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Keywords:

  • bladder cancer;
  • lymphovascular invasion;
  • urothelial carcinoma;
  • survival

What's known on the subject? and What does the study add?

  • Lymphovascular invasion (LVI) is an important step in systemic cancer cell dissemination. LVI has been shown to be an independent predictor of disease recurrence and cancer-specific survival in urothelial carcinoma of the bladder (UCB) for patients with carcinoma invading bladder muscle.
  • Patients with final pathological stage T1N0 UCB who underwent radical cystectomy (RC) have not been separately analysed for influence of LVI on outcomes. Our study shows that LVI predicts disease recurrence and cancer-specific survival in patients with final stage T1 UCB after RC.

Objective

  • To determine the outcomes of patients with final pathological stage T1N0 disease after radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB) and to determine whether lymphovascular invasion (LVI) is an independent predictor of prognosis in these patients.

Patients and Methods

  • Records of 958 consecutive patients who underwent RC at three academic centres were reviewed.
  • A total of 101 patients with negative lymph nodes and with final stage (the higher of the pre-RC clinical/transurethral resection [TUR] and post-RC pathological stages) T1 UCB were identified.
  • The median (range) follow-up was 38 (0.4–177) months and the median (range) number of nodes examined was 19 (9–80).

Results

  • Overall, 12/101 (11.9%) patients experienced cancer recurrence and 7/101 (6.9%) died from their cancer. The 3-year recurrence-free survival probability (SD) was 0.89 (0.04) and 3-year cancer-specific survival probability (SD) was 0.96 (0.02).
  • Six of 101 (6%) patients had LVI, of whom four experienced disease recurrence and three died from bladder cancer.
  • All recurrences and deaths occurred in patients who had either LVI and/or concomitant carcinoma in situ.
  • On multivariable analysis, LVI (hazard ratio [HR] 4.9, P = 0.01) and higher pathological stage (HR 8.5, P = 0.04) predicted cancer recurrence and LVI (HR 6.7, P = 0.01) predicted cancer-specific survival.

Conclusions

  • LVI helps identify patients with final pathological T1N0 UCB who are at significantly increased risk of bladder cancer recurrence and death.
  • These patients should be considered for close monitoring after cystectomy.