C.B. and E.H contributed equally to this work
Lymphovascular invasion is an independent predictor of oncological outcomes in patients with lymph node-negative urothelial bladder cancer treated by radical cystectomy: a multicentre validation trial
Article first published online: 8 JAN 2010
© 2010 THE AUTHORS. JOURNAL COMPILATION © 2010 BJU INTERNATIONAL
Volume 106, Issue 4, pages 493–499, August 2010
How to Cite
Bolenz, C., Herrmann, E., Bastian, P. J., Michel, M. S., Wülfing, C., Tiemann, A., Buchner, A., Stief, C. G., Fritsche, H.-M., Burger, M., Wieland, W. F., Höfner, T., Haferkamp, A., Hohenfellner, M., Müller, S. C., Ströbel, P. and Trojan, L. (2010), Lymphovascular invasion is an independent predictor of oncological outcomes in patients with lymph node-negative urothelial bladder cancer treated by radical cystectomy: a multicentre validation trial. BJU International, 106: 493–499. doi: 10.1111/j.1464-410X.2009.09166.x
- Issue published online: 23 JUL 2010
- Article first published online: 8 JAN 2010
- Accepted for publication 22 October 2009
- bladder cancer;
- urothelial carcinoma;
- lymphovascular invasion;
- lymphatic metastasis;
Study Type – Prognosis (inception cohort) Level of Evidence 1b
To validate the association of lymphovascular invasion (LVI) with disease recurrence and cancer-specific survival (CSS) in a multicentre cohort of patients treated with radical cystectomy (RC) for urothelial bladder cancer (UBC).
PATIENTS AND METHODS
We collected pathological and clinical data on 1099 lymph node-negative patients treated with RC at six German institutions. LVI was defined as the presence of tumour cells within an unequivocal endothelium-lined space in haematoxylin and eosin-stained sections.
LVI was present in 295 (26.8%) patients; the presence of LVI correlated significantly with increasing tumour stage, i.e. pT1, 65 (29.4%); pT2, 88 (31.5%); pT3 110 (31.8%); and pT4 32 (38.1%) (P= 0.002) and grade (P < 0.001). In univariable analysis the presence of LVI was significantly associated with reduced recurrence-free survival (P= 0.008) and reduced CSS (P= 0.039). On multivariable Cox regression analysis tumour stage (P < 0.001), age (>75 vs ≥75 years; P= 0.018) and LVI (P < 0.001) were identified as independent predictors of CSS.
Our large multicentre study confirms the independent prognostic value of LVI in patients with node-negative UBC. LVI can be regarded as a surrogate variable for lymphatic micrometastasis in node-negative UBC. Assessment of LVI might improve the selection of patients who are likely to benefit from adjuvant therapy after RC. The identification of factors involved in the process of LVI could reveal new therapeutic targets for UBC.