title: Lymphovascular invasion predicts poor prognosis in high-grade pT1 bladder cancer patients who underwent transurethral resection in one piece.
abstract: BACKGROUND
  Lymphovascular invasion (LVI) in high-grade clinical T1 bladder cancer is usually considered a poor prognostic factor, but it is often difficult to achieve correct staging of T1 bladder cancer and diagnose the presence of LVI because of the inadequacy of conventional transurethral resection specimens. The aims of this study were to evaluate the prognostic value of LVI in patients with correctly staged high-grade pathological T1 (pT1) bladder cancer who initially underwent transurethral resection in one piece (TURBO).
  
  
  METHODS
  Eighty-six high-grade pT1 bladder cancer patients who underwent TURBO were enrolled. Risk of tumor understaging was avoided by examining the vertical resection margin of the TURBO specimen. Immunohistochemical staining using D2-40 and CD31 was performed to confirm LVI. We examined the association of LVI with other clinicopathological factors and the impact of LVI on progression-free survival and cancer-specific survival.
  
  
  RESULTS
  The median follow-up period was 49 months (range, 6-142). In all patients, the tumors were accurately staged as pT1 at initial TURBO. LVI was detected in 15 patients (17%) and was significantly associated with tumor growth pattern (P = 0.001). Multivariate analysis identified LVI as the only independent predictor for reduced progression-free survival (HR, 4.48; 95% CI, 1.45-13.90; P = 0.009) and cancer-specific survival (HR, 4.35; 95% CI, 1.17-16.24; P = 0.029).
  
  
  CONCLUSIONS
  The presence of LVI in TURBO specimens independently predicts poor clinical outcomes in patients with high-grade pT1 bladder cancer. This information may help urologists to counsel their patients when deciding whether to choose a bladder-preserving strategy or radical cystectomy.
authors.affiliation: Department of Urology, JR Hiroshima Hospital, Hiroshima.
authors.forename: Rinzo
authors.initials: R
authors.lastname: Ukai
authors.affiliation: Department of Urology, JR Hiroshima Hospital, Hiroshima.
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Hashimoto
authors.affiliation: Department of Pathology and Laboratory Medicine, JR Hiroshima Hospital, Hiroshima.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Nakayama
authors.affiliation: Department of Pathology, Chuden Hospital, Hiroshima, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Iwamoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*
keywords: disease progression; lymphovascular invasion; survival; urinary bladder neoplasms; urothelial carcinoma