resection of a HG stage pT1 bladder cancer is a significant prognostic factor for overall survival.
authors.affiliation: Department of Urology, CHU Nantes Hôtel Dieu, Nantes, France. Julien.branchereau@chu-nantes.fr
authors.forename: Julien
authors.initials: J
authors.lastname: Branchereau
authors.forename: Sebastien
authors.initials: S
authors.lastname: Larue
authors.forename: Bertrand
authors.initials: B
authors.lastname: Vayleux
authors.forename: Georges
authors.initials: G
authors.lastname: Karam
authors.forename: Olivier
authors.initials: O
authors.lastname: Bouchot
authors.forename: Jérôme
authors.initials: J
authors.lastname: Rigaud
mesh_terms: D000368:Aged; D015653:Cystectomy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery