title: Presence of lymphovascular invasion in urothelial bladder cancer specimens after transurethral resections correlates with risk of upstaging and survival: a systematic review and meta-analysis.
abstract: OBJECTIVE
  This study aimed to elucidate the relationship between lymphovascular invasion (LVI) at transurethral resection of bladder tumor (TURBT) and the risk of pathologic upstaging as well as the clinical outcomes.
  
  
  METHODS
  PubMed, Scopus, Web of Science, and Cochrane Library databases were searched from the respective dates of inception until November 11, 2013.
  
  
  RESULTS
  A total of 16 articles met the eligibility criteria for this systematic review, which included a total of 3,905 patients. LVI was detected in 18.6% of TURBT specimens. A significant association was found between LVI at TURBT and pathologic upstaging of bladder cancer (odds ratio = 2.21, 95% CI: 1.44-3.39) without heterogeneity (I(2) = 45%, P = 0.14). The pooled hazard ratio (HR) was statistically significant for recurrence-free survival (HR = 1.47, 95% CI: 1.24-1.74), progression-free survival (HR = 2.28, 95% CI: 1.45-3.58), and disease-specific survival (HR = 1.35, 95% CI: 1.01-1.81), but not for overall survival (HR = 1.55, 95% CI: 0.90-2.67). Tests of inconsistency for disease-specific survival (I(2) = 66%, P = 0.007) and overall survival (I(2) = 72%, P = 0.03) could not exclude a significant heterogeneity. The results of the Begg and the Egger tests showed that there was evidence of publication bias on pathologic upstaging and progression-free survival.
  
  
  CONCLUSIONS
  The data obtained in this meta-analysis indicate that the presence of LVI at TURBT portends the increased risk of pathologic upstaging and may provide additional prognostic information. However, a large, well-designed, prospective study is needed to investigate potential treatment options for bladder cancer with LVI.
authors: Department of Urology, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors: Hyung Suk
authors: HS
authors: Kim
authors: Department of Urology, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors: Myong
authors: M
authors: Kim
authors: Department of Urology, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors: Chang Wook
authors: CW
authors: Jeong
authors: Department of Urology, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors: Cheol
authors: C
authors: Kwak
authors: Department of Urology, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors: Hyeon Hoe
authors: HH
authors: Kim
authors: Department of Urology, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: kuuro70@snu.ac.kr.
authors: Ja Hyeon
authors: JH
authors: Ku
mesh_terms: D018572:Disease-Free Survival; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*
keywords: Bladder cancer; Lymphovascular invasion; Meta-analysis; Prognosis; Transurethral resection; Urothelial carcinoma