title: Can lymphovascular invasion replace the prognostic value of lymph node involvement in patients with upper tract urothelial carcinoma after radical nephroureterectomy?
abstract: BACKGROUND
  This study aimed to evaluate whether lymphovascular invasion (LVI) can replace lymph node (LN) involvement as a prognostic marker in patients who do not undergo lymph node dissection (LND) during surgery in patients with upper tract urothelial carcinoma (UTUC).
  
  
  METHODS
  A total of 505 patients who underwent radical nephroureterectomy (RNU) were recruited from four academic centres and divided into four groups: node negative (N0, Group 1); node positive (N+, Group 2); no LND without LVI (NxLVI-, Group 3); and no LND with LVI (NxLVI+, Group 4).
  
  
  RESULTS
  Patients in Group 2 had larger tumours, a higher incidence of left-sided involvement, more aggressive T stage and grade, and a higher positive surgical margin rate than patients in other groups. Pathological features (T stage and grade) were poorer in Group 4 than in Groups 1 and 3. Compared to other groups, Group 2 had the worst prognostic outcomes regarding locoregional/distant metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). LVI and LN status in Group 4 was not associated with MFS in multivariate analysis. Among Nx diseases, LVI was not an independent predictor of MFS or CCS. The small number of cases in Groups 2 and 4 is a major limitation of this study.
  
  
  CONCLUSIONS
  Clinical outcomes according to LVI did not correlate with those outcomes predicted by LN involvement in patients with UTUC. Therefore, LVI may not be used as a substitute for nodal status in patients who do not undergo LND at the time of surgery.
authors.affiliation: Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea.
authors.forename: Eun Sang
authors.initials: ES
authors.lastname: Yoo
authors.affiliation: Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea.
authors.forename: Yun-Sok
authors.initials: YS
authors.lastname: Ha
authors.affiliation: Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea.
authors.forename: Jun Nyung
authors.initials: JN
authors.lastname: Lee
authors.affiliation: Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea.
authors.forename: Bum Soo
authors.initials: BS
authors.lastname: Kim
authors.affiliation: Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea.
authors.forename: Bup Wan
authors.initials: BW
authors.lastname: Kim
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Seok-Soo
authors.initials: SS
authors.lastname: Byun
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young Deuk
authors.initials: YD
authors.lastname: Choi
authors.affiliation: Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Chungbuk, Korea.
authors.forename: Ho Won
authors.initials: HW
authors.lastname: Kang
authors.affiliation: Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Chungbuk, Korea.
authors.forename: Seok-Joong
authors.initials: SJ
authors.lastname: Yun
authors.affiliation: Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Chungbuk, Korea.
authors.forename: Wun-Jae
authors.initials: WJ
authors.lastname: Kim
authors.affiliation: Department of Urology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea.
authors.forename: Jeong Hyun
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea.
authors.forename: Tae Gyun
authors.initials: TG
authors.lastname: Kwon