title: Prognostic significance of lymphovascular invasion in upper urinary tract urothelial carcinoma is influenced by tumor location.
abstract: BACKGROUND
  To examine the prognostic value of lymphovascular invasion (LVI) in different tumor locations (i.e., renal pelvis and ureter) of upper urinary tract urothelial carcinoma (UTUC).
  
  
  METHODS
  Data from a total of 250 patients with nonmetastatic UTUC who received radical nephroureterectomy between 2004 and 2010 at our institution were analyzed retrospectively. The significance of LVI and other relevant factors on cancer-specific survival (CSS), metastasis-free survival (MFS), and intraluminal recurrence-free survival (IRFS) were evaluated.
  
  
  RESULTS
  Lymphovascular invasion was present in 60 patients (24 %) and was related to advanced pathological T stage (P < 0.001), higher tumor grade (P < 0.001), lymph node metastasis (P = 0.005), and pyelocaliceal tumor location (P = 0.002). By Kaplan-Meier analysis, LVI was found to be significantly correlated with worse CSS and MFS but not with IRFS. Multivariate analysis showed that high pathological T stage and regional lymph node involvement were significant prognostic factors for CSS and MFS, and LVI was an independent predictor for MFS (hazard ratio 1.71, 95 % confidence interval 1.00-2.93, P = 0.049). In patients with ureteral tumors, LVI represented the only significant prognosticator for both CSS and MFS in multivariate analysis. The prognostic value of LVI was not observed in pyelocaliceal tumors.
  
  
  CONCLUSIONS
  The implication of LVI on prognosis, particularly in ureteral tumors but not in pyelocaliceal tumors, may imply diverse disease characteristics between different tumor locations among UTUC. LVI is essential to identify patients at high risk for metastasis/mortality and can facilitate treatment planning and surveillance strategies, especially in patients with ureteral tumors.
authors.affiliation: Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Hsiang-Ying
authors.initials: HY
authors.lastname: Lee
authors.forename: Ching-Chia
authors.initials: CC
authors.lastname: Li
authors.forename: Chun-Nung
authors.initials: CN
authors.lastname: Huang
authors.forename: Hung-Lung
authors.initials: HL
authors.lastname: Ke
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Li
authors.forename: Peir-In
authors.initials: PI
authors.lastname: Liang
authors.forename: Sheau-Fang
authors.initials: SF
authors.lastname: Yang
authors.forename: Hung-Pin
authors.initials: HP
authors.lastname: Tu
authors.forename: Wen-Jeng
authors.initials: WJ
authors.lastname: Wu
authors.forename: Hsin-Chih
authors.initials: HC
authors.lastname: Yeh
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D009392:Nephrectomy; D010386:Pelvic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014513:Ureter / Q000473:pathology* / Q000601:surgery; D014571:Urologic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D019043:Vascular Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery