title: Impact of lymphovascular invasion on oncological outcomes in patients with upper tract urothelial carcinoma after radical nephroureterectomy.
abstract: OBJECTIVE
  To assess the impact of lymphovascular invasion (LVI) on upper urinary tract urothelial carcinomas (UTUCs) in a multicentre study on cancer-specific survival (CSS), recurrence-free survival and metastasis-free survival (MFS). To show the negative impact of LVI for patients with pN0/x disease and to stratify these patients into risk groups for metastatic relapse.
  
  
  METHODS
  A multicentre retrospective study was performed on patients who underwent radical nephroureterectomy between 1995 and 2010. LVI status was evaluated as a prognostic factor for survival using univariate and multivariate Cox regression analysis.
  
  
  RESULTS
  Overall, 551 patients were included and were divided into two groups: those without LVI (LVI-), n = 388 and those with LVI (LVI+), n = 163. LVI+ status was associated with high stage and grade UTUC and lymph node metastasis (P < 0.001). The 5-year CSS and MFS rates were significantly worse in the LVI+ group than in LVI- group (52.2 vs 84.5%, P < 0.001 and 43.8 vs 82.7%, P < 0.001, respectively). In multivariate analysis, LVI+ status was an independent prognostic factor for CSS and MFS (P = 0.04 and P < 0.001). These findings were confirmed for the pN0/x patient subgroup (n = 504, P < 0.001). In the pN0/x patient subgroup, we described a prognostic tool for MFS based on independent factors that permitted us to stratify patients into groups of high, intermediate or low risk of metastasis relapse.
  
  
  CONCLUSIONS
  The presence of LVI was a strong predictor of a poor outcome for UTUC. When a lymphadenectomy has not been achieved, the report of LVI status is crucial to identfiy those patients at higher risk for metastatic relapse.
authors: Department of Urology, Côte de Nacre Hospital, CHU Caen, Caen, France.
authors: Sophie
authors: S
authors: Hurel
authors: Morgan
authors: M
authors: Rouprêt
authors: Adil
authors: A
authors: Ouzzane
authors: François
authors: F
authors: Rozet
authors: Evanguelos
authors: E
authors: Xylinas
authors: Marc
authors: M
authors: Zerbib
authors: Alexis Arvin
authors: AA
authors: Berod
authors: Alain
authors: A
authors: Ruffion
authors: Emilie
authors: E
authors: Adam
authors: Olivier
authors: O
authors: Cussenot
authors: Alain
authors: A
authors: Houlgatte
authors: Véronique
authors: V
authors: Phé
authors: François-Xavier
authors: FX
authors: Nouhaud
authors: Henri
authors: H
authors: Bensadoun
authors: Francky
authors: F
authors: Delage
authors: Julien
authors: J
authors: Guillotreau
authors: Laurent
authors: L
authors: Guy
authors: Gilles
authors: G
authors: Karsenty
authors: Alexandre
authors: A
authors: De La Taille
authors: Pierre
authors: P
authors: Colin
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D010388:Pelvis; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends*; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery