Clinical significance of lymphovascular invasion in upper urinary tract urothelial cancer

• Published in: BJU international Vol. 102; no. 5; pp. 572 - 575
• Main Authors: Akao, Jumpei, Matsuyama, Hideyasu, Yamamoto, Yoshiaki, Hara, Tomohiko, Kawai, Yoshihisa, Sakano, Shigeru, Ohmi, Chietaka, Gondo, Toshikazu, Naito, Katsusuke
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.09.2008; Blackwell
• Subjects: Aged; Biological and medical sciences; cancer‐specific survival; Female; Humans; Kidney Neoplasms - mortality; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Lymph Nodes - pathology; Lymphatic Metastasis; lymphovascular invasion; Male; Medical sciences; Multivariate Analysis; Neoplasm Invasiveness; Neoplasm Staging; Nephrectomy - methods; Nephrology. Urinary tract diseases; Prognosis; Regression Analysis; Retrospective Studies; Survival Analysis; upper urinary tract urothelial cancer; Ureteral Neoplasms - mortality; Ureteral Neoplasms - pathology; Ureteral Neoplasms - surgery; Urothelium - pathology; Vascular Neoplasms - mortality; Vascular Neoplasms - pathology; Vascular Neoplasms - surgery; Nephrology; cancer-specific survival; Metastasis; Malignant tumor; Urinary tract; Survival; Invasion; Urology; Urinary system; lymphovascular invasion; Cancer; Urothelium; upper urinary tract urothelial cancer
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2008.07749.x

OBJECTIVES To clarify the significance of lymphovascular invasion (LVI) in patients with pT3N0M0 upper urinary tract (UUT) urothelial carcinoma (UC) relative to prognosis in terms of disease‐specific survival, as LVI, which implies both blood vessel and lymph vessel involvement, is reportedly a poor prognostic factor in patients with UUT‐UC. PATIENTS AND METHODS The clinical records of 90 patients who had surgery for UUT‐UC were reviewed retrospectively. The median patient age was 71 years and the median follow‐up was 42 months. The prognostic significances of LVI (with vs without), T stage (<1 vs 2–4), grade (1–2 vs 3), N stage (0 vs 1–2), age (≤70 vs >70 years), gender and tumour location (renal pelvis vs ureter) for survival time were evaluated. RESULTS LVI of UUT‐UC was found in 34 patients (37.8%). There were significantly higher frequencies of LVI with advancing stage and lymph node metastasis. Kaplan‐Meier analysis showed that LVI was strongly associated with disease‐specific survival in all patients (P < 0.001) and in patients with pT3N0M0 disease (P < 0.001). Univariate analyses showed that LVI, T stage, N stage and tumour grade were significantly related to disease‐specific survival in all patients (P < 0.001, <0.001, 0.003 and 0.007, respectively). Multivariate analysis using Cox proportional hazards model showed that LVI was the only prognostic factor with independent significance for disease‐specific survival (P < 0.001). CONCLUSIONS LVI appears to be an important and independent prognostic factor for UUT‐UC in patients treated by nephroureterectomy. Our data suggest that the LVI status might be a predictive marker for disease‐specific survival in patients with T3N0M0 UTT‐UC.