title: Lymphovascular invasion in clear cell renal cell carcinoma--association with disease-free and cancer-specific survival.
abstract: OBJECTIVE
  The objective is to evaluate the effect of lymphovascular invasion (LVI) on disease-free survival (DFS) and cancer-specific survival (CSS) in patients with clinically localized clear cell renal cell carcinoma (ccRCC).
  
  
  METHODS
  Patients with ccRCC who were treated surgically in 1997 to 2010 were identified. Retrospective chart review was performed to identify clinical outcomes. Independent pathologic re-review was performed by a single pathologist to confirm LVI status. Pathologic features were correlated with clinical outcomes using Kaplan-Meier and Cox regression analyses.
  
  
  RESULTS
  Four hundred and nineteen patients with nonmetastatic ccRCC comprised the study cohort. Three hundred and thirty-three of these patients had an organ-confined (pT1-2, N any, and M0) disease. LVI was present in 14.3% of all nonmetastatic patients. In all patients with nonmetastatic ccRCC, presence of LVI was correlated with significantly shorter DFS (P <0.001) and CSS (P = 0.001) on Kaplan-Meier analysis. In cases of organ-confined, nonmetastatic ccRCC, presence of LVI was a significant predictor of DFS (hazard ratio = 4.0, P = 0.026) and CSS (hazard ratio = 12.7, P = 0.01) on multivariate analysis. Patients with organ-confined RCC who were LVI positive had similar DFS (P = 0.957) and CSS (P = 0.799) to patients with locally advanced tumors (pT3-pT4, N any, and M0) on Kaplan-Meier analysis.
  
  
  CONCLUSIONS
  The presence of LVI is an independent predictor of both DFS and CSS in organ-confined, nonmetastatic ccRCC. LVI positivity in patients with otherwise pathologically organ-confined ccRCC confers oncologic outcomes similar to those of patients with locally advanced disease. If confirmed by others, future revisions to the tumor-node-metastasis staging system may incorporate LVI status into the prognostic algorithm of patients with RCC.
authors: Department of Urology, UT Southwestern Medical Center, Dallas, TX.
authors: Michael
authors: M
authors: Belsante
authors: Department of Urology, UT Southwestern Medical Center, Dallas, TX.
authors: Oussama
authors: O
authors: Darwish
authors: Department of Urology, UT Southwestern Medical Center, Dallas, TX.
authors: Ramy
authors: R
authors: Youssef
authors: Department of Urology, UT Southwestern Medical Center, Dallas, TX.
authors: Aditya
authors: A
authors: Bagrodia
authors: Department of Pathology, UT Southwestern Medical Center, Dallas, TX.
authors: Payal
authors: P
authors: Kapur
authors: Department of Urology, UT Southwestern Medical Center, Dallas, TX.
authors: Arthur I
authors: AI
authors: Sagalowsky
authors: Department of Urology, UT Southwestern Medical Center, Dallas, TX.
authors: Yair
authors: Y
authors: Lotan
authors: Department of Urology, UT Southwestern Medical Center, Dallas, TX. Electronic address: vitaly.margulis@utsouthwestern.edu.
authors: Vitaly
authors: V
authors: Margulis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009392:Nephrectomy; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Clinical outcomes; Lymphovascular invasion; Nephrectomy; Renal cell carcinoma; Survival